Motivation For Self-care Research Articles

Evaluation of a Text Messaging Intervention to Support Self-Management of Diabetes During Pregnancy Among Low-Income, Minority Women: Qualitative Study.

BackgroundGiven the growing burden of diabetes in underserved communities and the complexity of diabetes self-management during pregnancy, the development of interventions to support low-income pregnant women with diabetes is urgently needed.ObjectiveThis study aims to develop and pilot test a theory-driven curriculum of SMS text messaging for diabetes support and education during pregnancy.MethodsThis was a prospective pilot investigation of a novel SMS text messaging intervention offered to pregnant women with pregestational or gestational diabetes mellitus and publicly funded prenatal care. Prior work yielded a conceptual model of diabetes self-management barriers and support factors in this population, which was used to guide curriculum development along with health behavior theories. Participants received three supportive or educational one-way text messages per week during pregnancy. In-depth semistructured interviews were performed at study exit to solicit feedback on the program. Narrative data were analyzed using the constant comparative technique to identify themes and subthemes.ResultsParticipants (N=31 enrolled and n=26 completed both interviews) consistently reported that SMS text messaging provided enhanced motivation for diabetes self-care, reduced diabetes-related social isolation, increased perceived diabetes-associated knowledge, enhanced comfort with the health care team, and reduced logistical burdens of diabetes during pregnancy. Participants requested enhanced interactive and customizable features in future intervention iterations.ConclusionsPregnant women with diabetes who were enrolled in this pilot study of an SMS text messaging curriculum for diabetes support described enhanced motivation, knowledge, and comfort with diabetes self-care activities as a result of the health education intervention. The next steps include enriching the interactive features of the intervention and investigating the effect of the intervention on perinatal outcomes.

Designing a structural equation model of marital satisfaction based on aging perception and demographic and clinical variables in Iranian elderly patients with coronary artery disease.

BACKGROUNDMarital satisfaction is an important variable in maintaining or promoting elderly health. Therefore, identifying the effective factors can increase life expectancy and quality of life. This study aimed to determine the relationship between aging perception and demographic and clinical characteristics with marital satisfaction in the elderly patients with coronary artery disease (CAD).METHODSThis was a descriptive-correlational study. The sample size was 480 elderly patients with CAD who were referred to the heart clinics of hospitals in the west of Mazandaran Province, Iran, who were recruited by convenience sampling. Data were collected by a demographic checklist, ENRICH Marital Satisfaction Inventory, and Aging Perceptions Questionnaire (APQ). The data were analyzed by structural equation model (SEM) using Goodness of Fit Index (GFI and chi-square test. P-value less than 0.050 was considered as significant level.RESULTSThe mean and standard deviation (SD) of marital satisfaction was 145.16 ± 12.12, and the mean and SD of aging perception was 113.39 ± 12.74. The results of the Pearson’s correlation coefficient indicated that the highest correlation was between aging perception and marital satisfaction (r = 0.68, P < 0.001). The model fit indices of the hypothesized model met the criteria, with the GFI = 0.91, Comparative Fit Index (CFI) = 0.93, Normed Fit Index (NFI) = 0.94, and non-Normed Fit Index (NNFI) = 0.91.CONCLUSIONConsidering the psychological risk factors affecting marital satisfaction such as aging perception and suitable measurement can lead to marital health and improve treatment outcomes by increasing elderly motivation in self-care. Therefore, the elderly patients with CAD need more serious and long-term educational, counseling, and supportive interventions.

Explaining Poor Medication Adherence among Adults with Type 2 Diabetes in an Urban Community Health Center.

Nonadherence to diabetes medication is a common and costly problem, significantly precluding the evidence-based benefits of diabetes care. Nonadherence is also a poorly understood multifactorial behavior, particularly among African Americans with type 2 diabetes receiving care in under-resourced primary care settings. We investigated several known or suspected individual-level factors influencing diabetes medication adherence among a predominantly African American group of adults with diabetes at a local community health center. Overall diabetes medication adherence was observed to be surprisingly low at 23% (95% confidence interval (CI) = 19%-26%) and did not differ by medication type (p=.435). Common sociodemographic factors were poor predictors of adherence. However, self-perceived health and presence of comorbid conditions were significant. The strongest independent predictors of diabetes medication adherence in this population were a heart attack and having maintained a desired level of glycemic control, indicating the importance of specific comorbidities and motivation for self-care in tailoring interventions to improve adherence.

Motherhood and HIV: reproductive desire, ambivalent feelings and a/an (not) offered care.

To identify in the scientific literature the feelings of women living with HIV in relation to reproduction and motherhood, as well as the care provided by health professionals regarding reproductive health as a right. Integrative review carried out in 2017, in the databases LILACS, PUBMED, BDENF and SciELO Virtual Library. We analyzed 30 articles. As feelings, the motivation for reproduction and self-care, fears, uncertainties and hopes were evidenced. As care, services that support reproductive decisions were evidenced, but, predominantly, the disregard for the desire and care incipience for reproductive planning. There is no comprehensive and humanized work on the reproductive issues of these women, either through the neglect of the desire and viability of gestation or by the incipient care to the ambivalent emotional experiences. There is a need to qualify the care model in order to configure it, in fact, as care, aiming at guaranteeing reproductive rights.

MENTAL ILL-HEALTH AND HEART FAILURE COMORBIDITY

This review aims to understand the co-existence of mental ill-health and heart failure and if this comorbidity affects patient self-care motivation and overall health outcomes. Databases searched were; PubMed®, Google® scholar and Science Direct® for studies related to heart failure, heart failure and mental health, depression and anxiety. Eleven articles were identified and reviewed. There were two studies disagreed with the theory that the mental ill-health and heart failure has disease modification and worsen patient health outcomes, three studies concluded that only anxiety has effect, five studies concluded that both anxiety and depression have effect, six studies concluded that depression only has effect but all eleven stated that more research is required. Recent theories on depression and cardiovascular disease comorbidity and the effect mental ill-health have on medication adherence in heart failure patients was discussed. People with long-term physical illnesses may suffer further complications to their health if they develop mental illness; increasing the cost of their care by an average of 45%, however, in the majority of these cases, the mental issues neither diagnosed nor treated. This review explored the link between cardiovascular disease (CVD) and mental ill health; and how comorbidity of the two conditions affects patients’ adherence to therapy behaviour. It was concluded that while the link between mental ill health and heart failure (HF) is recognized, studies that may be used as a basis of evidence to confirm this link are scarce.

Randomized Controlled Trial of E-Counseling for Hypertension: REACH.

The efficacy of internet-based interventions to improve hypertension management is not established. We evaluated the therapeutic benefit of e-counseling by adapting best evidence guidelines for behavioral counseling. This multicenter double-blind randomized controlled trial included assessments at baseline, 4 months, and 12 months. Participants were 35 to 74 years of age and diagnosed with hypertension: systolic/diastolic blood pressure (BP) 130 to 180/85 to 110 mm Hg. BP was assessed by automated office measurement. E-Counseling used multimedia and interactive tools to increase motivation and skill for self-care (exercise, diet, medication adherence, and smoking cessation). Control used self-care education. Frequency of contact by our e-platform was equal for both trial arms. Primary end points were change at 4 and 12 months in systolic BP, diastolic BP, pulse pressure, total lipoprotein cholesterol, low-density lipoprotein cholesterol, total lipoprotein cholesterol/high-density lipoprotein cholesterol ratio, non-high-density lipoprotein cholesterol, and Framingham 10-year cardiovascular risk index. Intention-to-treat analysis used generalized linear models adjusted for baseline measures, sex, and medications. Among 264 participants, mean age was 57.6 years (SE, 0.6), 58% were women, with 83% on antihypertensive medications. At 12 months, e-counseling versus control evoked greater reduction in systolic BP (-10.1 mm Hg [95% confidence interval (CI), -12.5, -7.6] versus -6.0 mm Hg [95% CI, -8.5, -3.5]; P=0.02); pulse pressure (-5.2 mm Hg [95% CI, -6.9, -3.5] versus -2.7 mm Hg [95% CI, -4.5, -0.9]; P=0.04), and Framingham risk index (-1.9% [95% CI, -3.3, -0.5] versus -0.02% [95% CI, -1.2, 1.7]; P=0.02), respectively. Among males in e-counseling versus control, 12-month end points included lower diastolic BP (P=0.01), non-high-density lipoprotein cholesterol (P=0.04), total lipoprotein cholesterol (P=0.03), and a trend for total lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (P=0.07). To our knowledge, this is the first double-blind randomized trial of e-counseling for hypertension. Added benefit for medical therapy was achieved by combining available technology with a clinically organized protocol of motivational and cognitive-behavioral counseling. https://www.clinicaltrials.gov; Unique identifier: NCT01541540.

Young and motivated for self-care? An interview study with young adults suffering from type 1 diabetes

Background: Europe has the largest number of children and adolescents with type 1 diabetes mellitus, 286,000 in total. One major goal in diabetes care is to minimise the risk of complications among patients by glycaemic control, medical check-ups and education to support patients’ self-management and quality of life. The aim of the current study was designed to explore young adults’ with type 1 diabetes and their motivation for self-care.Methods: The present study had a qualitative design with a descriptive approach. A purposeful sample of eight (n = 8) young adults with type 1 diabetes and HbA1c &gt; 70 mmol/mol were interviewed. A semi-structured interview with four open-ended questions was chosen as the method. The interviews were analysed using qualitative content analysis.Results: The results revealed factors both promoting and hindering self-care. The first main category was “Factors promoting motivation for self-care” with three sub-categories: (1) feeling safe and getting support, (2) experiencing control over own life, and (3) striving for wellbeing and meaning in life. The second main category was “Factors that hindered motivation for self-care” with two sub-categories: (1) feelings of vulnerability, and (2) feeling excluded.Conclusions: According to the results, motivation increases with positive response. Therefore a positive approach is of utmost importance when young adults come to the clinic for check-ups. Trying to always find something positive is of great significance for motivation and self-care. The focus should be on health and good experiences in life.

DIABETES SELF MANAGEMENT EDUCATION AGAINST TYPE 2 DM PATIENTS INDEPENDENCE IN MANAGING DIET

Introduction. Diabetes mellitus has been the cause of 4.6 million deaths. In addition, health expenditure for diabetes mellitus has reached 465 billion USD. Complications experienced by patients with type 2 diabetes mellitus that causes the sufferer to experience dependence in regulating dietary patterns. Patients depend in managing the diet due to a lack of knowledge and lack of motivation in self-care. The purpose of this study was to identify the effectiveness of Diabetes Self-Management Education to independence yipe 2 diabetic patients in managing the diet. Method. This research was aPre-experimental study. Research design was one group pre-post-test design. The sampling technique used simple random sampling with 30 samples. Data was analyze by using Wilcoxon Signed Rank Test with a significance value of α = 0.05. Result. Pre-test results showed that almost all respondents (80%) or 24 samples in the category of partial care. The post-test results showed that the majority (56.7%) or 17 respondents in the category of minimal care. Statistical analysis showed Wilcoxon p = 0.000. Discussion. The conclusion of this research showed that the effects of Diabetes Self-Management Education on patient autonomy in managing diet in type 2 diabetes patient. Keywords: Diabetes Self-Management Education, Diet, Independence

Social comparisons in adults with type 2 diabetes: Patients’ reasons for target selection

Objective: To examine reasons for selecting a social comparison target (i.e. a specific other for relative self-evaluation), and their influence on affect and motivation for self-care, in type 2 diabetes (T2DM).Design: Adults with T2DM (n = 180, MA1c = 7.6%) chose to read about one of four targets. Participants rated five reasons for their choice (strongly disagree – strongly agree), and rated affect and self-care motivation before and after reading.Results: To boost confidence in my ability to manage diabetes was rated highest overall (ps < 0.01), though choosing worse-off (vs. better-off) targets was associated with to gain useful information about how to improve (p = 0.04, = 0.05). Selection in order to feel better worked for those who chose better-off targets; choosing worse-off targets for this purpose worsened mood and stress (ps < 0.04, s = 0.02). Choosing worse-off targets to learn about similar others reduced self-care motivation (p < 0.01, = 0.05). Selection in order to boost confidence showed increased motivation only among those who chose better-off targets (p = 0.01).Conclusions: Patients’ reasons for a particular comparison are associated with short-term changes in affect and self-care motivation, and warrant greater empirical and clinical attention.

Adolescents' Experiences and Their Suggestions for HIV Serostatus Disclosure in Zambia: A Mixed-Methods Study.

HIV serostatus disclosure is an immense challenge for adolescents living with HIV, their caregivers, and health workers. In Zambia, however, little guidance is available from the adolescents' point of view on the HIV disclosure process. This study aimed to examine the setting of HIV serostatus disclosure for adolescents, its impacts on them, and their suggestions on the best practice of HIV disclosure. We conducted a mixed-methods study at the University Teaching Hospital in Zambia from April to July 2014. We recruited 200 adolescents living with HIV, aged 15-19 years. We collected data using a structured questionnaire including two open-ended questions. We excluded two adolescents due to withdrawal during the survey, and eight from the data set due to out-of-eligibility criteria in age. Eventually, we included 190 in the analysis. We performed descriptive analysis to calculate the distributions of basic characteristics of the adolescents, their experience and preference on HIV serostatus disclosure, its emotional and behavioral impacts, and health education topics they had ever learned at hospital. We performed thematic analysis with open-ended data to explain first impressions upon disclosure in detail and to determine perceived advantages of HIV serostatus disclosure. The majority of adolescents recommended the age of 12 as appropriate for adolescents to learn about their HIV serostatus and preferred disclosure by both parents. Out of 190 adolescents, 73.2% had negative or mixed feelings about HIV serostatus disclosure, while 86.2% reported that disclosure was beneficial. Thematic analyses showed that the adolescents reacted emotionally due to an unexpected disclosure and a belief of imminent death from HIV. However, they improved adherence to treatment (84.7%), limited self-disclosure of their HIV serostatus to others (81.1%), and felt more comfortable in talking about HIV with their caregivers (54.2%). Thematic analysis identified perceived benefits of disclosure as follows: better understanding of their sickness and treatment, and improved self-care and treatment adherence. Lower percentage of the adolescents have learned about psychosocial well-being, compared to facts about HIV and treatment. Despite initial emotional distress experienced after the disclosure, knowing one's own HIV serostatus was found to be a crucial turning point for adolescents to improve motivation for self-care. HIV serostatus disclosure to adolescents requires follow-up support involving parents/primary caregivers, health workers, and peers.

Assessment of Motivational Cognitions in Diabetes Self-Care: the Motivation Thought Frequency Scales for Glucose Testing, Physical Activity and Healthy Eating.

There is a need for improved measurement of motivation for diabetes self-care. The Elaborated Intrusion Theory of Desire offers a coherent framework for understanding and identifying the cognitive-affective events that constitute the subjective experience of motivation and may therefore inform the development of such an instrument. Recent research has shown the resultant Motivation Thought Frequency scale (MTF) to have a stable factor structure (Intensity, Incentives Imagery, Self-Efficacy Imagery, Availability) when applied to physical activity, excessive snacking or alcohol use in the general population. The current study aimed to confirm the four-factor structure of the MTF for glucose testing, physical activity and healthy eating in people with type 2 diabetes. Associations with self-reports of concurrent diabetic self-care behaviours were also examined. Confirmatory factor analyses tested the internal structure, and multiple regressions assessed the scale's relationship with concurrent self-care behaviours. The MTF was completed by 340 adults with type 2 diabetes, and 237 from that sample also reported self-care behaviours. Separate MTFs assessed motivation for glucose testing, physical activity and healthy eating. Self-care was assessed using questions from the Summary of Diabetes Self-Care Activities. The MTF for each goal achieved an acceptable fit on all indices after selected errors within factors were allowed to intercorrelate. Intensity and Self-Efficacy Imagery provided the strongest and most consistent correlations with relevant self-care behaviours. Results provide preliminary support for the MTF in a diabetes sample. Testing of its sensitivity to change and its predictive utility over time is needed.

Unmet core needs for self-determination in HIV-infected women of color in medical care

ABSTRACTThe levels of satisfaction of the core self-determination needs (relatedness, autonomy and competence) among HIV-infected women of color as well as the association between need fulfillment and patient characteristics were examined. Having less than a high-school education was associated with lowest need satisfaction: autonomy (β = −1.90; 95%CI = −3.20, −0.60), relatedness (β = −2.70; 95%CI = −4.30, −1.10) and competency (β = −2.50; 95%CI = −3.60, −1.30). Each additional point increase in affective symptoms of depression was associated with decrements in need satisfaction (−.61 autonomy, −.68 relatedness and −.59 competency). Relatedness satisfaction was lower with higher responses on all three measures of violence (psychological abuse: β = −0.13, 95%CI = −0.19 to −0.07; adult traumatic experiences: β = −0.24, 95%CI = −0.35 to −0.13 and childhood traumatic experiences: β = −0.24, 95%CI = −0.40 to −0.08). Interventions that address core self-determination needs, and the characteristics that influence them, may enhance the motivation for self-care of HIV-infected women.

Lost opportunities to prevent early onset type 2 diabetes mellitus after a pregnancy complicated by gestational diabetes

ObjectivesGestational diabetes mellitus (GDM) greatly increases the risk of developing diabetes in the decade after delivery, but few women receive appropriately timed postpartum glucose testing (PPGT) or a referral to...

Effective Teaching Strategies for Patient Education in Individuals With Spinal Cord Injury in Iran

Background: Spinal cord injury (SCI) causes multiple complications, which can be prevented or minimized, through patient education (PE). Individuals with SCI are different, according to culture, socioeconomic status, level of education, access to educational facilities, and geographic region. Therefore, different teaching strategies should be used to increase effectiveness of education. Objectives: The aim of this study is to evaluate the perspectives of individuals with SCI, about their preferred methods of PE. Patients and Methods: This was a descriptive cross-sectional study undertaken at the brain and spinal cord injury research center (BASIR), Tehran university of medical sciences, Tehran, Iran. The participants comprised of 119 SCI persons (81 men and 38 women), with mean age of 32 ± 10.5 years, referred to BASIR clinic to receive outpatient rehabilitation, in 2012. The patients were asked about their views, concerning preferred methods of PE. Results: Most participants (94%) appreciated to be informed concerning their illness. The two most preferred education methods were educational movies by CD or DVD (44%) and lectures or face classes (36%), followed by educational TV programs (30%), brochures (24%), education via internet or computer-aided (14.3%), and, finally, educational books (2%). Conclusions: Health care providers should take into account the differences between individuals with SCI, to use effective teaching strategies. Also, they should apply appropriate teaching methods and more than one teaching strategy, in relation to the different time and situation. Effective PE, in individuals with SCI, can increase their knowledge and motivation in self-care, improve satisfaction, prevent complications and make the PE more effective.

Self-Care Motivation Among Patients With Heart Failure: A Qualitative Study Based on Orem's Theory.

Initiating and adhering to self-care activities necessitate self-care motivation. This study was undertaken in Iran to explore self-care motivation among patients with heart failure (HF). This qualitative study was done in 2014 and 2015. Study participants were patients with HF and their family members who were purposively selected from Shaheed Rajaei Cardiovascular, Medical and Research Center, Tehran, Iran. The study data were collected from December 2014 to May 2015 by doing in-depth semistructured face-to-face interviews and were analyzed via the directed content analysis approach. Eleven primary codes were generated which reflected motivations for self-care among patients with HF in the Iranian sociocultural context. To enhance the clarity of the findings, these primarily codes were summarized and grouped into 7 subcategories including fear of death and love of life, returning to previous physical health status and preventing or alleviating symptoms, understanding the value of self-care behaviors and trusting them, having the desire for remaining independent, relying on God, reassuring and supporting family members, and preventing family members from feeling irritation. The findings of this study indicate that patients with HF have different motivations for doing self-care activities. Fear of death, love of life, wish to return to previous health status, and prevention or alleviation of HF symptoms were the participants' strongest motivations for self-care. Understanding the motivations for self-care among patients with HF, based a holistic approach and evidence-based practice, can help nurses and physicians develop motivational programs for promoting self-care behaviors.

Perceptions of similarity and response to selected comparison targets in type 2 diabetes

Objective: Social comparisons (i.e. self-evaluations relative to others) may affect motivation for diabetes self-care behaviours. Comparisons can have either positive or negative effects, but it is not clear what differentiates these responses. This study tested the effect of a patient’s perceived similarity to a comparison target on motivation for self-care.Design: Individuals with type 2 diabetes (n = 180, MA1c = 7.59%) selected to read one of four brief descriptions of a patient with diabetes.Main outcome measures: Participants rated their motivation for self-care behaviours prior and subsequent to reading and reported the extent to which they focused on similarities between the self and the selected patient while reading.Results: Perceived similarity moderated the effect of selection on motivation for self-care (p = .01, η2 = .06). Increased motivation was observed if participants focused on similarities with patients ‘doing better’ (i.e. high coping effectiveness/low symptom severity) and decreased motivation if they focused on similarities with patients ‘doing worse’ (low coping effectiveness/high symptom severity).Conclusions: Providing social comparison information in diabetes management (and perhaps other chronic diseases) may improve motivation for self-care among some patients. A subset of patients, however, may benefit from guidance to focus on similarities with certain targets.

Apathy in Parkinson's disease: A systematic review and meta-analysis.

Apathy is a frequently reported neuropsychiatric symptom in Parkinson's disease (PD), but its prevalence and clinical correlates are debated. We aimed to address these issues by conducting a systematic review and meta-analysis. Embase, Medline/PubMed, and PsychINFO databases were searched for relevant studies. Data were extracted by two independent observers, using predefined extraction forms tailored specifically to the research question. From 1,702 titles and abstracts, 23 studies were selected. Meta-analysis showed a prevalence of apathy in PD of 39.8% (n = 5,388, 905% CI 34.6-45.0%). Apathy was associated with higher age (3.3 years, 95% CI = 1.7-4.9), lower mean Mini-Mental State Evaluation (MMSE) score (-1.4 points, 95% CI = -2.1 to -0.8), an increased risk of co-morbid depression (relative risk [RR] = 2.3, 95% CI = 1.9-2.8), higher Unified Parkinson's Disease Rating Scale (UPDRS) motor score (6.5 points, 95% CI = 2.6-10.3), and more severe disability (Hedges-G = 0.5, 95% CI = 0.3-0.6). Half of the patients with apathy had concomitant depression (57.2%, 95% CI = 49.4-64.9%), and this estimate was similar after exclusion of patients with cognitive impairment (52.5%, 95% CI = 42.2%-62.8%). In conclusion, we found that apathy affects almost 40% of patients with PD. Several factors influence reported prevalence rates, contributing to the considerable heterogeneity in study results. Half of patients with apathy do not suffer from concomitant depression or cognitive impairment, confirming its status as a separate clinical syndrome in PD. The pervasiveness of apathy in PD warrants research into its treatment, although different underlying pathophysiological mechanisms may require different treatment strategies. Treatment of apathy could improve patient quality of life, reduce caregiver burden, alleviate disability by increasing motivation for self-care, and reduce cognitive impairment by improving executive functioning.

Family partner intervention influences self-care confidence and treatment self-regulation in patients with heart failure.

Heart failure self-care requires confidence in one's ability and motivation to perform a recommended behavior. Most self-care occurs within a family context, yet little is known about the influence of family on heart failure self-care or motivating factors. To examine the association of family functioning and the self-care antecedents of confidence and motivation among heart failure participants and determine if a family partnership intervention would promote higher levels of perceived confidence and treatment self-regulation (motivation) at four and eight months compared to patient-family education or usual care groups. Heart failure patients (N=117) and a family member were randomized to a family partnership intervention, patient-family education or usual care groups. Measures of patient's perceived family functioning, confidence, motivation for medications and following a low-sodium diet were analyzed. Data were collected at baseline, four and eight months. Family functioning was related to self-care confidence for diet (p=0.02) and autonomous motivation for adhering to their medications (p=0.05) and diet (p=0.2). The family partnership intervention group significantly improved confidence (p=0.05) and motivation (medications (p=0.004; diet p=0.012) at four months, whereas patient-family education group and usual care did not change. Perceived confidence and motivation for self-care was enhanced by family partnership intervention, regardless of family functioning. Poor family functioning at baseline contributed to lower confidence. Family functioning should be assessed to guide tailored family-patient interventions for better outcomes.

Consejería Telefónica, un Cuidado Imaginario Real que Apoya el Automanejo de Personas con Enfermedades Crónicas

Las enfermedades cronicas aumentan cada dia, impactando a personas, servicios sanitarios y sociedad. Actualmente, los sistemas de salud implementan innovadoras estrategias, como la asistencia telefonica para apoyar el automanejo de personas con Diabetes, mejorando su compensacion metabolica y literacidad. Dicha atencion remota podria realizarla una enfermera en formacion, previa capacitacion. Objetivos: Describir una experiencia en consejerias telefonicas de apoyo al automanejo de personas con Diabetes Mellitus tipo 2. Metodologia: En el contexto del proyecto: Ensayo clinico controlado de Literacidad en Salud, para incrementar la compensacion metabolica y autoeficacia de personas con Diabetes Mellitus tipo 2 en Centros de Salud Familiar de la comuna de La Florida (FONIS SA13/20357), se realizaron consejerias telefonicas a diabeticos durante seis meses, complementado con sesiones presenciales grupales para aumentar su automanejo y nivel de literacidad. Resultados: El contacto a distancia es diferente a la atencion directa; causando incertidumbre. El uso del telefono impacta el ser, saber y hacer profesional. La comunicacion a distancia apoya toma de decisiones en salud. El oido y voz - herramientas de cuidado- remueven necesidades del enfermo, fomentan la comprension de su enfermedad, visibilizan motores de cambio y construyen motivacion en una atencion humanizada para el automanejo; interaccion imaginaria real. Conclusiones: El concepto de literacidad en salud, entrevista motivacional y tecnologias en el cuidado serian utiles en la formacion de pregrado de profesionales de salud; promoviendo el automanejo. Se propone develar la experiencia vivida por consejeros telefonicos para apoyarlos.

A Survey of Self-Management and Intrusiveness of Illness in Native Americans with Diabetes Mellitus.

Diabetes mellitus (DM) has emerged as an important focus of national public health efforts because of the rapid increase in the burden of this disease. In particular, DM disproportionately affects Native Americans. Adequate management of DM requires that patients participate as active partners in their own care and much of patient activation and empowerment can be attributed to their experience with DM and self-care. That is, the degree to which the patient feels the disease intrudes on his or her daily life would impact the motivation for self-care. We conducted a study in collaboration with 2 tribal nations in Oklahoma, collecting data on survey questions regarding intrusiveness of illness and self-management behaviors from a sample of 159 members of the Chickasaw and Choctaw Nations. Previously validated variables measuring intrusiveness of illness and self-care were included in the survey. Descriptive statistics and bivariate analyses illustrated the distribution of these variables and identified possible tribal and gender differences. Our findings showed that our sample adjusted well to DM and in general exhibited high compliance to self-care. However, our findings also revealed striking gender differences where female respondents were better adjusted to their disease, whereas male respondents reported higher adherence to self-management. Findings from our study, particularly those that describe tribal differences and gender disparities, can inform strategies for case management and patient interactions with providers and the health care system.