Diabetes Self-management Practices Research Articles

The Impact of Promotoras on Social Support and Glycemic Control Among Members of a Farmworker Community on the US-Mexico Border

The purpose of this study is to describe the effect of a promotora-driven intervention to build social support as a means to affect self-management behaviors and clinical outcomes in a farmworker community on the US-Mexico border. Promotoras implemented a community-based intervention that included support groups, home/hospital visits, telephone support, and advocacy to people with diabetes. A 12-month pre/post study design was used to investigate the relationship between promotora contact, perceived support, and clinical outcomes. Clinical data were gathered from 70 participants during routine physician visits. A pre/post questionnaire was used to measure perceived support and self-management practices. Glycosylated hemoglobin (HbA1c) levels decreased 1% among high-risk participants. Improved HbA1c level was associated with promotora advocacy and participation in promotora-led support groups. Participants reported increased support from family and friends and more comfort speaking about diabetes (la enfermedad) with family and friends. These findings document improvement in both clinical and social health indicators for Mexican Americans in a farmworker community when a promotora model is used to provide and facilitate culturally relevant support for diabetes self-management practices.

Integrating glucometers and digital photography as experience capture tools to enhance patient understanding and communication of diabetes self-management practices

Glucometers measure the accumulation of glucose in the bloodstream and are essential for avoiding health complications related to diabetes. Despite their value as tools to record and present physiological data, they lack the ability to capture the behaviors that cause fluctuations in blood glucose levels, activities that ultimately need to be understood and managed in order to maintain good health. In this paper, we describe an intervention that introduces digital photography into diabetes self-management routines to augment glucometer data and facilitate the sharing of experiences that affect long-term health. Two studies of the approach are presented to illustrate the ways that diabetics use visualizations of past activities to reflect on their health. We also discuss design suggestions for augmented memory systems based on our findings, focusing on ways to enhance learning with repositories of past experiences collected automatically and/or manually.

Profiles of people with type 2 diabetes mellitus: the extremes of glycemic control

For people with diabetes, hemoglobin A 1c (HbA 1c) is a measure of blood glucose control and an indication of the risk of developing diabetes complications. However, a given HbA 1c value does not provide information about the diabetes self-management practices or philosophies of individuals in poor (HbA 1c >8.0%) or excellent (HbA 1c<6.5%) control. To contrast the experiences and attitudes of people at the extremes of glycemic control, interviews were conducted among 44 individuals (40–65 years old) diagnosed with diabetes for over 1 year. The participants were identified based upon their HbA 1c value from a larger sample of people with type 2 diabetes that included African Americans, women, and persons with low income. Narratives were analyzed using a case-based and conceptually clustered matrix approach. The life course concept (life histories and natural transitions in roles and responsibilities across the life span) and the explanatory model of illness (individuals’ beliefs about the causes, consequences, and treatment of a disease) provided the framework for the interview guide and the analysis of the narratives. Two self-management philosophy groups emerged from participants with excellent control (Committed [ n=15] and Tentative [ n=7]) and three groups were identified among the poorly controlled group (Hopeful [ n=8], Hassled [ n=6], and Overwhelmed [ n=8]). Perseverance, coping skills, and age at diagnosis were life course concepts that distinguished participants within these groups. From the explanatory model of illness, beliefs about the cause of the disease, physical changes, and accepting the consequence of the disease influenced differences in these self-management philosophies. The profiles of people at the extremes of glycemic control can help those treating people with diabetes or seeking to improve self-management interventions understand differences in self-management philosophies and concentrate on specific issues hindering self-care control.