Psychometric testing of the Family‐Carer Diabetes Management Self‐Efficacy Scale

The aim of this study was to develop and test the construct and content validity, internal consistency of the Family‐Carer Diabetes Management Self‐Efficacy Scale (F‐DMSES). A sample of 70 Thai individuals who cared for those living with type 2 diabetes mellitus (T2DM) in a rural community in Thailand was included in the study. Data were collected by a questionnaire survey in January 2014. The F‐DMSES was initially derived from the DMSES, with subsequent forward and backward translations from and to English and Thai languages. The psychometric properties (content, construct and internal consistency) of the Thai version were explored using the Content Validity Index approach, exploratory factor analysis and Cronbach's alpha test. The F‐DMSES initially designed with 20 items was reduced to 14 items within four factors (general diet and blood glucose monitoring, medications and complications, diet in differing situations, and weight control and physical activities), and explained 72.2% of the total variance in overarching construct. Internal consistency was supported (α = 0.89). The F‐DMSES was also able to measure change over time following an intervention, with an effect size of 0.9. The F‐DMSES is a valid and reliable self‐administered instrument that measures the diabetes management self‐efficacy of family‐carers of individuals with T2DM. This instrument can be used in practice and clinical trials to assess the impact of family‐carers on the health outcomes of individuals with T2DM.     

Utilising clinical settings to identify and respond to the social determinants of health of individuals with type 2 diabetes—A review of the literature

Type 2 diabetes (T2DM) is increasing in global prevalence. It is more common among people with poor social determinants of health (SDoH). Social determinants of health are typically considered at a population and community level; however, identifying and addressing the barriers related to SDoH at an individual and clinical level, could improve the self‐management of T2DM. This literature review aimed to explore the methods and strategies used in clinical settings to identify and address the SDoH in individuals with T2DM. A systematic search of peer‐reviewed literature using the electronic databases MEDLINE, CINAHL, Scopus and Informit was conducted between April and May 2017. Literature published between 2002 and 2017 was considered. Search results (n = 1,119) were screened by title and abstract against the inclusion and exclusion criteria and n = 56 were retained for full text screening. Nine studies met the inclusion criteria. Review and synthesis of the literature revealed written and phone surveys were the most commonly used strategy to identify social determinant‐related barriers to self‐management. Commonly known SDoH such as; income, employment, education, housing and social support were incorporated into the SDoH assessments. Limited strategies to address the identified social needs were revealed, however community health workers within the clinical team were the primary providers of social support. The review highlights the importance of identifying current and individually relevant social determinant‐related issues, and whether they are perceived as barriers to T2DM self‐management. Identifying self‐management barriers related to SDoH, and addressing these issues in clinical settings, could enable a more targeted intervention based on individually identified social need. Future research should investigate more specific ways to incorporate SDoH into the clinical management of T2DM.     

Challenges to developing diabetes self‐management skills in a low‐income sample in North Carolina,USA

High rates of diabetes diagnosis and poor diabetes outcomes are particularly significant in low‐income, socially disadvantaged populations. Although many social and economic predictors of poor self‐management outcomes are known, few studies have examined how these elements impact the ability to develop self‐management capacities in low‐income populations. This article presents new insights into low‐income women's challenges and successes to becoming more adept self‐managers. Interview data were collected in 2012 with a sample of low‐income, middle‐age women with type II diabetes recruited from a non‐profit medical clinic serving low‐income clients in North Carolina, United States. Data were analysed using a grounded theory approach. Developing self‐management skills within disadvantaged life contexts involved negotiating three related, overlapping sub‐processes: negotiating access to care systems, negotiating disruptions to diabetes self‐management patterns, and negotiating self‐care knowledge. Developing diabetes self‐management skills is a long and arduous process. Data and analysis presented here help explain how disadvantaged life contexts can impact self‐managers' efforts to develop self‐management skills and why continued support is important for reducing and preventing future problems. These initial findings suggest that future studies and intervention development on the topic are warranted.     

Supporting self‐management by Community Matrons through a group intervention; an action research study

The aim of this study was to examine the feasibility and impact of a group intervention by Community Matrons to support those living with multiple long‐terms conditions. Little evidence exists as to how the role of the Community Matron (CM) should be delivered to effectively enhance disease self‐management and levels of self‐efficacy for the service users. This qualitative participatory action research study explored the use of group work as a method of intervention by CMs. A purposive sample of 29 participants was recruited. Each patient group had 8–10 participants, led by a CM working in both the researcher and practitioner role, operating over 12‐month period. Data were collected by participant observation, researcher reflexive account and interviews. Grounded theory method was used to systematically analyse the data. Three main data categories emerged: (i) comparison by patients that leads to re‐motivation of the self; (ii) learning, leading to enhanced self‐management techniques, through storytelling and understanding of each other's experiences; and (iii) ownership that resulted in the self‐awareness, cognisance and insight into the role of the support group they were based in and how it benefited them. The core category of ‘Taking back the self – understanding the whole,’ conveyed the impact that this care delivery method had upon readjusting the balance of power between health professional and service users and its consequence in refreshing and improving their self‐management and the patients’ self‐efficacy. It was concluded that CM intervention using a model of group learning can lead to more effective and efficient support, through improving self‐efficacy and patients’ related self‐management ability.     

Self‐management abilities and quality of life among frail community‐dwelling individuals: the role of community nurses in the Netherlands

The objective of the study was to determine whether community nurses in the Netherlands improve self‐management abilities and quality of life of frail community‐dwelling people. This longitudinal study was performed in the context of a larger evaluation study of the ‘Zichtbare Schakels’(Visible Link) programme, conducted to determine the quality of care provided by community nurses to community‐dwelling frail people in Rotterdam, the Netherlands. For the current study, clients seen by community workers in Rotterdam between July 2013 and November 2014 participated. Data were gathered via personal interviews by the community nurses as part of care delivery at the start (T0; n = 220) and end of care delivery (T1; n = 111 – the remaining 109 clients were still receiving care) to evaluate and improve quality of care. We measured client's quality of life (using the EQ5D), self‐management abilities (using the Self‐Management Ability Scale) and background characteristics. Results showed that clients seen by the community nurses especially experience problems when it comes to usual activities and pain/discomfort. Furthermore, quality of life was much worse among clients of the community nurses (0.51) than among frail older (aged ≥70 years) people in Rotterdam (0.61), Dutch patients with chronic illnesses [CVD (0.83), COPD (0.79) or diabetes (0.83)] and older (aged ≥65 years) people who had recently been hospitalised (0.80). Significant improvements were seen in client's self‐management and quality of life over time. Self‐management abilities at T0 and changes in self‐management abilities (T1 – T0) clearly predicted quality of life at T1. Investing in community health nurses may be beneficial for the improvement of self‐management abilities and quality of life among very frail people in the community.     

The role of nutritional status in the relationship between diabetes and health-related quality of life

BACKGROUND/OBJECTIVESThe association between nutritional status and health-related quality of life (HRQoL) among patients with type 2 diabetes mellitus (T2DM) is not fully understood. This study was conducted to understand the role of nutritional status on HRQoL among people with and without T2DM.SUBJECTS/METHODSStructured survey and direct measurement of anthropometric data were conducted among people with and without T2DM. Nutritional status was measured with Mini Nutritional Assessment tool and HRQoL was measured with a 36-item Short Form Healthy Survey. Data collection was conducted in Chuncheon, South Korea with 756 participants who are older than 40 yrs of age.RESULTSThis study found that overall HRQoL were significantly lower in people with T2DM than people without T2DM after controlling for key covariates. When stratified by nutritional status, a greater degree of negative impact of T2DM on overall physical HRQoL was observed among well-nourished or at risk of malnutrition, whereas significant and more evident negative impact of diabetes on overall psychological HRQoL was observed only among malnourished.CONCLUSIONSThe study results suggest the role of nutritional status among people with T2DM on overall, especially psychological aspects of HRQoL. Future longitudinal or intervention studies are warranted to test the impact of nutritional status on HRQoL among people with T2DM.     

An evaluation of the effects of general practitioner–supported patient noncommunicable diseases control model in Shanghai,China

Noncommunicable diseases (NCDs) are the leading cause of death worldwide. A litmus test for China's health reform is its ability to effectively deal with NCDs. The general practitioners (GPs)–supported NCD control model was designed to address ways to effectively prevent and control NCDs population‐wide. This study aimed to evaluate the GPs‐supported NCD control model and its effect on China's NCD control. The model was structured with three layers of two‐way relationships between patients, GPs, and specialists. The four technologies included the community‐based NCD self‐management model, the electronic clinical‐pathways–supporting community NCD intervention, the largest regional independent medical information system engaged by the Shanghai Healthcare Cloud, and continuous and successive policy intervention. Under the influence of the model, hypertension awareness, treatment, and control were the highest in Shanghai. By 31 August 2017, 131 453 users declined to use the mobile application while 10 444 completed the type 2 diabetes mellitus (T2DM) risk assessment. By 15 August 2017, 249 000 residents had participated in early detection and screening, leading to the identification of 29 304 (11.8%) being in a prediabetic state and 24 422 (9.8%) being newly diagnosed with T2DM. From 2012 to 2016, 208 537 patients were newly identified with hypertension using Internet‐connected devices and hypertension awareness increased 5.7%. After implementing the self‐management interventions, patients' blood pressure was controlled at around 90% (from 2007 to 2015). This pilot model in Shanghai suggested positive social benefits and appears to have played an important role in advancing NCD control in China.     

Design and methods for a pilot randomized clinical trial involving exercise and behavioral activation to treat comorbid type 2 diabetes and major depressive disorder

Background

The comorbidity of type 2 diabetes mellitus (T2DM) and depression is associated with poor glycemic control. Exercise has been shown to improve mood and glycemic control, but individuals with comorbid T2DM and depression are disproportionately sedentary compared to the general population and report more difficulty with exercise. Behavioral activation, an evidence-based depression psychotherapy, was designed to help people with depression make gradual behavior changes, and may be helpful to build exercise adherence in sedentary populations. This pilot randomized clinical trial will test the feasibility of a group exercise program enhanced with behavioral activation strategies among women with comorbid T2DM and depression.

Methods/design

Sedentary women with inadequately controlled T2DM and depression (N = 60) will be randomly assigned to one of two conditions: exercise or usual care. Participants randomized to the exercise condition will attend 38 behavioral activation-enhanced group exercise classes over 24 weeks in addition to usual care. Participants randomized to the usual care condition will receive depression treatment referrals and print information on diabetes management via diet and physical activity. Assessments will occur at baseline and 3-, 6-, and 9-months following randomization. The goals of this pilot study are to demonstrate feasibility and intervention acceptability, estimate the resources and costs required to deliver the intervention and to estimate the standard deviation of continuous outcomes (e.g., depressive symptoms and glycosylated hemoglobin) in preparation for a fully-powered randomized clinical trial.

Discussion

A novel intervention that combines exercise and behavioral activation strategies could potentially improve glycemic control and mood in women with comorbid type 2 diabetes and depression.Trial registration: NCT01024790.     

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.     

Family Economic Hardship and Progression of Poor Mental Health in Middle‐Aged Husbands and Wives

Using prospective data from 370 middle‐aged husbands and wives during a 12‐year period, we investigated the intra‐individual and dyadic influence of family economic hardship on the levels of depressive symptoms of husbands and wives over their middle years. The results suggest that family economic hardship during the early middle years contributes to a subsequent increase in depressive symptoms of husbands and wives. Consistent with stress‐process theory, economic hardship influences depressive symptoms directly and indirectly through its influence on self‐esteem. The results also provided evidence for the scar hypothesis, which suggests that depression predicts subsequent level of self‐esteem and forms a reciprocal process between depressive symptoms and self‐esteem over time. In sum, for both husbands and wives, our findings showed that depressive symptoms progress over the middle years through a self‐perpetuating reciprocal process between self‐esteem and depression initiated by early family economic hardship and through cross‐spouse influences involving self‐esteem and depressive symptoms.     

The effectiveness of self‐care support interventions for children and young people with long‐term conditions: a systematic review

Children's health policy has highlighted the need to develop self‐care programmes. However, there is a lack of evidence on which to base the development of such programmes. This paper reviews the published research on the effectiveness of self‐care support interventions for children and young people with asthma, cystic fibrosis and diabetes. A systematic search was conducted of a range of electronic databases, supplemented by searching the reference lists of retrieved papers and published reviews. Retrieved studies were assessed against quality and eligibility criteria by two independent reviewers. The results were narratively synthesized to examine the effectiveness of self‐care support interventions on health status, psycho‐social well‐being, condition‐related knowledge, health service use and participant satisfaction. The search strategy identified 4261 papers which were screened against the review inclusion criteria. A total of 194 papers were assessed as being potentially eligible for inclusion with 15 papers being judged as adequate to include in the review. There is strong evidence of the effectiveness of interventions that target children/young people; use e‐health or group‐based methods; that are delivered in community settings. There is no evidence that interventions that focus on parents alone or are delivered only in hospital settings are effective. While there is some evidence to inform the development of self‐care support programmes, there is a need for well‐designed trials of interventions that are feasible to transfer into real‐life settings and which involve parents and children in their development.     

Correlates of Depressive Symptoms in Urban Youth at Risk for Type 2 Diabetes Mellitus

Background:  Rates of overweight in youth have increased at an alarming rate, particularly in minority youth, and depressive symptoms may affect the ability of youth to engage in healthy lifestyle behaviors to manage weight and reduce their risk for health problems. The purpose of this study was to examine the relationships between depressive symptoms, clinical risk factors, and health behaviors and attitudes in a sample of urban youth at risk for type 2 diabetes mellitus (T2DM).
Methods:  We obtained self-report questionnaire data on depressive symptoms and health attitudes and behaviors related to diet and exercise and clinical data on risk markers (eg, fasting insulin) from 198 youth from an urban setting. Seventh-grade students were eligible if they were at risk for developing T2DM because they had a body mass index (BMI) in the 85th percentile or higher and a family history of diabetes.
Results:  Clinically significant levels of depressive symptoms were evident in approximately 21% of the sample, and Hispanic youth reported higher levels of depressive symptoms than black youth. Higher levels of depression were associated with several health behaviors and attitudes, in particular less perceived support for physical activity and poorer self-efficacy for diet. Depressive symptoms were also related to some clinical risk markers, such as higher BMI and fasting insulin levels.
Conclusions:  Because depressive symptoms may affect ability to engage in healthy behavior changes, evaluation and treatment of depressive symptoms should be considered in preventive interventions for youth at risk for T2DM.     

Studying the Genetics of Complex Disease With Ancestry‐Specific Human Phenotype Networks: The Case of Type 2 Diabetes in East Asian Populations

Genome‐wide association studies (GWAS) have led to the discovery of over 200 single nucleotide polymorphisms (SNPs) associated with type 2 diabetes mellitus (T2DM). Additionally, East Asians develop T2DM at a higher rate, younger age, and lower body mass index than their European ancestry counterparts. The reason behind this occurrence remains elusive. With comprehensive searches through the National Human Genome Research Institute (NHGRI) GWAS catalog literature, we compiled a database of 2,800 ancestry‐specific SNPs associated with T2DM and 70 other related traits. Manual data extraction was necessary because the GWAS catalog reports statistics such as odds ratio and P‐value, but does not consistently include ancestry information. Currently, many statistics are derived by combining initial and replication samples from study populations of mixed ancestry. Analysis of all‐inclusive data can be misleading, as not all SNPs are transferable across diverse populations. We used ancestry data to construct ancestry‐specific human phenotype networks (HPN) centered on T2DM. Quantitative and visual analysis of network models reveal the genetic disparities between ancestry groups. Of the 27 phenotypes in the East Asian HPN, six phenotypes were unique to the network, revealing the underlying ancestry‐specific nature of some SNPs associated with T2DM. We studied the relationship between T2DM and five phenotypes unique to the East Asian HPN to generate new interaction hypotheses in a clinical context. The genetic differences found in our ancestry‐specific HPNs suggest different pathways are involved in the pathogenesis of T2DM among different populations. Our study underlines the importance of ancestry in the development of T2DM and its implications in pharmocogenetics and personalized medicine.     

Cost‐effectiveness of Occupational Therapy in Older People: Systematic Review of Randomized Controlled Trials

A systematic review of the cost‐effectiveness of occupational therapy for older people was conducted. MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library, OT seeker and unpublished trials registers were searched. Reference lists of all potentially eligible studies were searched with no language restrictions. We included trial‐based full economic evaluations that considered both costs and outcomes in occupational therapy for older people compared with standard care (i.e. other therapy) or no intervention. We reviewed each trial for methodological quality using the Cochrane risk of bias tool and assessed the quality of economic evaluations using a Drummond checklist. In the results of this review, we included five eligible studies (1–5) that were randomized controlled trials with high‐quality economic evaluation. Two studies were full economic evaluations of interventions for fall prevention (1 and 2); two studies were full economic evaluations of preventive occupational therapy interventions (3 and 4; one was a comparison of an occupational therapy group with a social work group); one study was a full economic evaluation of occupational therapy for individuals with dementia (5). Two of the studies (one was preventive occupational therapy [3] and the other was occupational therapy for dementia [5]) found a significant effect and confirmed the cost‐effectiveness of occupational therapy for older people compared with the control group. These studies found that occupational therapy for older people was clinically effective and cost‐effective in comparison with standard care or other therapies. With reference to their clinical implication, these intervention studies (using a client‐centred approach) suggested potentially cost‐effective means to motivate clients to maintain their own health. However, this review has limitations because of the high heterogeneity of the reviewed studies on full economic evaluations of occupational therapy for older people. Future studies on the cost‐effectiveness of occupational therapy in older people are strongly warranted. Copyright © 2015 John Wiley & Sons, Ltd.     

"For someone who's rich,it's not a problem". Insights from Tanzania on diabetes health-seeking and medical pluralism among Dar es Salaam's urban poor

The prevalence of chronic non-communicable disease, such as type 2 diabetes mellitus (T2DM), is rising worldwide. In Africa, T2DM is primarily affecting those living in urban areas and increasingly affecting the poor. Diabetes management among urban poor is an area of research that has received little attention. Based on ethnographic fieldwork in Dar es Salam, the causes and conditions for diabetes management in Tanzania have been examined. In this paper, we focus on the structural context of diabetes services in Tanzania; the current status of biomedical and ethnomedical health care; and health-seeking among people with T2DM. We demonstrate that although Tanzania is actively developing its diabetes services, many people with diabetes and low socioeconomic status are unable to engage continuously in treatment. There are many challenges to be addressed to support people accessing diabetes health care services and improve diabetes management.     

The role of collective efficacy in long‐term condition management: A metasynthesis

Social networks have been found to have a valuable role in supporting the management of long‐term conditions. However, the focus on the quality and how well self‐management interventions work focus on individualised behavioural outcomes such as self‐efficacy and there is a need for understanding that focuses on the role of wider collective processes in self‐management support. Collective efficacy presents a potentially useful candidate concept in the development and understanding of self‐management support interventions. To date it has mainly been utilised in the context of organisations and neighbourhoods related to social phenomena such as community cohesion. Drawing on Bandura's original theorisation this meta‐synthesis explores how studies of collective efficacy might illuminate collective elements operating within the personal communities of people with long‐term conditions. A qualitative meta‐synthesis was undertaken. Studies published between 1998 and 2018 that examined collective efficacy in relation to health and well‐being using qualitative and mixed methods was eligible for inclusion. Timing of engagement with others, building trust in the group, and legitimising ongoing engagement with the group arised as central elements of collective efficacy. The two themes forming third order constructs were related to the presence of continuous interaction and ongoing relational work between members of the group. Collective efficacy can develop and be sustained over time in a range of situations where individuals may not have intense relationships with one another and have limited commitment and contact with one another. Extending this to the personal communities of people with long‐term conditions it may be the case that collective efficacy enables a number of engagement opportunities which can be oriented towards assisting with support from networks over a sustained length of time. This may include negotiating acceptable connections to resources and activities which in turn may help change existing practice in ways that improve long‐term condition management.     

‘I’m on the train and I can't stop it': Western Canadians' reactions to prediabetes and the role of self‐compassion

Prediabetes, a condition characterised by impaired glucose regulation, is on the rise worldwide. This condition puts people at risk for cardiovascular disease, and 50% of people with prediabetes will develop type 2 diabetes (T2D). People with prediabetes can reduce their risk of developing T2D through lifestyle changes such as regular physical activity and healthy eating. However, the experience of health risks can be associated with negative reactions that can undermine people's ability to self‐regulate the health behaviours that would reduce such risk. Self‐compassion, or treating oneself kindly in the face of challenge, is known to help people manage negative emotions and facilitate self‐regulation. Therefore, self‐compassion may be helpful for people with prediabetes who have to manage their health behaviours in the context of a health threat. The purpose of this study was to explore how people, from a small Canadian city who learn that they have prediabetes, react emotionally to their prediabetes diagnosis. We also explored participants' receptivity to applying self‐compassion in the context of their prediabetes. Twenty‐one adults, recently notified by their doctors as having HbA1c scores indicative of prediabetes (M_age = 57.76, SD = 5.43), engaged in a semi‐structured interview between June 2017 and January 2018. Inductive thematic analysis was used to analyse the data and four themes emerged. Participants' reactions to learning that they had prediabetes were characterised by (a) distress and concern, (b) downplay of T2D risks, (c) guilt and shame, and participants were receptive to (d) self‐compassion as a beneficial approach to take in relation to their prediabetes. Findings suggest that people experience negative reactions to their prediabetes diagnosis yet are receptive to self‐compassion, which could mitigate these reactions. These findings can inform lifestyle behaviour change programmes for individuals living with prediabetes by providing a better understanding of their perspectives of disease diagnosis.     

5-HTTLPR moderates the relation between changes in depressive and bulimic symptoms in adolescent girls: a longitudinal study

Objective

Depression and bulimia both are associated with low serotonin levels. We examined whether the serotonin transporter gene (5‐HTTLPR) moderates the relation between depressive and bulimic symptoms over time.

Method

Fifty adolescent girls with no current or past Axis I disorder were genotyped for the 5‐HTTLPR gene. Twice, 6 months apart, participants completed self‐report measures of depressive symptoms and bulimic symptoms.

Results

The association between change in depressive symptoms and change in bulimic symptoms over time was significantly stronger in girls who are homozygous for the short 5‐HTTLPR allele than for girls with at least one long allele.

Discussion

This finding is consistent with previous studies documenting a relation between depressive and bulimic symptoms in adolescents. Few studies, however, considered the possible role of serotonin linking both disorders. Gaining a better understanding of developmental effects of low serotonin could help to identify high‐risk individuals and provide effective prevention and intervention. © 2010 by Wiley Periodicals, Inc. Int J Eat Disord 2011