Diabetes Self-care Education Research Articles

DIABETES SELF-CARE EXPERIENCE ON ELDERLY WITHOUT MEDICATION

Increasing of the number of elderly contributes to the increasing of prevalence of chronic degenerative diseases such as diabetes mellitus. Diabetes mellitus requires long-term care through self-care. Theaims of this study to find out the experience of elderly on diabetes self-care. The study used qualitative method of descriptive phenomenology with in-depth interviews on nine participants. Interview results were analyzed using the Colaizzi method. The results of the study identified a variety of self-care diabetes, were regulates food, exercise, and blood sugar checking. Self-care has not been done consistently so it needs diabetes self-care guidelines, diabetes self-care education, and a community health nurse program that can foster elderly with diabetes mellitus.

Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study.

To describe self-care as defined by the Middle Range Theory of Self-Care of Chronic Illness and to identify clinical and socio-demographic determinants in a T2DM population. A multicentre observational cross-sectional study was conducted involving 540 adults with a confirmed diagnosis of T2DM from six outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management, and confidence dimensions. For each separate scale, scores were standardized 0-100 with higher SCODI scores indicating better self-care; a score ≥ 70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension. Self-care maintenance (median = 81.3) and self-care confidence (median = 79.5) were adequate in most of the subjects. Self-care monitoring was adequate in only half of the sample (median = 70.6). Self-care management was poor (median = 59.4). Lower self-care maintenance was associated with lower self-care confidence (p < 0.001). Lower self-care monitoring was associated with being male (p < 0.001), having lower self-care confidence (p < 001), and having diabetes for < 10years (p < 0.001). Lower self-care management was associated with being male (p = 0.002), being older (p = 0.005), having a low income (p = 0.030), being employed (p = 0.008), having missed diabetes education in the last year (p = 0.002), and lower self-care confidence (p < 0.0001). Lower self-care confidence was associated with having diabetes for < 10years (p = 0.008), and having at least one comorbid condition (p = 0.006). Determinants of self-care maintenance, monitoring, management and confidence include both clinical and socio-demographic variables. Modifiable determinants such as self-care confidence and diabetes self-care management education could be used to tailor interventions to improve diabetes self-care.

Levels and Predictors of Adherence to Self-care Behaviour among Adult Type 2 Diabetics at Arba Minch General Hospital, Southern Ethiopia

Background: Diabetes self-care behaviour adherence is considered to be the cornerstone in diabetes care. Hence, the success of long-term maintenance therapy for diabetes depends largely on the patients’ adherence with self-care behaviour. Objective: To assess Levels and Predictors of Adherence to self-Care Behaviour and Glycaemic Control among Adult Type 2 Diabetics at Arba Minch General Hospital, Southern Ethiopia. Method: An institutional based cross sectional study was conducted from [15th-February to 15th-March, 2015] and data were collected by using interviewer administered questionnaires. The data were entered into EPI-DATA version 3.1, and analysed by Statistical Package for Social Science (SPSS) version 20.0. Descriptive statistics were used for most variables; a bivariate analysis was employed to determine the presence of association between adherence to self-care behaviour with other variables at P-value less than 0.05. Multi-variable logistic regression was performed to identify independent predictors of glycaemic control and self-care behaviour adherence. Results: One hundred ninty four type 2 diabetics were participated in this study and 99 (51.0%) were Females. Mean age of participants was 50.3(±13.2) years, and 41.2% had good self-care behaviour adherence. Above one half (57.2%) had diabetes duration less than five years, with mean duration of diabetes 5.02 ± 3.8 years. Most of patients 169 (87.1%) were on oral anti diabetics Age 35-44 years [AOR=13.4, 95% CI=1.582, 113.56], Monthly income<750.00 birr [AOR=0.340, 95% CI=0.119, 0.976] and age at diabetes onset 15-24 years [AOR=11.3, 95% CI=2.621, 49.065] were independent predictors of self-care behaviour adherence. Conclusion: In our study area adherence to self-care behaviour of the study subjects were low. So strategies that can improve these discrepancies like provision of diabetes self-care education and counselling especially on importance of self-monitoring of blood , physical activity and problem solving should be considered by responsible bodies.

The Role of Narrative and Other-Referencing in Attenuating Psychological Reactance to Diabetes Self-Care Messages

ABSTRACTThis study charts pathways through message resistance to enhance the persuasiveness of diabetes self-care messages. A 2 (narrative) × 2 (other-referencing) × 2 (message) × 4 (order) experiment with adult diabetics (N = 58) tested whether packaging overt recommendations as a story rather than an informational argument (i.e., narrative structure) and highlighting the impact of health decisions on family and friends rather than the individual (i.e., other-referencing) can effectively attenuate psychological reactance to messages encouraging healthy diet and physical activity. Narrative and other-referencing each led to lower perceived threat to choice, less state anger and counterarguing, less negative cognitive responses, more positive attitudes toward the ad and the behaviors promoted, and greater intended compliance with message recommendations. Findings illustrate two strategies that communicators may employ in order to benefit from clear, direct health messages while avoiding the reactance they may provoke. Moreover, findings inform message design for diabetes self-care education.

Association of sociodemographics, technology use and health literacy among type 2 diabetic individuals living in an Indian setting: an exploratory cross-sectional study

Diabetes is a prevalent health problem in developing as well developed countries. Previous study advocates for diabetes self-management education (DSME) among diabetics. In this study, we have examined the association of sociodemographics and technology use with health literacy among type 2 diabetic individuals. This exploratory cross-sectional study was performed by enrolling a convenient sample of 100 type 2 diabetes mellitus (T2DM) patients. Individuals of age 18 years or above were enrolled during regular outpatient visit to the diabetic clinic of Saveetha Medical College in Chennai, a metropolitan city in southern state of India in August 2013. A modified version of previously validated questionnaires was used for gathering information on sociodemographic characteristics, technology use assessments, diabetes-related information, health literacy, and health information-seeking behavior. Results of the study showed that majority of the individuals had received some form of diabetes education from their doctor at the time of diagnosis. However, 56 % of the participants had difficulty (sometimes to always) in understanding the health information provided by the healthcare professional. Individuals who had access to computer and Internet at home or work required less support for reading instructions, pamphlets, or other written material from the doctor or pharmacy. Individuals having access to technology had higher health literacy as compared to individuals with no access. Technology can act as potential enabler for improving the health literacy. Future research is warranted to identify most cost-effective, feasible, and accessible technology medium for providing diabetes self-care management education.

Developmental changes in the roles of patients and families in type 1 diabetes management.

Developmentally-tailored diabetes self-care education and support are integral parts of contemporary multidisciplinary T1D care. The patient with T1D must have the support of the family and the diabetes team to maintain the rigors of diabetes management, but the specific roles of patients and families with regard to daily diabetes tasks change considerably throughout the developmental span of early childhood, middle childhood/school-age years, and adolescence. This review provides a framework of key normative developmental issues for each of these developmental stages. Within this context, ideal family diabetes management is reviewed within each developmental stage and anticipated challenges that can arise during these stages and that can adversely impact diabetes management are presented. This paper also summarizes empirical evidence for specific intervention and care strategies to support optimal diabetes management across these stages in order to maximize opportunities for a successful transfer of diabetes management tasks from parents to maturing youth. Finally, the review provides an emphasis on approaches to promote family teamwork and adolescent diabetes self-care adherence as well as opportunities to use novel technology platforms as a means to support optimal diabetes management.

Health literacy and nurses' communication with type 2 diabetes patients in primary care settings.

The use of the interactive communication loop has been recommended as an effective method to enhance patient understanding and recall of information. The aim of the study was to examine the application of interactive communication loops, use of jargon, and the impact of health literacy (HL) when nurses provide education and counseling to patients with type 2 diabetes in the primary care setting in Alberta, Canada. Encounters between nurses and patients with type 2 diabetes were audio recorded, and a patient survey including a HL measure was administered. Topics within each interaction were coded based on five key components of the communication loop and categories of jargon. Nine nurses participated in this study, and encounters with 36 patients were recorded. A complete communication loop was noted in only 11% of the encounters. Clarifying health information was the most commonly applied component (58% often used), followed by repeating health information (33% often used). Checking for understanding was the least applied (81% never used), followed by asking for understanding (42% never used). Medical jargon and mismatched language were often used in 17% and 25% of the encounters, respectively. Patients' HL did not materially affect patterns of communication in terms of using communication loops; however, nurses used less jargon and mismatched words with patients with inadequate HL. The overuse of medical jargon accompanied with underuse of communication loop components jeopardizes patients' comprehension and retention of information that they need to know to properly self-manage their diabetes. Nurses need to develop more effective ways to communicate concepts critical to chronic diabetes self-care education and management.

Diabetes island: preliminary impact of a virtual world self-care educational intervention for african americans with type 2 diabetes.

BackgroundDiabetes is a serious worldwide public health challenge. The burden of diabetes, including prevalence and risk of complications, is greater for minorities, particularly African Americans. Internet-based immersive virtual worlds offer a unique opportunity to reach large and diverse populations with diabetes for self-management education and support.ObjectiveThe objective of the study was to examine the acceptability, usage, and preliminary outcome of a virtual world intervention, Diabetes Island, in low-income African Americans with type 2 diabetes. The main hypotheses were that the intervention would: (1) be perceived as acceptable and useful; and (2) improve diabetes self-care (eg, behaviors and barriers) and self-care related outcomes, including glycemic control (A1C), body mass index (BMI), and psychosocial factors (ie, empowerment and distress) over six months.MethodsThe evaluation of the intervention impact used a single-group repeated measures design, including three assessment time points: (1) baseline, (2) 3 month (mid intervention), and (3) 6 month (immediate post intervention). Participants were recruited from a university primary care clinic. A total of 41 participants enrolled in the 6 month intervention study. The intervention components included: (1) a study website for communication, feedback, and tracking; and (2) access to an immersive virtual world (Diabetes Island) through Second Life, where a variety of diabetes self-care education activities and resources were available. Outcome measures included A1C, BMI, self-care behaviors, barriers to adherence, eating habits, empowerment, and distress. In addition, acceptability and usage were examined. A series of mixed-effects analyses, with time as a single repeated measures factor, were performed to examine preliminary outcomes.ResultsThe intervention study sample (N=41) characteristics were: (1) mean age of 55 years, (2) 71% (29/41) female, (3) 100% (41/41) African American, and (4) 76% (31/41) reported annual incomes below US $20,000. Significant changes over time in the expected direction were observed for BMI (P<.02); diabetes-related distress (P<.02); global (P<.01) and dietary (P<.01) environmental barriers to self-care; one physical activity subscale (P<.04); and one dietary intake (P<.01) subscale. The participant feedback regarding the intervention (eg, ease of use, interest, and perceived impact) was consistently positive. The usage patterns showed that the majority of participants logged in regularly during the first two months, and around half logged in each week on average across the six month period.ConclusionsThis study demonstrated promising initial results of an immersive virtual world approach to reaching underserved individuals with diabetes to deliver diabetes self-management education. This intervention model and method show promise and could be tailored for other populations. A large scale controlled trial is needed to further examine efficacy.

Impact of a First-Year Student Pharmacist Diabetes Self-Care Education Program

To evaluate the effectiveness of a first-year diabetes self-care education program by measuring student pharmacists' confidence and knowledge retention, and the clinical applicability of the skills learned. Integrated into a Pharmacy Practice Course, a 9-hour program consisting of lectures, a home glucose monitor assignment, and active-learning workshops was completed by 2 cohorts of first-year student pharmacists. Three survey instruments were developed and administered to the student pharmacists prior to the program, immediately after the program, and 9 months after the program to assess confidence, knowledge retention, and the clinical applicability of the knowledge and skills learned. In cohort 1, 54 student pharmacists (response rate 90%) perceived that their confidence and ability improved significantly (increased by 88% and 110%, respectively, from baseline, p<0.001). Overall knowledge of diabetes increased as well as indicated by a 40% increase in test scores (p<0.001). About two-thirds of student pharmacists used their training to assist patients with diabetes within 9 months of completing the program. Findings in cohort 2 mirrored those observed with cohort 1, indicating good generalizability. An innovative first-year diabetes self-care education program significantly improved student pharmacists' knowledge and confidence in providing diabetes self-care education, and the majority immediately used their leaned skills to assist diabetes patients and caregivers. Training first-year student pharmacists in diabetes care so they are prepared to use these skills as early as their first year of pharmacy school may be an effective approach to increasing the number of providers available to counsel and care for this expanding patient population.

Successful Delivery of Diabetes Self-Care Education and Follow-Up through eHealth Media

BackgroundeHealth systems are being rapidly diffused and used by health organizations, healthcare providers and patients for diabetes educational purposes because of perceived cost savings, convenience and access from remote locations. ObjectiveTo compare the use of 3 education systems that varied media (face-to-face vs. electronic), communication (e.g. synchronous and asynchronous) and information processing functionality (e.g. Internet searching, view laboratory blood test results) for education of newly diagnosed patients with type 2 diabetes mellitus. Design/MethodsIn a randomized controlled trial, changes in glycated hemoglobin (A1C), self-efficacy and diabetes knowledge were compared between 3 models of education and communication support in newly diagnosed patients with type 2 diabetes: controls (face-to-face education, synchronous and asynchronous communication), Web Static (electronic education and virtual appointments using asynchronous communication) and Web Interactive (electronic education and virtual appointments using both synchronous and asynchronous communication). ResultsIn an intent-to-treat analysis, all 3 groups had similar improvement in diabetes knowledge, self-efficacy and diabetes self-care activities. Independent of which group subjects were randomized to, findings were significant when examining correlation between website usage and outcomes: a higher total use was associated with a higher diabetes knowledge score (r=0.265, p=0.029), a higher total diabetes self-efficacy by final study visit (r=0.317, p=0.008) and a lower A1C by final study visit (r=−0.271, p=0.026) by the last visit. ConclusionsInitial diabetes education can be delivered successfully through electronic media. Higher adoption of electronic media is associated with improved clinical outcomes.

Reimbursement for Shared Medical Appointments Incorporating Diabetes Self-Management Education/Training or Diabetes Medical Nutrition Therapy

In Brief What patients with diabetes want and need for the successful management of their disease is exactly what shared medical appointments (SMAs) can provide. Topping the list are increased access to care, quality time with the physician, an active role in medical and lifestyle decision-making, their unique needs individually addressed in a timely manner, and encouragement and support from other people with diabetes. For health care professionals, SMAs are a cost-effective way to provide both diabetes medical management and self-care education in the same visit in a manner consistent with highly interactive patient-centered care. This article offers an overview of Medicare and private insurance reimbursement for SMAs.

Knowledge and attitude: important components in diabetes education

This descriptive cross-sectional study was conducted from March to November 2007 at a research and community services center of a Brazilian university. It aimed to explore the knowledge and attitude of people with diabetes mellitus who were attending a diabetes self-care education program. The sample was composed of 82 adults with diabetes mellitus. Data were collected through the Portuguese versions of the Diabetes Knowledge Questionnaire (DKN-A) and the Diabetes Attitude Questionnaire (ATT-19). Results revealed that 78.05% of the participants obtained scores higher than eight on knowledge about diabetes, which indicates they have knowledge and understand the disease. Scores on attitude ranged from 25 to 71 suggesting difficulty in coping with the disease. We conclude that although participants obtained a good score on knowledge, their attitude did not change so as to more adequately cope with the disease.

Diabetes management and self-care education for hospitalized patients with cancer.

Managing diabetes can be a daunting task for patients with cancer. Empowerment-based diabetes education and motivational interviewing are complementary approaches. Oncology nurses may feel unprepared to teach patients and their families about self-care for diabetes, but they provide individualized information on symptom management of cancer throughout hospitalization and at discharge. The essential self-care issues include food, exercise, medication, blood glucose monitoring, prevention, recognition and treatment of hypoglycemia and hyperglycemia, and when and how to get additional medical and educational support. This patient-centered model of diabetes education differs from the older "compliance" model that covers many universal rules for all patients, which are predetermined by the nurse. Informing nurses about their role in care of patients with cancer and diabetes is critical.