The effectiveness of peer support on self-efficacy and self-management in people with type 2 diabetes: A meta-analysis

ObjectivesThis study aims to investigate the effectiveness of peer support on self-efficacy and self-management in people with type 2 diabetes.MethodsEight databases were utilized for selecting eligible studies that were published from inception to Jan., 2020. The eligible studies were screened, extracted and then the methodological quality was evaluated independently by two researchers. RevMan version 5.3 software and Stata version 14.0 software were utilized for the meta-analysis.ResultsSeventeen studies were included in the meta-analysis. Compared with the control group, peer support significantly improved self-efficacy [SMD = 0.41, 95 % CI = (0.20, 0.62), p = 0.0001] and self-management [SMD = 1.21, 95 % CI = (0.58, 1.84), p = 0.0002] in people with type 2 diabetes, but had no significant effect on distress (p = 0.34).ConclusionsPeer support significantly improved self-efficacy and self-management, but there was no clear evidence that peer support improved distress in people with type 2 diabetes. More studies are needed to further verify the validity of the results.Practice implicationsThis meta-analysis suggested that peer support should be considered as a complementary treatment for patients with type 2 diabetes. Medical staff can encourage the use of peer support in the teaching content of patients with type 2 diabetes to improve their self-efficacy and self-management.     

Communicating with older diabetes patients: self-management and social comparison

OBJECTIVE: The health status and life experiences of older diabetes patients may be highly heterogeneous, thus making their perspectives particularly relevant for developing individualized self-management plans for this population. Our earlier research showed older diabetes patients' healthcare goals and self-management behaviors are frequently shaped through social comparisons with peers/family members. The present paper explores this role of social comparison in their self-management practices and develops a conceptual model depicting the process. METHODS: Data were collected using open-ended, semi-structured interviews to elicit 28 older, type 2 diabetes patients' healthcare goals and self-management practices. Qualitative techniques were used to extract salient themes. RESULTS: Social comparison plays a salient role in routinizing older patients' self-management practices. Almost all patients assess their self-management by making "downward" comparisons with individuals doing worse than them; "upward" comparisons are rarely invoked. Occasionally patients' social comparisons lead them to adopt "normalizing" behaviors resulting in deviations from medically recommended self-care. CONCLUSION: The findings formed the basis for developing a conceptual model delineating the role of social comparison in self-management that can be beneficial for providers in tailoring educational interventions for self-management. PRACTICE IMPLICATIONS: Fostering these comparisons can help providers enhance communication on initiating and sustaining self-management practices.     

Ethnic differences in outcomes of diabetes care and the role of self-management behavior

OBJECTIVE: Ethnic differences in outcomes of outpatient diabetic care and the role of self-management behavior and its determinants in explaining observed differences. METHODS: Face-to-face interviews were held with 102 Turkish or Moroccan, and 102 native Dutch diabetic patients to measure self-management behavior and determinants of self-management (as derived from the Attitudes-Social support self-Efficacy model, and Personal Models and Barriers). A medical record review was conducted to measure ethnic differences in outcomes of diabetes care. Data were analyzed using multiple linear regression. RESULTS: Outcomes differed significantly with ethnic minorities having higher levels of lipids (risk difference=RD=0.7%; CI: 0.3-1.2) and HbA1c (RD=0.9%; CI: 0.4-1.4) than native Dutch patients. Differences in self-management could not explain the ethnic differences in outcomes. Self-efficacy explained 18% of the ethnic differences in HbA1c. Beliefs about seriousness of diabetes and social support regarding diabetes management together explained 47% of the ethnic differences in lipids. CONCLUSION: This study provides evidence for ethnic differences in outcomes of diabetes care. Self-efficacy is the most important determinant in explaining the differences in HbA1c. PRACTICE IMPLICATIONS: For diabetes practice this suggests that strengthening patients' self-efficacy may improve the control of HbA1c and may result in a decrease of ethnic differences. The relationship between behavioral determinants like seriousness and social support and outcomes of diabetes care was differential by ethnic group, implying that caution is required when applying behavioral models to different ethnic groups.     

Predictors and effectiveness of diabetes self-management education in clinical practice

OBJECTIVE: To describe the demographic and clinical predictors of attendance at a diabetes education center (DEC) for self-management education, and to compare subsequent quality of care indicators between attendees and non-attendees. METHODS: DEC attendance in 2002 was determined from a written questionnaire completed by 781 adults with diabetes across Ontario, Canada. Predictors of attendance and quality of care indicators were defined from the questionnaire and from linkage with health care administrative data. A multivariate logistic regression model was built to find the independent predictors of attendance, while quality of care was evaluated using propensity score methods. RESULTS: 30% of survey participants reported attending a DEC in 2002. Independent predictors of attendance were shorter duration of diabetes, receiving regular primary care, receiving regular diabetes specialist care and single marital status. Attendees were more likely to receive a retinal screening examination in the following 2 years than non-attendees. CONCLUSION: Receiving regular primary care was the strongest predictor of attending a DEC, suggesting that DECs are not substitute providers of diabetes care for people without a regular physician. Increased retinal screening among DEC attendees suggests that self-management education improved their self-efficacy to ensure adequate screening was performed. PRACTICE IMPLICATIONS: The findings characterize the types of people who attend DECs, which may lead to identification and targeting of inequities in access. The findings also highlight the influence diabetes education can have on quality of care in real-world practice.     

Integrating diabetes self-management with the health goals of older adults: a qualitative exploration

OBJECTIVE: This study investigates the life and health goals of older adults with diabetes, and explores the factors that influence their diabetes self-management. METHODS: Qualitative in-depth interviews were conducted with 24 older adults with diabetes and other morbid conditions and/or their caregivers, when appropriate. RESULTS: Participants' provided a consistent set of responses when describing life and health goals. Participants described goals for longevity, better physical functioning, spending time with family, or maintaining independence. Diabetes discordant conditions, but not diabetes, were seen as barriers to life goals for participants with functional impairments. Functionally independent participants described additional health goals that related to diabetes self-management as diabetes was seen often a barrier to life goals. Caregivers, co-morbid conditions, denial and retirement were among the factors that influenced initiation of diabetes self-management. CONCLUSION: Participants endorsed health goals and diabetes self-management practices that they believed would help them accomplish their life goals. Functional capabilities and social support were key factors in the relationship between diabetes self-management and their broader goals. PRACTICE IMPLICATIONS: When planning diabetes treatments, clinicians, patients and caregivers should discuss the relationship between diabetes self-management and health and life goals as well as the affects of functional limitations and caregiver support.     

The effect of diabetes self-management education on psychological status and blood glucose in newly diagnosed patients with diabetes type 2

Objective

The purpose of this study was to evaluate the efficacy of self-management education on psychological outcomes and glycemic control in type 2 diabetes mellitus.

Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes

Objective

The aim of this study was to explore the interaction between diabetes specialist nurses (DSNs) and patients with type 2 diabetes (T2D) during group sessions about self-management.

Methods

Ten DSNs and 44 patients were observed during group sessions about self-management, and thereafter the observations were analyzed using qualitative content analysis.

Results

The interaction was characterized by three themes: becoming empowered, approaching each other from different perspectives, and struggling for authority. The interaction was not a linear process, but rather a dynamic process with distinct episodes that characterized the content of the sessions.

Conclusion

It is important to achieve an interaction that is patient-centered, where the DSN is aware of each patient's individual needs and avoids responding to patients in a normative way. A satisfying interaction may strengthen patients’ self-management, and also may strengthen the DSNs in their professional performance.

Practice implications

Authority struggles between patients and DSNs could be a prerequisite for patients to become autonomous and decisive in self-management. DSNs might benefit from an increased awareness about this issue, because they can better support patients if they do not perceive authority struggles as threats to their professional role.     

Communicative and critical health literacy,and self-management behaviors in end-stage renal disease patients with diabetes on hemodialysis

Objective

Health Literacy (HL) has been linked to disease self-management and various health outcomes, and can be separated into components of functional, communicative and critical skills. The high comorbidity between diabetes and end-stage renal disease (ESRD) poses concerns for compromised disease self-management. This study aimed to identify the relationships between HL and self-management behaviors in end-stage renal disease patients with diabetes.

Methods

Self-report questionnaires measuring HL and self-management with the Functional, Communicative and Critical HL scale and Summary of Diabetes Self-Care Activities, respectively, were implemented with a sample of 63 patients. Socio-demographic and clinical characteristics were obtained from medical records.

Results

Self-management in diabetes was associated with communicative and critical HL, but not functional HL. Educational attainment was associated only with functional HL. No relationship between HL and glycated hemoglobin (Hb_A1c) was identified.

Conclusion

Communicative and critical HL skills are associated with self-management in ESRD patients with diabetes. Education levels are not related to self-management.

Practice implications

Healthcare professionals and health information aiming to improve self-management in ESRD patients with diabetes should consider their capacities of communicative and critical HL instead of solely assessing functional HL.     

Twelve-month outcomes of an Internet-based diabetes self-management support program

Objective

Internet-based programs offer potential for practical, cost-effective chronic illness self-management programs.

Methods

We report 12-month results of an Internet-based diabetes self-management program, with and without additional support, compared to enhanced usual care in a 3-arm practical randomized trial. Patients (n = 463) were randomized: 77.3% completed 12-month follow-up. Primary outcomes were changes in health behaviors of healthy eating, physical activity, and medication taking. Secondary outcomes were hemoglobin A1c, body mass index, lipids, blood pressure, and psychosocial factors.

Results

Internet conditions improved health behaviors significantly vs. usual care over the 12-month period (d for effect size = .09–.16). All conditions improved moderately on biological and psychosocial outcomes. Latinos, lower literacy, and higher cardiovascular disease risk patients improved as much as other participants.

Conclusions

The Internet intervention meets the reach and feasibility criteria for a potentially broad public health impact. However, 12-month magnitude of effects was small, suggesting that different or more intensive approaches are necessary to support long-term outcomes. Research is needed to understand the linkages between intervention and maintenance processes and downstream outcomes.

Practice implications

Automated self-management interventions should be tailored and integrated into primary care; maintenance of patient self-management can be enhanced through links to community resources.     

When knowing is not enough: Emotional distress and depression reduce the positive effects of health literacy on diabetes self-management

Objectives

Adequate self-management activities are important predictors of diabetes outcomes. As diabetes literacy and self-efficacy are strong predictors of diabetes self-care, self-management education programs focus essentially on these factors. This study investigated whether emotional distress or depression moderates the relation between health literacy, self-efficacy and diabetes self-care behaviors.

Mastery and perceived autonomy support are correlates of Dutch diabetes patients’ self-management and quality of life

Objective

The aim of this study was to assess the associations between type 2 diabetes patients’ mastery and perceived autonomy support and their self-management skills and health-related quality of life (HRQOL).

Methods

A cross-sectional questionnaire survey was conducted among 3352 patients with type 2 diabetes. Key variables were assessed with validated questionnaires.

Results

Patients’ mastery and perceived autonomy support correlated positively with their self-management skills (r = 0.34, p < 0.001; r = 0.37, p < 0.001) and HRQOL (r = 0.37, p < 0.001; r = 0.15, p < 0.001). In the linear regression analysis, mastery and perceived autonomy support were positive correlates of self-management (β = 0.23; p < 0.001; β = 0.25; p < 0.001). Patients with more physical or psychological complications had significantly lower scores on mastery, perceived autonomy support, self-management and HRQOL.

Conclusion

Our results indicate the importance of mastery in relation to diabetes patients’ perceived autonomy support, self-management skills and HRQOL.

Practice implications

Since a greater sense of mastery is likely to increase patients’ autonomous motivation to cope with their disease, interventions can aim to influence patients’ motivational regulation. In addition, we confirmed the need for autonomy support to improve patients’ self-management skills. Professionals can be trained to be autonomy-supportive, which relates to person-centered approaches such as motivational interviewing (MI).     

Psychometric Properties of the Perceived Diabetes Self-Management Scale (PDSMS)

Patients with chronic medical conditions such as diabetes mellitus need to self-manage their condition for optimal outcomes. The degree to which patients with diabetes feel competent or self-efficacious in managing their diabetes has been related to behaviors such as dieting or exercise as well as to indicators of glycemic control. A diabetes-specific adaptation of the Perceived Medical-Condition Self-Management Scale was administered to 398 patients with either type 1 (n=57) or type 2 (n=341) diabetes. Cronbach's alpha of the 8-item Perceived Diabetes Self-Management Scale (PDSMS) was .83 indicating internal consistency. PDSMS scores were uncorrelated with age, years since diagnosis, and years of schooling, but were negatively correlated with body mass index. Those with type 1 DM had higher PDSMS scores than those with type 2 DM. PDSMS scores were positively correlated with a number of self-reported self-care activities and negatively related to measures of glycemic control. The PDSMS is a valid measure of diabetes self-efficacy, and the more generic template from which it was adapted can easily be altered for use with other chronic medical conditions.     

Modular ICT-based patient empowerment framework for self-management of diabetes: Design perspectives and validation results

IntroductionIt is estimated that more than 382 million people suffer from diabetes across the globe, most of which are between the age of 40 and 59 years. ICT can play a key role in better management of diabetes and in patient empowerment. Patient empowerment involves patients to a greater extent in their own healthcare process and disease management becomes an integrated part of their daily life. Self-management opens the possibility for patients to contribute to their own healthcare as well as to be more in control of their disease.ObjectivesThe objective of our study was to explore the impact of an ICT-based patient empowerment framework in diabetes self-management.MethodsA modular patient empowerment framework that fosters diabetes self-management was designed and implemented. The framework incorporates expert knowledge in the form of clinical guidelines, and it supports patients in the specification of personalized activities that are based on medical recommendations and personal goals, and in the collection of observations of daily living. The usability and usefulness of the proposed framework were assessed in a pilot study with the participation of 60 patients and 12 health professionals.ResultsThe study revealed that a patient empowerment approach based on self-management ICT tools is useful and accepted by both the patients and the physicians. For those patients who were already disciplined in their disease management the piloted solution served as a facilitator for data logging. For the rest, it served as an incentive for better adherence to disease management principles. The ICT tools prompted many patients into becoming more physically active and into making dietary habits’ adjustments. However, this impact proved to be tightly correlated with the sociocultural background of the subjects. The study also demonstrated that even in patient-centric self-management interventions the physicians still have a key role to play. However, the acceptance of such interventions by the healthcare professionals depends not only on the level of impact in their patients’ disease management but also on the level of impact in their workflow.ConclusionsIt is evident that a patient empowerment approach based on self-management ICT tools is useful and accepted by patients and physicians. Further, there are clear indications that ICT frameworks such as the one presented in this paper support patients in behavioral changes and in better disease management. Finally, it was realized that self-management solutions should be built around the objective not only to educate and guide patients in disease self-management, but also to assist them in exploring the decision space and to provide insight and explanations about the impact of their own values on the decision.     

Preferences for self-management support: findings from a survey of diabetes patients in safety-net health systems

OBJECTIVE: We sought to identify interest in different modes of self-management support among diabetes patients cared for in public hospitals, and to assess whether demographic or disease-specific factors were associated with patient preferences. We explored the possible role of a perceived communication need in influencing interest in self-management support. METHODS: Telephone survey of a random sample of 796 English and Spanish-speaking diabetes patients (response rate 47%) recruited from four urban US public hospital systems. In multivariate models, we measured the association of race/ethnicity, primary language, self-reported health literacy, self-efficacy, and diabetes-related factors on patients' interest in three self-management support strategies (telephone support, group medical visits, and Internet-based support). We explored the extent to which patients believed that better communication with providers would improve their diabetes control, and whether this perception altered the relationship between patient factors and self-management support acceptance. RESULTS: Sixty-nine percent of respondents reported interest in telephone support, 55% in group medical visits, and 42% in Internet. Compared to Non-Hispanic Whites, Spanish-speaking Hispanics were more interested in telephone support (OR 3.45, 95% CI 1.97-6.05) and group medical visits (OR 2.45, 95% CI 1.49-4.02), but less interested in Internet self-management support (OR 0.56, 95% CI 0.33-0.93). African-Americans were more interested than Whites in all three self-management support strategies. Patients with limited self-reported health literacy were more likely to be interested in telephone support than those not reporting literacy deficits. Forty percent reported that their diabetes would be better controlled if they communicated better with their health care provider. This perceived communication benefit was independently associated with interest in self-management support (p<0.001), but its inclusion in models did not alter the strengths of the main associations between patient characteristics and self-management support preferences. CONCLUSION: Many diabetes patients in safety-net settings report an interest in receiving self-management support, but preferences for modes of delivery of self-management support vary by race/ethnicity, language proficiency, and self-reported health literacy. PRACTICE IMPLICATIONS: Public health systems should consider offering a range of self-management support services to meet the needs of their diverse patient populations. More broad dissemination and implementation of self-management support may help address the unmet need for better provider communication among diabetes patients in these settings.     

Effectiveness and acceptability of a text message intervention (DTEXT) on HbA1c and self-management for people with type 2 diabetes. A randomized controlled trial

ObjectiveDetermine the effectiveness and acceptability of a text message intervention (DTEXT) on HbA1c and self-management behaviors for Australian adults with type 2 diabetes.MethodsUsing intention to treat analysis and generalized estimating equations, this randomized controlled trial of 395 adults determined change in HbA1c at 3 and 6 months between the intervention and control group. Secondary outcomes included change in nutrition, physical activity, blood lipid profile, body mass index, quality of life, self-efficacy, medication taking and program acceptability.ResultsNo significant difference was observed between the intervention or control group for HbA1c at 3 months (P = 0.23) or 6 months (P = 0.22). Significant improvements were seen in consumption of vegetables at 3 months (P < 0.001) and 6 months (P = 0.04); fruit at 3 months (P = 0.046) and discretionary sweet foods at 3 months (P = 0.02). No other significant effects seen. The intervention demonstrated high rates of acceptability (94.0%) and minimal withdrawal (1.5%).ConclusionsDTEXT was an acceptable text message intervention that improved some nutritional behaviors in people with type 2 diabetes, but did not significantly improve HbA1c or other outcomes. Further research is required to optimize DTEXT.Practice implicationsDTEXT provides an acceptable, feasible form of self-management support that may complement existing diabetes care.     

The Look After Yourself (LAY) intervention to improve self-management in stroke survivors: Results from a quasi-experimental study

ObjectiveTo test the efficacy of a self-management intervention for stroke survivors vs. usual care.MethodsUsing a quasi-experimental study, participants were recruited from three public Italian hospitals. Questionnaires assessing self-efficacy (SSEQ), quality of life (SF-12), physical performance (SPPB), depression (GDS) and activities of daily living (MBI) were administered at baseline, discharge and two months after discharge. Mixed models with a propensity score were used between experimental group (EG) and control group (CG). Logistic models were used to compare the use of health services.ResultsEighty-two stroke survivors were enrolled in the EG and 103 in the CG. Self-efficacy in self-management improved in the EG compared to the CG during hospitalization. Improvements from baseline to discharge were found in the EG in the mental component of SF-12 and in MBI. The EG were 8.9 times more likely to contact general practitioners after discharge and 2.9 times to do regular exercise than CG. Notably, EG with higher education benefitted more from the intervention.ConclusionThe intervention was efficacious in improving self-efficacy, mental health and activities of daily living.Practice implicationsStructured educational interventions based on problem-solving and individual goal setting may improve self-management skills in stroke survivors.     

Emotion regulation contributes to the development of diabetes distress among adults with type 1 diabetes

Objective

To demonstrate how maladaptive emotion regulation (ER) can lead to diabetes distress (DD), with subsequent effects on management and metabolic outcomes among adults with type 1 diabetes.

Effectiveness of a nurse-led multidisciplinary self-management program for patients with coronary heart disease in communities: A randomized controlled trial

ObjectiveTo examine the effectiveness of a nurse-led multidisciplinary self-management program (NMSP) on self-management behaviors, self-efficacy, health-related quality of life (HRQoL) and unplanned health service utilization (HSU) among Chinese patients with coronary heart disease (CHD) in communities.MethodsA randomized controlled trial with repeated measurements was used. A convenience sample of 144 participants was recruited from a community health center in China. All participants were randomly assigned to an intervention group (n = 72) in the newly developed NMSP or a control group (n = 72) in routine care. Outcome measurement was performed at baseline, 3 months and 6 months using Coronary Artery Disease Self-Management Scale (CADSs), Self-efficacy for Chronic Disease 6-item Scale (SECD6), and Short Form-12 health survey questionnaire (SF-12).ResultsOver the six months, the two groups reported significant differences in disease medical and emotional management of CADSs, confidence in symptom and disease management of SECD6, physical and mental component summary of SF-12, as well as emergency and outpatient visits of unplanned HSU.ConclusionsThe NMSP improves self-management behaviors, self-efficacy, HRQoL and reduces unplanned HSU among CHD patients in communities.Practice implicationsThis study provides an effective approach to empower CHD patients with emphasizing on collaboration support of health professionals in communities.