Beliefs about health and illness: a comparison between Ugandan men and women living with Diabetes Mellitus

Background: The diabetes mellitus (DM) pandemic greatly affects developing countries. Self‐care is an important part of management, guided by beliefs about health and illness. Dissimilarities in health‐related behaviour in men and women have been described but not comparisons of their beliefs about health and illness. Aim: To explore beliefs about health and illness that might affect self‐care practice and healthcare‐seeking behaviour in men and women with DM in Uganda. Methods: This was an exploratory study with a consecutive sample from an outpatient diabetes clinic at a university hospital. Semi‐structured interviews were conducted with 15 women and 10 men aged 21–70 years. Data analysis was conducted by qualitative content analysis. Findings: Men's and women's beliefs about health and illness indicated limited knowledge about the body and DM. Dissimilar were men's focus on socio‐economic factors, particularly affordability of drugs, sexual function and lifestyle, while women valued well‐being, support in daily life and household activities and had a higher risk‐awareness of DM. Irrespective of gender, limited self‐care measures were used, and health professionals were consulted about health problems. Conclusion: Similarities and dissimilarities were found between men and women in beliefs about health and illness that affect self‐care practice and healthcare seeking. Underlying living conditions, with different gender roles, appear to determine the beliefs about health and illness, which are based on individual knowledge. Measures to increase knowledge about DM are urgently needed in Uganda. In diabetes care, it is important to search for individual beliefs and consider gender and living conditions.     

From diagnosis to health: a cross‐cultural interview study with immigrants from Somalia

Scand J Caring Sci; 2010; 24; 357–365
From diagnosis to health: a cross‐cultural interview study with immigrants from Somalia Objective: Being diagnosed as having a chronic disease gives rise to emotions. Beliefs about health are culturally constructed and affect people’s decisions regarding treatment. No studies have been reported that focus on the health beliefs of immigrants of Somalian origin with diabetes and how these people experiences the diagnosis. Therefore the aim of the present study was to investigate how immigrants from Somalia living in Sweden experienced receiving the diagnosis and describe their beliefs about health. Method: The sample consisted of 19 adults with diabetes born in Somalia and now living in Sweden who were interviewed with the aid of an interpreter. The interviews were subjected to qualitative content analysis. Results: From the analysis of what the participants said about their experiences of the diagnosis there emerged three themes: ‘Existential brooding’, ‘Avoiding the diagnosis’ and ‘Accepting what is fated’. Three themes also emerged from the analysis of what they said about beliefs about health: ‘Health as absence of disease’, ‘Health as general well‐being’ and ‘Fated by a higher power’. A major finding was that women when they communicated their experiences regarding the diagnosis and health beliefs made more use of supernatural beliefs than men did. The participants, irrespective of gender, did not immediately respond with shock or other strong emotion when they received the diagnosis. Conclusions: The study provides health‐care staff with knowledge concerning a minority group’s experiences of being diagnosed as having diabetes and their beliefs about health. The findings indicate that men and women differ in how they experiences the diagnosis and how they described their health beliefs. The quality improvement of health education and nursing for patients with diabetes calls for consideration of the variation of beliefs related to cultural background and gender.     

Management of gestational diabetes from the patient's perspective--a comparison of Swedish and Middle-Eastern born women

Aim. To explore patients’ evaluation of a specialized diabetes clinic for management of women with gestational diabetes born in Sweden and the Middle East and its contribution to a decreased level of stress and improved coping capability to promote health in patients receiving care. Background. No studies comparing patients’ perceptions of healthcare in women of different origin with gestational diabetes have been found. A perceived clinical problem in specialized diabetes care is of lower activity level in self‐care in foreign‐ than Swedish‐born women and the question is whether the healthcare organization is optimal in meeting different individuals’ needs. Design. Explorative study. Method. Semi‐structured individual interviews by external evaluators. Participants. Consecutive sample. Females with gestational diabetes, 13 born in Sweden and 14 born in the Middle East. Results. The healthcare model was perceived as functioning well. Swedish women were problem focused and information seeking. Frustration and stress were increased due to perceived delay in information concerning gestational diabetes, limited access to telephone service and lack of confidence in staff because they lacked the expected competence. Control of gestational diabetes and pregnancy by different persons led to perceived lack of holistic care. Women from the Middle East felt cared, had been given the necessary information and claimed to follow advice. Adequate information reduced respondents’ anxiety and increased their control over the situation. Conclusions. The clinic needs to be further improved by adapting programmes to persons to become problem focused by giving adequate information immediately. Relevance to clinical practice. Cultural differences in coping strategies and attitudes to gestational diabetes need to be considered. Training of staff working with gestational diabetes patients is urgently needed.     

Does systematically organized care improve outcomes for women with diabetes?

Objective To investigate whether financial reimbursement for a bundle of diabetes care items self‐reported by general practitioners (GPs) leads to improved outcomes for women with diabetes. Methods Longitudinal cohort study of women in the Australian Longitudinal Study on Women's Health aged 45–50 and 70–75 years when recruited in 1996. Outcomes Short Form 36‐item (SF‐36), Medicare and pharmaceutical benefits costs 2002–2005, uptake of annual cycle of care for diabetes (ACC). Results Annual cycle of care claims were identified for 23% of 388 mid‐age, and 40% of 616 older women with diabetes. ACC was not associated with statistically significantly higher costs in either group. Women for whom the GP had received an ACC fee were more likely to have been overweight, had more GP visits, more medications, and more ‘no cost’ visits. Unlike older women, mid‐age women for whom the GP had received an ACC fee were more likely to have difficulty managing on their income and tended to have worse physical and social function scores prior to the time the ACC was introduced and compared with other women with diabetes continued to have poorer scores at subsequent surveys. There was no association between ACC, co‐morbidities or country of birth. Women who developed diabetes after the first survey (incident cases) tended to have better SF‐36 health profile scores and lower costs than those who reported diabetes on the first survey (prevalent cases). Conclusions General practitioners of women with diabetes, who have more health care encounters and poorer health‐related quality of life, have adopted ACC with little impact on the decline in quality of life of the women nor on health care costs.     

Perceptions of health and their relationship to symptoms in African American women with type 2 diabetes.

Diabetes mellitus is an incurable disease and a major cause of mortality and morbidity. Diabetes disproportionately affects members of minorities who suffer from higher rates of complications and greater disability (Cowie & Eberhardt, 1996). The purpose of this study was to (a) describe the symptoms of African American women with Type 2 diabetes and examine the relationship among diabetes-related symptoms; (b) document complications of diabetes and perceptions of health and functioning; and (c) examine the relationship between duration of diabetes and age at diagnosis and perceived health. A convenience sample of 75 African American women with Type 2 diabetes were interviewed. A 44-item questionnaire measured selected demographic variables, symptoms, documented complications, and their perceived relationship to diabetes. The SF-20 was used to measure perceptions of health status. Data show that African American women with Type 2 diabetes have a wide variety of symptoms and poor perceptions of their general health and physical functioning.     

Women's experiences of making healthcare decisions about their breast cancer: A phenomenological study

There are few studies about how healthcare decisions are made for women with breast cancer in China and this knowledge is vital, both to further develop person‐centered health care and to ensure that women have a voice in their healthcare decisions. This phenomenological study explored the meaning of women's lived experiences of making healthcare decisions about their breast cancer in China. Semistructured, in‐depth interviews were conducted with a purposive sample of eight women with breast cancer. Data were analyzed using Colaizzi's phenomenological analytic method. The results of this study identified four themes: authority and expertise, lack of knowledge, family support, and Chinese cultural and social influences. Women were deferential to medical authority and perceived expertise, but they wanted to be involved to a greater degree in healthcare decisions. It is important for health professionals to optimize women's participation in decision‐making by removing barriers and advocating on their behalf.     

Diabetes and oral health: doctors' knowledge,perception and practices

Objectives To assess Jordanian doctors' knowledge of the connection between diabetes and oral health and assess their willingness to advise their diabetic patients to seek dental treatment and determine the associated factors. Methods Data were collected from 164 doctors practising in Jordan using a structured questionnaire. Chi‐squared test and regression analyses were conducted to reveal factors influencing the awareness, perception and knowledge of health care professionals regarding diabetes and oral health. Results Of the respondents, 70% had heard of the link between diabetes and oral health. The majority agreed that diabetes increased the tendency to have periodontitis but only half advised their diabetic patients to consult a dentist concerning their oral health. Only a third of doctors agreed that oral health was an issue in controlling diabetes. Books, magazines and pamphlets were the main source of information with the rate of 58%, medical journals and medical curriculum were the second and third sources, respectively. General medical practitioners were less informed than specialized doctors about the relationship between oral health and diabetes. Factors that significantly predicted doctors would advise dental visits were: (1) being a specialist (P = 0.037); (2) having positive knowledge about the association between diabetes and oral health (P = 0.02, P = 0.007 and P = 0.004, respectively). Conclusion There is limited knowledge of the relationships between oral health and diabetes. The more knowledgeable doctors are, the more likely they are to make dental referrals. Screening and referral by health professionals may benefit diabetic patients by improving access to dental care. Therefore, there is a need to educate doctors about oral health and diabetes.     

Gender differences in the relationship between physical functioning and depressive symptoms in low‐income older adults living alone

This study examined gender differences in the relationship between physical functioning and depressive symptoms in low‐income older adults living alone in Korea, and the variables influencing these symptoms. Data from a total of 317 older adults in the 2011 Korean National Survey were used. Upper limb mobility, lower limb mobility, activities of daily living, instrumental activities of daily living, and depressive symptoms were measured. Data were analyzed using multiple regression analysis. Low‐income older men and women living alone experienced depressive symptoms. Regression analysis showed that lower limb mobility and age together explained 35.4% of the variance in depressive symptoms in men. Subjective health status explained 16.7% of the same in women. These findings suggest that low‐income older adults living alone should be carefully monitored by public healthcare managers to improve their physical and mental health, considering gender‐specific elements.     

Gestational diabetes: prospective interview‐study of the developing beliefs about health,illness and health care in migrant women

Aims and objectives. To explore the development over time of beliefs about health, illness and health care in migrant women with gestational diabetes mellitus born in the Middle East and living in Sweden and to study the influence on self‐care and care seeking. Background. With today’s extensive global migration, contact with the new society/health care confronts the migrant’s culture of origin with the culture of the host country. The question is whether immigrants’ patterns of beliefs about health, illness and health‐related behaviour change over time, as no previous studies have been found on this topic. Design. A qualitative prospective exploratory study. Methods. Semi‐structured interviews, with 14 women (28–44 years), on three occasions: during pregnancy in gestational weeks 34–38 and three and 14 months after delivery. Results. There was a U‐shaped development of beliefs, from focusing on worries about the baby’s health during pregnancy and trying to comply with advice from health professionals, particularly a healthy diet, through regression to dietary habits (more sugar, less fibre) and lifestyle held before being diagnosed with gestational diabetes mellitus three months after delivery, back to a healthy diet/lifestyle and worries 14 months after delivery but then focusing on their own risk, as mothers, of developing type 2 diabetes and being unable to care for the child. Over time, the number of persons perceiving gestational diabetes mellitus as a transient condition decreased. Respondents lacked information about gestational diabetes mellitus, diet and follow‐ups. Conclusion. Beliefs changed over time and influenced health‐related behaviour. Beliefs about the seriousness of gestational diabetes mellitus among healthcare staff/care organisation influence the development of patients’ beliefs and need to be considered in planning care. Relevance to clinical practice. Pregnancy should be used as an opportunity to provide complete information about gestational diabetes mellitus and future health risks. This should continue after delivery and wishes for regular follow‐ups should be met.     

Barriers to diabetes control from Syrian women's perspectives

Aim: Diabetes constitutes a major public health problem and is a leading cause of morbidity and mortality. The purpose of this study was to explore the barriers to diabetes control of middle‐aged Syrian women with type 2 diabetes. Methods: A qualitative approach was adopted using conventional content analysis of semi‐structured interviews carried out with 12 women with type 2 diabetes in the diabetic center in Lattakia (Syria) between March 2010 and December 2010. The participants were recruited by the purposeful sampling method. Results: Three main themes emerged from the data analysis: (i) a poor patient–healthcare provider relationship; (ii) inadequate education; (iii) and psychosocial problems. The first theme had two subthemes: (i) relationship with doctors; and (ii) relationship with nurses. The second theme was without subthemes. The third theme consisted of six subthemes: (i) work and family responsibilities; (ii) motherhood role; (iii) lack of social support; (iv) anxiety; (v) depression; and (vi) low self‐efficacy. Conclusion: The findings support that effective relationships can be enhanced through active listening and by opening a free channel for the flow of ideas and information between patients and healthcare providers. Additionally, providers have an important role to play in learning to identify and manage the psychosocial problems that arise in living with diabetes, so that their patients can be supported in overcoming barriers to managing their diabetes more effectively.     

Migraine and Its Relation with Lifestyle in Women

Migraine is a very common primary headache disorder with no underlying identifiable pathological cause. It has a profound effect on the well‐being and general functioning of its victims. Migraine is best understood as a chronic disorder with episodic manifestations, progressive in some individuals, having dramatic social and economic costs. Migraine causes stress in patients and their families, changes the roles and lifestyles and disturbs the social interactions between family members. Being more common in women, migraine is a significant women's health concern. The low rate of headaches with identifiable organic causes suggests that individual and environmental factors are determinants of migraine. Therefore, studying lifestyle and its relation with migraine is very important. This study examines the relation between migraine headaches and lifestyle in women refereed to university clinics in Iran. Methods: This is a case‐control study of 170 patients selected randomly using Poisson sampling. The study population included female patients suffering from headache referred to the neurology clinics and health centers in Iran (with neurologist‐diagnosed migraine according to the criteria of the International Society of Headache). The study population for the control group included women without migraine headache whose life conditions were similar to the migraine group and who were living in the same area. Data were collected by interview and a questionnaire which was tested for reliability and validity using content validity and retest methodologies. Results: Findings showed a significant relation between some dimensions of lifestyle, such as diet eating habits (P = 0.001), resting and sleeping habits (P = 0.012), and drug usage patterns (P = 0.001) with migraine headaches. But there were no significant relationships noted between smoking, exercise or stress levels with migraine headaches. Discussion: Lifestyle habits, including rest and sleep, diet and drug usage, are important factors in migraine attacks. It is important to emphasize changing habits, such as improper use of analgesics, to decrease side effects in migraine victims. The health centers should consider promoting healthy habits and behaviors as a priority in their services.     

Coping with type-2 diabetes: the role of sense of coherence compared with active management

Coping with type‐2 diabetes: the role of sense of coherence compared with active management Changes in lifestyle, particularly in dietary and exercise habits, are necessary for the majority of patients with type‐2 diabetes but are difficult to carry out. However, Antonovsky describes a salutogenic health perspective grounded in patients’ developing what he terms ‘a sense of coherence’ (SOC). Can a strong SOC help diabetes patients to control the disease? The aim of this study was to analyse the relationship between SOC and treatment results measured as glucolysed haemoglobine (HbA1c) in patients with type‐2 diabetes. The aim was further to test the relationship between treatment results and an index of patients’ participation in active management and emotional state. Eighty‐eight patients answered a questionnaire containing 13 statements about sense of coherence (SOC‐13), questions about self‐assessed health, diabetes activity such as self‐management of diet, exercise and self‐control of blood sugar and emotional acceptance. There was no direct relationship between SOC‐13 and treatment results measured as HbA1c but there was a positive correlation between SOC‐13, self‐assessed health and HbA1c (P < 0·02). Self‐assessed health was seen as a mediating factor. The better patients’ estimation of their own health, the higher were SOC‐13 scores and the lower HbA1c. There was also a strong positive correlation between low levels of HbA1c and high levels of an index of active management and emotional acceptance of diabetes (P < 0·001).     

Educational attainment moderates the associations of diabetes education with health outcomes

Diabetes education is a critical element of care for people with diabetes. However, the associations between diabetes education and self‐care or health outcomes have not been clearly demonstrated at a national level. The aims of this study were to examine the associations of attendance of diabetes education classes with health behaviours and glycaemic control, and to understand whether these associations were moderated by level of educational attainment. Data were analysed for 456 adults from the 2012 Korea National Health and Nutrition Examination Survey V, collected from January 2010 to December 2012. No significant differences were observed between patients who had attended diabetes education classes and those who had never attended for factors such as smoking, drinking, exercise, nutrition therapy or glycaemic control. There was a significant interaction effect between receiving diabetes education and level of educational attainment on obtaining optimal glycaemic control. Attending diabetes education was positively associated with optimal glycaemic control among patients with more than a high school education but was negatively associated with it among those with less than middle school education. Diabetes education programmes need to be tailored to the needs and cognitive capacities of the target population.     

Patterns in the lives of African American women with diabetes

The experience of African American women with diabetes has not been fully understood to guide meaningful practice. This community-based collaborative action research, based on Newman's nursing theory of health as expanding consciousness, sought to understand the experience of African American women living with diabetes, and to envision new patterns of health by engaging women in dialogue about the meaning of their experiences. Interviews with 7 women revealed the multi-faceted nature of living with diabetes; blood sugars rise and fall with stress, depression, and trauma, as well as spiritual strength, mentors, and sister friends balance energy demands. Findings were woven into a spoken word narrative to engage the wider community in dialogue to gain new insights into how to live and relate in healthier ways. These findings give rise to a different model of community health and guide nurses to focus holistically on what is meaningful in the lives of their patients.     

Effectiveness of a behavior modification program for older people with uncontrolled Type 2 Diabetes

This quasi‐experimental study examined the effectiveness of a behavior modification program for diabetic control in Thai elders with uncontrolled Type 2 Diabetes. Purposive sampling was used to select 30 elders from one community as an intervention group, and 30 from a neighboring community as a control group. The intervention group participated in a program of 12 weeks' duration involving activities related to group counseling, group discussion, and an empowerment process that enhanced appropriate consumption of healthy diet, medication taking, and exercise. Data were collected by interviews using a questionnaire to assess knowledge of diabetes, perceived self‐efficacy, and diabetes control behavior, including fasting blood glucose and glycosylated hemoglobin, were examined at the baseline and three months thereafter. At program completion, the intervention group had significantly higher scores of knowledge, self‐efficacy, and health behaviors than those in the control group, but blood glucose and glycosylated hemoglobin were not significantly different. Although nurses can use aspects of this program to benefit elders with diabetes who require support and education, further research is required to provide improved health outcomes such as better glycemic control.