Gender influences beliefs about health and illness in diabetic subjects with severe foot lesions

BACKGROUND: No studies have been found regarding beliefs about health and illness in patients with diabetic foot ulcers investigated from a patient perspective. Beliefs might affect self-care and health. AIM: To explore beliefs about health and illness among patients with severe diabetic foot lesions that might affect self-care practice and care-seeking behaviour. METHOD: The study design was explorative. A purposive sampling procedure was used. Focus group interviews were held, with 10 women and 11 men under 65 years (working age) and six women and 12 men over 65 years (range 23-83 years) with present or previous diabetic foot lesions managed at a specialized multidisciplinary diabetic foot clinic. FINDINGS: Foot problems were perceived by participants as caused by both external and internal factors related to the individual. Self-care was practised to restore health when ill and in daily foot care. When help was needed it was sought in the professional sector. Women were active in self-care and preventive care, searched for information and tried to adapt to the situation. Men more often sought help for acute problems, discussed more foot-related problems, had a pessimistic view of the future, showed a passive attitude, accepted information given and used more complementary care from the lay sector (wife) and/or the professional sector (district nurse, home care staff, podiatrist). Foot lesions caused deterioration of perceived health and quality of life due to decreased ability to be active. CONCLUSION: The present study emphasizes the need to take into account the existence of different beliefs about health and illness, especially regarding gender, in the prevention and management of the diabetic foot.     

Perceptions of psychiatric care among foreign- and Swedish-born people with psychotic disorders

AIM: This paper is a report of a study to explore different perceptions of psychiatric care among foreign- and Swedish-born people with psychotic disorders. BACKGROUND: Research from different countries reports a high-incidence of psychosis among migrants. The risk-factors discussed are social disadvantages in the new country. To understand and meet the needs of people from different countries, their perspective of psychiatric care must be illuminated and taken into consideration. METHOD: A phenomenographic study was conducted in 2005-2006 using semi-structured interviews with a convenience sample of 12 foreign-born people and 10 Swedish-born people with psychosis. FINDINGS: Three categories were identified: personal and family involvement in care; relating to healthcare staff; and managing illness and everyday life. Foreign-born people differed from Swedish-born people in that they struggled to attain an everyday life in Sweden, relied on healthcare staff as experts in making decisions, and had religious beliefs about mental illness. Among Swedish-born people, the need for more support to relatives and help to perform recreational activities was important. CONCLUSION: It is important to identify individual perceptions and needs, which may be influenced by cultural origins, when caring for patients with psychosis. Previous experience of care, different ways of relating to staff, and individual needs should be identified and met with respect. Social needs should not be medicalized but taken into consideration when planning care, which illustrates the importance of multi-professional co-operation.     

The nursing care towards individuals with diabetic foot: a phenomenological focus

The starting point of this study stands on the experiences shared with individuals presenting diabetes mellitus. The existential phenomenology of Martin Heidegger allowed the apprehension of the moments lived by these individuals. Interviews were performed, at their home, with eight people living in Bandeirantes, a city situated in the North of Paraná, and who had had a podological complication due to the disease, in the period from February to August of 2007. The study aimed to comprehend their experiences when dealing with a podological complication in their being in the world. In order to study the language of the subjects, the following guiding question was employed: What is it like, for you, to live with a podological complication developed due to your diabetes mellitus? From the language of the subjects, the following theme emerged: The being (Dosein) and the unauthentic care. The obtained results showed the importance to offer a holistic care to the being who experiences this situation, since the care subjectivity is often absorbed by the massification of the institutional norms and rules.     

Beliefs about health and illness essential for self-care practice: a comparison of migrant Yugoslavian and Swedish diabetic females

In a multicultural society the frequency of contact with migrant diabetic individuals will increase, as well as the need for knowledge about their beliefs about health and illness, which have rarely been studied. The aim of the present study was to explore beliefs about health and illness among migrant Yugoslavian and Swedish diabetic subjects that might affect their self-reported self-care practices and care-seeking behaviours. The study design was explorative, and a purposive sampling procedure was used. Fifteen females born in Sweden and 13 in former Yugoslavia, aged 33-73 years, with previously known diabetes mellitus were recruited from primary health care centres in southern Sweden. Median time of residence in Sweden was 5 years (range 2-30 years). Eight of the Yugoslavians had their diabetes diagnosed in Sweden. Focus-group interviews including scenarios of common problems related to diabetes mellitus were held. Yugoslavian females in general gave less tangible examples concerning beliefs about health and illness. Yugoslavians were orientated towards feelings related to their migratory experiences, enjoyed life by making deviations from dietary advice and retaining former traditions, and were less inclined towards self-monitoring and preventive foot care. They also expressed a passive role, depending on health care personnel, and discussed the influence of supernatural forces. Swedes expressed themselves in terms of medicine and a healthy lifestyle, took active part in their self-care and let self-monitoring guide their actions. Self-care was mainly practised to restore health when ill in both groups, and when help was needed it was sought in the professional sector (nurse or physician). Yugoslavians expressed higher confidence in physicians and used more natural cure medicine, side by side with biomedicine, while Swedes more frequently used alternative medicine. Demonstrated dissimilarities illustrate that beliefs about health and illness differ between migrant Yugoslavian and Swedish diabetic individuals, and are essential for self-care practice and care-seeking behaviour and must be considered when planning diabetes care.     

Quasi-experimental comparison of coercive interventions on client outcomes in individuals with severe and persistent mental illness

This study compares outpatient commitment (OPC) and Assertive Community Treatment (ACT) as forms of coercive treatment interventions to evaluate the influence of each individually and in combination on clients' perception of procedural justice and coercion, as well as clinical outcomes that include treatment compliance, quality of life, symptom distress, empowerment, and violence/victimization. Findings support that the perception of procedural justice and coercion are inversely related; persons subject to OPC experience higher levels of perceived coercion, and higher levels of perceived coercion do not influence treatment compliance. ACT alone does not increase the perception of coercion nor is there any interaction effect.     

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.     

The high prevalence of poor physical health and unhealthy lifestyle behaviours in individuals with severe mental illness

Recent mental health care policy has addressed the need for health care professionals to consider the physical health of consumers. Mental health nurses are particularly well-placed for this role. To provide mental health nurses with practical information, this narrative review summarises evidence from recent research on the physical health of individuals with Serious Mental Illness (SMI). In those with SMI, the international prevalence of obesity, the metabolic syndrome, diabetes mellitus, symptoms of cardiovascular disease, and respiratory disease all exceed that of the general population by at least two times, and HIV prevalence may be increased by as much as eight times. This increased prevalence of chronic disease may be largely responsible for an increased risk of death of up to five times, resulting in as much as 30 years of potential life lost. Of particular concern, the recent evidence suggests that for physical health and increased mortality, the gap between individuals with SMI and the general population is worsening. Unhealthy lifestyle behaviours undoubtedly play a role in the development of poor physical health and chronic disease, and the present review indicates that low physical activity, poor diet, smoking, alcohol and substance abuse, and risky sexual behaviour are common in individuals with SMI. This narrative review demonstrates that the prevalence of poor physical health and health behaviours in people with SMI far exceed that observed in the general population, and reinforces the urgent need for mental health nurses to address physical health concerns in patients.     

Gaps in health care for the somatic health of outpatients with severe mental illness

The physical health of outpatients with severe mental illness (SMI) can be improved by changes in the health‐care system. Analysis of current practice is necessary to develop these strategies. We compared the number of somatic health problems of outpatients with SMI with the frequency of consulting a general practitioner (GP). This was a cross‐sectional study based on interviews, and records from the GP and the pharmacy. We checked whether Dutch community pharmacies had complete and correct information about the patients' medication. We observed that all patients (n = 118) had somatic problems in need of clinical attention. Patients who visited their GP less than once a year (35%, n = 42), had a mean of 2.8 somatic health problems. This was less than patients who consulted their GP more than once a year (P ≤ 0.01). In 37% of cases, the pharmacy did not have adequate information on the drug use. Many patients with SMI seemed to have insufficient contact with their GP for their somatic health problems. Insufficient information about the patients' medication suggested that the pharmacist and GP should increase exchange of information. Mental health nurses can take a lead in coordinating the care to improve somatic health for their patients.     

Training practice nurses to improve the physical health of patients with severe mental illness: effects on beliefs and attitudes

Annual health checks are recommended for patients with severe mental illness (SMI) as they are at high risk of cardiovascular disease. Ideally, these health checks should be carried out in primary care. Practice nurses are already competent in carrying out physical health checks, but might have misconceptions about mental illness, which is a barrier to offering the service. We used a mirror imaging study to establish the effectiveness of a training package for practice nurses that aims to address common misconceptions about the physical health of people with SMI. This 2-hour training package (Northampton Physical Health and Wellbeing Project) was delivered to eight practice nurses. Their misconceptions and beliefs were assessed before and after training. Motivation to work with community mental health workers was assessed after training. The practice nurses involved in the study rejected commonly held misconceptions about the physical health of people with SMI after training. Their attitudes towards their role in providing health checks appeared to be modified in a positive direction. Their motivation to work with community mental health workers also seemed to be enhanced. The Northampton Physical Health and Wellbeing Project training was effective in modifying practice nurses' misconceptions about physical health in people with SMI.     

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.     

Improving the physical health of people with severe mental illness: Boundaries of care provision

There is compelling evidence that the physical health of people with severe mental illness is poor. Health‐promotion guidelines have been recommended as a mechanism for improving the physical health of this population. However, there are significant barriers to the adoption of evidence‐based guidelines in practice. The purpose of this research was to apply existing implementation theories to examine the capability of the health system to integrate physical health promotion into mental health service delivery. Data were collected within a regional city in Queensland, Australia. Fifty participants were interviewed. The core theme that emerged from the data was that of ‘care boundaries’ that influenced the likelihood of guidelines being implemented. Boundaries existed around the illness, care provision processes, sectors, the health‐care system, and society. These multilevel boundaries, combined with participants' ways of responding to them, impacted on capability (i.e. the ability to integrate physical health promotion into existing practices). Participants who were able to identify strategies to mediate these boundaries were better positioned to engage with physical health‐promotion practice. Thus, the implementation of evidence‐based guidelines depended heavily on the capability of the workforce to develop and adopt boundary‐mediating strategies.     

Increasing expenditure on health care incurred by diabetic subjects in a developing country: a study from India

OBJECTIVE: This study aimed to assess the direct cost incurred by diabetic subjects who were in different income groups in urban and rural India, as well as to examine the changing trends of costs in the urban setting from 1998 to 2005. RESEARCH DESIGN AND METHODS: A total of 556 diabetic subjects from various urban and rural regions of seven Indian states were enrolled. A brief uniform coded questionnaire (24 items) on direct cost was used. RESULTS: Annual family income was higher in urban subjects (rupees [Rs] 100,000 or $2,273) than in the rural subjects (Rs 36,000 or $818) (P < 0.001). Total median expenditure on health care was Rs 10,000 ($227) in urban and Rs 6,260 ($142) in rural (P < 0.001) subjects. Treatment costs increased with duration of diabetes, presence of complications, hospitalization, surgery, insulin therapy, and urban setting. Lower-income groups spent a higher proportion of their income on diabetes care (urban poor 34% and rural poor 27%). After accounting for inflation, a secular increase of 113% was observed in the total expenses between 1998 and 2005 in the urban population. The highest increase in percentage of household income devoted to diabetes care was in the lowest economic group (34% of income in 1998 vs. 24.5% in 2005) (P < 0.01). There was a significant improvement in urban subjects in medical reimbursement from 2% (1998) to 21.3% (2005). CONCLUSIONS: Urban and rural diabetic subjects spend a large percentage of income on diabetes management. The economic burden on urban families in developing countries is rising, and the total direct cost has doubled from 1998 to 2005.     

The influence of mothers' health beliefs on use of preventive child health care services and mothers' perception of children's health status

During the first three years of life, many health problems are preventable, and health maintenance visits present an excellent opportunity to prevent disease and disability. Unfortunately, preventive child health care services are underutilized. Children who do not adequately use preventive health care services are often seen late in the course of an illness. Thus, they do not receive the continuing care that could eliminate the onset of preventable health problems. In our research, we sought to determine whether mothers' health beliefs influence their use of preventive child health care services and whether their use of preventive child health care services influence their perceptions of the child's health status. The sample was composed of low-income mothers living in an urban environment. No significant relationships were found between the variables. These results indicate the need to develop more sensitive tools to measure these variables in a similar sample.