Enhancing health literacy and behavioural change within a tele‐care education and support intervention for people with type 2 diabetes

Background Behavioural change interventions for persons with chronic illness draw on a variety of theoretical approaches including motivational interviewing and shared decision making. Health literacy provides an additional, potentially powerful explanatory framework to guide research and practice. Objective To examine the changes in the depth and detail of diabetes‐related knowledge and confidence for persons with type 2 diabetes. Design Two‐year, prospective, observational study, using questionnaire data at two time points (baseline and 2 years later) and in‐depth interviews with a theoretically selected subsample. Setting and participants A total of 319 patients initially recruited from a deprived urban area in north‐west England Intervention Dedicated tele‐carer education and support, tailored to the individual circumstances of the patient. Main outcome measures Perceptions of confidence, levels of empowerment, learning for self‐care and most helpful aspects of the intervention. Results Over 90% expressed confidence in keeping their blood sugar controlled, and high levels of perceived empowerment (mean = 4.25; 95% CI, 4.17–4.33) were found. Changes in the depth and detail of diabetes‐related knowledge and confidence, from the specific to the more general, were observed and enhanced competence in translating knowledge into practice. Discussion and conclusions The intervention, built within a developed working partnership between tele‐carer and patient, operated at two levels: health literacy, enhancing knowledge, developing personal skills and enabling self‐control; and socio‐psychological behavioural change, tailored to individuals within their socio‐economic environments, enabling increased motivation and supportive problem‐solving. Both approaches find reflection in the findings and provide powerful explanatory lenses to interrogate the data.     

Country‐of‐birth differences in adverse health behaviours among people with type 2 diabetes

Objective: To identify differences in patterns of adverse health behaviours among people with type 2 diabetes according to country or region of birth. Methods: Population‐based study of 23,112 individuals with type 2 diabetes aged 45 years and older, from New South Wales, Australia. Self‐reported questionnaire data and logistic regression models were used to estimate odds ratios for adverse health behaviours according to country or region of birth, adjusted for confounding factors. Results: People with diabetes born in the Middle East and in the United Kingdom (UK) were more likely to be current smokers than those born in Australian, while those from Asia were less likely to be smokers. Relative to Australian‐born people with diabetes, those born in the Middle East were more likely to have insufficient physical activity, while those born in Oceania, North West Europe and the UK were less likely. People with diabetes from Asia, North Africa, the Middle East and Sub‐Saharan Africa were less likely to consume alcohol than those born in Australia, but people born in the UK were slightly more likely to consume alcohol. People with diabetes born in the UK, Asia, and North Africa were more likely than those born in Australia to have an inadequate intake of fruit and vegetables. Conclusion: Adverse health behaviours among people with type 2 diabetes varied markedly according to country or region of birth. Promoting smoking cessation and increasing physical activity levels among people with diabetes who were born in Middle Eastern countries are clear priorities.     

基于智能手机的青中年2型糖尿病患者健康管理的效果观察

目的:观察基于智能手机对青中年2型糖尿病患者进行健康管理的效果。方法:选择126例青中年2型糖尿病出院患者,随机分为健康管理组和对照组。健康管理组除常规临床治疗外,在智能手机上下载使用交流软件和常见的糖尿病相关应用软件,随访后观察健康管理效果。结果:2组基线水平无统计学差异,具有可比性。干预后健康管理组空腹血糖、餐后2 h血糖和糖化血红蛋白水平比对照组显著改善,差异有统计学意义(P值均<0.000 1);健康管理组能够改善饮食结构、运动坚持情况,患者对治疗依从性和健康满意度均较高,差异均有统计学意义(P<0.05)。结论:与单纯常规应用临床治疗2型糖尿病相比,联合智能手机平台进行健康管理的方式可为青中年2型糖尿病的健康管理提供一个新的思路。     

社区2型糖尿病患者健康素养量表编制研究

目的初步编制社区糖尿病患者健康素养量表,评价其信度和效度。方法根据世界卫生组织健康素养的定义,确定量表的理论结构,编制社区糖尿病患者健康素养量表,并进行预调查和信度及效度检验。结果通过预调查后调整量表,确定社区糖尿病患者健康素养量表分为5个维度,其中防治基本知识14个条目,膳食治疗知识7个条目,运动知识6个条目,药物与心理知识5个条目,防治行为9个条目,根据各条目具体内容进行赋分后,总分共100分。经内部一致性分析,克朗巴哈系数α=0.903,大于一般标准0.800,认为量表内部一致性较好。因子分析量表的KMO值为0.891,各条目在其公因子上的负荷值均大于0.400,认为内容效度较高。结论编制的社区糖尿病患者健康素养量表具有较好的信度和效度,可作为社区糖尿病患者健康素养的测量和干预效果评价的简易工具。     

健康素养、授权能力对初诊2型糖尿病患者自我管理能力的影响研究

目的 探索健康素养、授权能力对初诊2型糖尿病患者自我管理能力的影响，为开展糖尿病人的自我管理干预提供理论依据。方法 采用方便抽样的方法，运用自拟问卷、慢性病患者健康素养量表、糖尿病授权中文简化量表、中文版糖尿病自我管理量表对687名初诊2型糖尿病患者进行调查。采用多元线性回归模型分析健康素养、授权能力对初诊2型糖尿病患者自我管理能力的影响，并采用Bootstrap法对健康素养、授权能力及自我管理能力间的中介效应进行检验。结果 初诊2型糖尿病患者健康素养得分为(69.93±23.30)分，授权能力得分为(3.02±0.96)分，自我管理得分为(24.34±12.40)分。健康素养、授权能力和自我管理得分三个变量，两两之间呈正相关。多元线性回归结果显示，健康素养、授权能力与婚姻状况是自我管理能力的影响因素。授权能力在健康素养对自我管理的影响中发挥着部分中介效应的作用，中介效应占比10.51%。结论 在糖尿病患者的健康管理工作中，应重视提高初诊2型糖尿病患者的健康素养，授权能力和自我管理能力。     

Health literacy experiences of multi‐ethnic patients and their health‐care providers in the management of type 2 diabetes in Malaysia: A qualitative study

BackgroundPatients with type 2 diabetes mellitus (T2DM) require adequate health literacy to understand the disease and learn self‐management skills to optimize their health. However, the prevalence of limited health literacy is high in patients with T2DM, especially in Asian countries.ObjectiveThis study aimed to explore experiences related to health literacy in Asian patients with T2DM.DesignThis is a qualitative study using in‐depth interviews and focus group discussions. A framework analysis was used to analyse the data.Setting and participantsarticipants (n = 24) were multi‐ethnic patients with T2DM (n = 18) and their primary health‐care providers (n = 6). This study was conducted in four primary health‐care clinics in Malaysia.ResultsNine subthemes were identified within the four dimensions of health literacy: accessing, understanding, appraising and applying information.DiscussionMotivated patients actively sought information, while others passively received information shared by family members, friends or even strangers. Language and communication skills played important roles in helping patients understand this information. Information appraisal was lacking, with patients just proceeding to apply the information obtained. Patients'' use of information was influenced by their self‐efficacy, and internal and external barriers.ConclusionIn conclusion, the experiences of multi‐ethnic patients with T2DM regarding health literacy were varied and heavily influenced by their cultures.     

The role of spousal support for dietary adherence among type 2 diabetes patients: a narrative review

Healthy eating is key to successful management of type 2 diabetes (T2D). As discussed in this narrative review, there are strong indications that spousal support is an important element affecting dietary adherence in T2D. To provide a synthesized review of this evidence, Google Scholar and PubMed were searched, 28 relevant studies were selected, and the results were narratively summarized. A framework for information synthesis was developed which categorized results into three major themes: how gender roles and spousal dynamics function in spousal support for dietary adherence, the role of race and ethnicity in the influence of spousal support on dietary adherence, and the extant interventional work specifically targeting spousal support for T2D. The reviewed studies indicate that gender role performance is the principal factor in the relationship between spousal support and dietary adherence in T2D, though race and ethnicity also contribute. Despite this evidence, interventions that specifically target spousal support to improve dietary adherence in T2D have had limited efficacy. A better understanding of the relationship between spousal support and dietary adherence, as well as a subsequent utilization of this information to create targeted and effective interventions, would be of great benefit to the field of diabetes management.     

健康素养视角下2型糖尿病患者病耻感影响因素分析

目的 在健康素养视角下了解2型糖尿病患者病耻感现状及干预因素,为糖尿病患者更好实现自我管理提供干预措施。方法 采用便利抽样法,于2021年7—10月对某市3所综合型医院内分泌科门诊的355例糖尿病患者进行问卷调查,通过一般资料调查表、糖尿病健康素养量表、2型糖尿病病耻感量表进行数据收集,结果分析采用多元逐步回归。结果 2型糖尿病患者区别对待、责怪和评判、自我耻辱病耻感得分依次为（16.45±5.02）分、（18.27±6.06）分、（17.23±6.85）分,处于中等偏上水平。调查结果显示,健康素养、健康教育、居住类型为三个维度共同的影响因素,病程和治疗方式是责怪和评判病耻感与自我耻辱病耻感的共性影响因素,付费类型（β = - 0.139,t = - 2.797,P = 0.005）、居住地（β = - 0.204,t = - 3.865, P＜0.001）、婚姻状况（β = - 0.116,t = - 2.313, P = 0.021）、并发症数量（β = 0.110,t = 2.348, P = 0.019）为区别对待病耻感的独特影响因素,经济负担（β = 0.088,t = 2.065, P = 0.040）为责怪和评判病耻感的独特影响因素,性别（β = 0.120,t = 2.833, P = 0.005）为自我耻辱病耻感的独特影响因素。各个维度中,除并发症数量、经济负担、治疗方式、病程、性别正向预测病耻感,其余均可负向预测糖尿病病耻感。结论 2型糖尿病患者病耻感中等偏上,从提升健康素养视角出发,提供个性化干预措施减低病耻感,提高糖尿病患者生活质量。     

健康素养及运动干预控制糖尿病患者血糖水平的效果评估

目的 评估健康素养及运动干预降低2型糖尿病（T2DM）患者血糖水平的效果。方法 以上海市闵行区和长宁区799名最近一次糖化血红蛋白（HbA1c）≥ 7.5%（或FPG≥10 mmol/L）的T2DM患者为研究对象,采用整群随机分组方法分为健康素养干预组、运动干预组、综合干预组（健康素养＋运动干预）和对照组,每组各约200人。基线调查、身体测量及生化检测完成后,各干预组分别接受为期1年的干预。第3、6和12个月时,对所有患者进行问卷调查随访、身体测量和HbA1c检测。结果 3、6和12个月时患者的总应答率分别为99.4%、98.4%和95.2%。干预满3个月时,综合干预组HbA1c达标率（HbA1c<7.0%）最高,为25.3%,6和12个月时运动干预组达标率最高,分别为25.3%和34.6%。与基线时相比,各干预组HbA1c值在不同随访时段均有下降,以6个月时最明显,综合干预组平均下降0.48%（95% CI：-0.71%～-0.25%）,健康素养干预组下降0.33%（95% CI：-0.55%～-0.11%）,运动干预组下降0.70%（95% CI：-0.92%～-0.48%）,而对照组略升高0.03%（95% CI：-0.19%～0.25%）,差异有统计学意义（P<0.001）。以对照组为参比,调整可能的混杂因素后,3个月时综合干预组HbA1c效果最佳（β=-0.47,95% CI：-0.73～-0.20）;随后运动干预的效果逐渐凸现,6和12个月时HbA1c降幅分别达-0.73（95% CI：-0.98～-0.47）和-0.75（95% CI：-1.05～-0.45）。分层分析显示,在健康素养较低的患者中3种干预手段均有效,而在算术能力高者中运动干预更为有效。结论 健康素养及运动干预均可有效降低上海市社区T2DM患者的HbA1c水平,这将有助于降低患者并发症的发生和早死风险。     

Involving people with type 2 diabetes in facilitating participation in a cardiovascular screening programme

BackgroundKnowledge is lacking about how to increase uptake among people with type 2 diabetes (T2D) invited to preventive initiatives like cardiovascular screening.AimTo explore how to improve participation of people with T2D in cardiovascular screening using patient and public involvement (PPI).MethodsPatient and public involvement was included in a qualitative research design. From April to October 2019, we invited 40‐ to 60‐year‐old people with T2D (n = 17) to individual consultative meetings, using an interviewing approach. Before the interviews, participants were asked to read a proposed invitation letter to be used in a cardiovascular screening programme. Inductive content analysis was undertaken.ResultsParticipants considered cardiovascular screening important and beneficial from both a personal and social perspective. We found that the relational interaction between the person with T2D and the health‐care professional was key to participation and that nudging captured through the design of the screening programme and the wording of the invitation letter was requested.ConclusionIn preventive initiatives perceived as meaningful by the invitee, a focus on recruitment is crucial to facilitate participation. This study contributed with knowledge about how to promote participation by involving health‐care professionals in recruitment initiatives and through nudging. This knowledge may assist researchers, policymakers and ethicists'' understanding and assessment of the ethical appropriateness and public acceptability of nudging in cardiovascular screening.Patient or public contributionBy consulting 17 people with T2D, we are now in a position to suggest how a screening initiative should be altered because tools to improve uptake have been identified.     

社区健康教育在居家胰岛素治疗的 2 型糖尿病患者中的应用简

目的：探讨社区健康教育对居家使用胰岛素治疗的2型糖尿病（T2 diabetic mellitus, T2DM）患者的临床意义。方法对120例居家使用胰岛素治疗的T2DM患者进行专题讲座、血糖监测及专门辅导等规范化健康教育12个月,比较健康教育前后糖尿病相关知识知晓情况、医嘱依从性、空腹血糖等相关指标。结果健康教育12个月后糖尿病相关知识的知晓率比教育前明显提高（P＜0．01）;医嘱依从性从教育前的64．67％提高到教育后的92．67％,差异极显著（P＜0．01）;健康教育后的FPG、2h PG、HbA1c接近正常水平,与健康教育前比较差异极显著（P＜0．01）。结论社区健康教育对居家使用胰岛素治疗的2型糖尿病患者可促进血糖控制,延缓并发症,提高生活质量。     

Green space and cardiovascular health in people with type 2 diabetes

Associations between green space type and 9-year risk of incident cardiovascular disease (CVD) hospitalisations and deaths were analysed in 4166 people with type 2 diabetes in the Sax Institute's 45 and Up Study. Incidence of all-cause mortality, cardiovascular mortality, fatal or non-fatal CVD events and acute myocardial infarctions (AMI) were 14.67%, 7.23%, 47.36%, and 4.51%, respectively. After full adjustment, more tree canopy was associated with lower CVD mortality, lower fatal or non-fatal CVD events, and lower AMI risk. More open grass was associated with lower all-cause mortality, lower CVD mortality and lower fatal or non-fatal CVD events, but higher AMI risk.     

Types and sources of social support among adults living with type 2 diabetes in rural communities in the Dominican Republic

Type 2 diabetes management hinges on various determinants, including the role of interpersonal relationships in self-management behaviours. The aim of this study was to explore the types and sources of social support received by adults in the diabetes diagnosis and self-management processes. We conducted qualitative interviews with 28 men and women at two rural clinics in the Dominican Republic and used a combination of narrative and thematic analytic techniques to identify key sources and types of social support in their diabetes experiences. Participants described three stages in their diabetes experience: diagnosis, programme-enrolment, and long-term management. During diabetes diagnosis, most participants described receiving no support. At the programme-enrolment stage, friends and neighbours frequently provided informational or instrumental support to get to the clinic. In long-term management, cohabiting partners provided the most support, which was often assistance with their diet. Our findings highlight he need to assess and leverage distinct types and sources of social support at different stages of the diabetes experience.     

Connectivity,contest and the ties of self‐management support for type 2 diabetes: a meta‐synthesis of qualitative literature

This paper presents a meta‐synthesis of the literature on community‐based self‐management to support experiences of people diagnosed with type 2 diabetes. The aim was to synthesise findings on both formal and informal self‐management support with particular reference to the relevance and influence of the social context operating at different levels. The review forms part of EU‐WISE, a project financed through EU's 7th Framework Programme. The review was performed by systematically searching MEDLINE, PubMed, EMBASE, CINAHL, PsycINFO and Web of Science for English language publications between 2005 and 2014 presenting research conducted in Europe on the experiences and perspectives of self‐management concerns of patients diagnosed with type 2 diabetes. The search yielded 587 abstracts, which were reduced through search strategy refinement and eligibility and quality criteria to 29 papers that were included in the review. This review highlights the relevance of contextual factors operating at micro‐ and macro‐levels. The synthesis yielded six second‐order thematic constructs relating to self‐management: sense of agency and identity, the significance and meaning of social networks, minimal disruption of everyday life, economic hardship, the problem of assigning patients’ responsibility and structural influences of primary care. Using a line of argument synthesis, these themes were revisited, and a third‐order construct, connectivity emerged which refers to how links in daily life are interwoven with peoples’ social networks, local communities, economic and ideological conditions in society in a way which support self‐management activities. This meta‐synthesis indicates a need to heed the notion of connectivity as a means of mobilising and supporting the self‐management strategies of people with type 2 diabetes in everyday life.     

基于ROCCIPI框架的基层2型糖尿病患者健康管理问题识别与对策

基层2型糖尿病患者健康管理作为基本公共卫生服务项目均等化的重要措施,已取得初步成效,同时也面临着新的机遇和挑战.本文运用ROCCIPI分析方法从规则、机会、能力、交流、利益、过程和意识等方面剖析基层2型糖尿病健康管理服务中存在的问题,提出建立支撑性硬软件环境、构建"医防融合"的管理模式、加强糖尿病管理规范化培训及推广自...