Factors influencing patients' hypertension self-management and sustainable self-care practices: a qualitative study

Public Health ◽  
2019 ◽  
Vol 173 ◽  
pp. 5-8
Author(s):  
H. M. Yatim ◽  
Y.Y. Wong ◽  
C.F. Neoh ◽  
S.H. Lim ◽  
M.A. Hassali ◽  
...  
2017 ◽  
Vol 05 (02) ◽  
pp. 071-076 ◽  
Author(s):  
Saurav Basu ◽  
Suneela Garg

AbstractPatient adherence to recommended diabetes self-care practices reduces the risk of diabetic complications. However, most clinic-based approaches have proved inadequate in maintaining optimal diabetic self-management and the prevention of undesirable health outcomes at the population level among disadvantaged populations. Several sociocultural factors influence patient adherence to diabetic self-care practices which should be recognized and addressed by the health-care provider, especially in lower socioeconomic status and women patients. The lack of physician empathy and tendency to assign blame upon diabetic patients for the failure of adherence without recognizing the complex sociocultural factors influencing patient behavior can undermine the possibilities for better management. The enlistment of familial support when available is valuable for improving medical adherence and health outcomes in vulnerable diabetic patients with low health literacy. Young unmarried women with diabetes are particularly at risk of diabetes stigma eroding familial support and marital prospects require need effective health communication along with their family. Moreover, women with diabetes have a greater likelihood of compromising their dietary needs for the sake of their familial dietary preferences. The inability of patients to comply with recommended exercise regimen may be derived from environmental factors; primarily unsafe neighborhoods, lack of availability of nearby recreational facilities such as public parks, and cultural resistance in patriarchal social environments. Policy approaches for improving diabetes management in disadvantaged diabetic populations should consider mandatory registration, assured diabetic medication, and follow-up in case of missed appointments. Community mobilization for overcoming societal stigma against women with diabetes also persists as a formidable challenge.


Author(s):  
Amy L. Miko ◽  
Emily Berger ◽  
Govind Krishnamoorthy

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Katrien Danhieux ◽  
Veerle Buffel ◽  
Anthony Pairon ◽  
Asma Benkheil ◽  
Roy Remmen ◽  
...  

Abstract Background The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for next waves of the pandemic. Methods A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. Twenty-one people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM). Results Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated. Conclusion Our findings show a disruption of the delivery of chronic care in the Belgium prim care context. In such contexts, the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during next waves of the epidemic.


2016 ◽  
Vol Volume 11 ◽  
pp. 2977-2990 ◽  
Author(s):  
Yvonne Korpershoek ◽  
Sigrid CJM Vervoort ◽  
Lisa IT Nijssen ◽  
Jaap CA Trappenburg ◽  
Marieke J. Schuurmans

2014 ◽  
Vol 27 (4) ◽  
pp. 397-420 ◽  
Author(s):  
Cristiano Storni

Purpose – The purpose of this paper is to raise issues about the design of personal health record systems (PHRs) and self-monitoring technology supporting self-care practices of an increasing number of individuals dealing with the management of a chronic disease in everyday life. It discusses the results of an ethnographic study exposing to analysis the intricacies and practicalities of managing diabetes “in the wild”. It then describe and discuss the patient-centric design of a diabetes journaling platform that followed the analysis. Design/methodology/approach – The study includes ethnometodological investigation based on in depth interviews, observations in a support group for adults with type 1 diabetes, home visits, shadowing sessions and semi-structured interviews with a series of medical experts (endocrinologists, general practitioners and diabetes nurses). Findings informed the design of a proof-of-concept PHR called Tag-it-Yourself (TiY): a mobile journaling platform that enables the personalization of self-monitoring practices. The platform is thoroughly described along with an evaluation of its use with real users. Findings – The investigation sheds light on a series of general characters of everyday chronic self-care practices, and how they ask to re-think some of the assumptions and connotations of the current medical model and the traditional sick role of the patient – often unreflectively assumed also in the design of personal technologies (e.g. PHR) to be used by patients in clinically un-controlled settings. In particular, the analysis discusses: the ubiquitous nature of diabetes that is better seen as a lifestyle, the key role of lay expertises and different forms of knowledge developed by the patient in dealing with a disease on a daily basis, and the need of more symmetrical interactions and collaborations with the medical experts. Research limitations/implications – Reported discussions suggest the need of a more holistic view of self-management of chronic disease in everyday life with more attention being paid on the perspective of the affected individuals. Findings have potential implications on the way PHR and systems to support self-management of chronic disease in everyday life are conceived and designed. Practical implications – The paper suggests designers and policy makers to look at chronic disease not as a medical condition to be disciplined by a clinical perspective but rather as a complex life-style where the medical cannot be separated by other aspects of everyday life. Such shift in the perspective might suggest new forms of collaborations, new ways of creative evidence and new form of knowledge creation and validation in chronic self-care. Social implications – The paper suggests re-thinking the role of the patient in chronic-disease self-management. In particular, it suggests giving more room to the patient voice and concerns and suggest how these can enrich rather than complicate the generation of knowledge about self-care practices, at least in type 1 diabetes. Originality/value – The paper sheds light on everyday intricacies and practicalities of dealing with a chronic disease. Studies of self-care practices that shed light on the patient perspectives are sporadic and often assume a clinical perspective, its assumptions (e.g. biomedical knowledge is the only one available to improve health outcome, doctors know best) and implications (e.g. compliance, asymmetry between the specialist and the patient).


2020 ◽  
Vol 29 (3) ◽  
pp. 136-141
Author(s):  
Allyson L. Varley ◽  
Sunil Kripalani ◽  
Thomas Spain ◽  
Amanda S. Mixon ◽  
Erin Acord ◽  
...  

2019 ◽  
Author(s):  
Marilyn D Ritholz ◽  
Owen Henn ◽  
Astrid Atakov Castillo ◽  
Howard Wolpert ◽  
Stephanie Edwards ◽  
...  

BACKGROUND Adults with type 1 diabetes (PWDs) face challenging self-management regimens including monitoring their glucose values multiple times a day to assist with achieving glycemic targets and reduce the risk of long-term diabetes complications. Recent advances in diabetes technology have reportedly improved glycemia, but little is known about how PWDs utilize mobile technology to make positive changes in their diabetes self-management. OBJECTIVE The aim of this qualitative study was to explore PWDs’ experiences using Sugar Sleuth, a glucose sensor–based mobile app and Web-based reporting system, integrated with the FreeStyle Libre glucose monitor that provides feedback about glycemic variability. METHODS We used a qualitative descriptive research design and conducted semistructured interviews with 10 PWDs (baseline mean glycated hemoglobin, HbA1c) 8.0%, (SD 0.45); 6 males and 4 females, aged 52 years (SD 15), type 1 diabetes (T1D) duration 31 years (SD 13), 40% (4/10, insulin pump) following a 14-week intervention during which they received clinical support and used Sugar Sleuth to evaluate and understand their glucose data. Audio-recorded interviews were transcribed, coded, and analyzed using thematic analysis and NVivo 11 (QSR International Pty Ltd). RESULTS A total of 4 main themes emerged from the data. Participants perceived Sugar Sleuth as an Empowering Tool that served to inform lifestyle choices and diabetes self-management tasks, promoted preemptive self-care actions, and improved discussions with clinicians. They also described Sugar Sleuth as providing a Source of Psychosocial Support and offering relief from worry, reducing glycemic uncertainty, and supporting positive feelings about everyday life with diabetes. Participants varied in their Approaches to Glycemic Data: 40% (4/10) described using Sugar Sleuth to review data, understand glycemic cause and effect, and plan for future self-care. On the contrary, 60% (6/10) were reluctant to review past data; they described receiving benefits from the immediate numbers and trend arrows, but the app still prompted them to enter in the suspected causes of glucose excursions within hours of their occurrence. Finally, only 2 participants voiced Concerns About Use of Sugar Sleuth; they perceived the app as sometimes too demanding of information or as not attuned to the socioeconomic backgrounds of PWDs from diverse populations. CONCLUSIONS Results suggest that Sugar Sleuth can be an effective educational tool to enhance both patient-clinician collaboration and diabetes self-management. Findings also highlight the importance of exploring psychosocial and socioeconomic factors that may advance the understanding of PWDs’ individual differences when using glycemic technology and may promote the development of customized mobile tools to improve diabetes self-management.


Author(s):  
Arogundade, Toliah Abiodun ◽  
Salawu, Rasidi Akinade

Aims: Diabetes is a chronic non-communicable disease with many irreversible complications that can be prevented by strict adherence to self-care practice. This study aims to investigate the factors influencing adherence to self-care practices among diabetes patients Study Design: This study adopted a descriptive research design carried out among diabetes patients attending outpatient endocrinology clinic of Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State between July and September 2021. Methodology: Sample size was calculated using Cochran formula and total number of sample used were two hundred and eight (208) diabetes patients. Samples were selected using convenient sampling technique. A self-developed structured Questionnaire on knowledge of diabetes and factors influencing adherence to diabetes self-care practices with reliability index of 0.858 and 0.863 respectively. Two (2) adapted questionnaire; Diabetes self-care practices by Schmitt et al (2013) and Level of adherence to self-care practices scale by Morisky et al. (1986) with reliability index of 0.731 and 0.851 respectively were also used for data collection. Data collected were analyzed using descriptive statistics of frequency, percentage, mean and standard deviation while inferential statistics of Pearson product moment correlation and regression were used to test stated hypotheses at 0.05 level of significance. Results: The result from the study revealed good knowledge of diabetes mellitus and diabetes self-care practices among the respondents. The results also revealed high level of adherence to diabetes medication, diet, physical activity, blood glucose testing, follow-up and foot care. Factors influencing the level of adherence with diabetes self-care practices include cost of treatment, longer year of being diagnosed, good relationship between healthcare team, level of education, good family and social support. There is also a significant relationship between knowledge of diabetes mellitus and adherence with physical activity (r = 0.210; P = 0.02) and blood glucose testing (r = 0.203; P = 0.003). However, there is no significant relationship between knowledge of self-care practices and adherence to self-care practices; socio-demographic characteristics of age (r = -0.040; P = 0.568), education (r = 0.112; P = 0.107) and adherence to self-care practices. Conclusion: The study concluded that there was high level of knowledge about diabetes and diabetes self-care practices as well as adherence to diabetes self-care practices, therefore, health care providers should continue to monitor self-care practices among diabetes patients to achieve positive health outcome and reduce morbidity and mortality associated with diabetes mellitus.


2020 ◽  
Author(s):  
Katrien Danhieux ◽  
Veerle Buffel ◽  
Anthony Pairon ◽  
Asma Benkheil ◽  
Roy Remmen ◽  
...  

Abstract Background. The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for a second wave or flare-ups of the pandemic.Methods. A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. 21 people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM).Results. Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated.Conclusion: Our findings show the delivery of chronic care as disrupted. It indicates that the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during a second wave or in flare-ups.


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