Understanding Challenges, Strategies, and the Role of Support Networks in Medication Self-management Among Patients With Type 2 Diabetes

2017 ◽  
Vol 43 (2) ◽  
pp. 190-205 ◽  
Author(s):  
Gerda Bernhard ◽  
Dominik Ose ◽  
Ines Baudendistel ◽  
Hanna M. Seidling ◽  
Marion Stützle ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Support Networks ◽  
The Self ◽  
Self Management ◽  
Medication Regimen ◽  
Self Help ◽  
Self Help Groups

Purpose The purpose of this qualitative study was to investigate the challenges and strategies of patients with type 2 diabetes mellitus (T2DM) regarding daily management of their medication regimen focusing on the role of their support networks. Methods A purposeful sample of 25 patients with T2DM was recruited from local self-help groups, general practitioner practices, and a university hospital in southwestern Germany. Four semi-structured focus groups were conducted to identify the challenges patients experienced, the strategies they used, and their collaboration with support networks to assist them in self-managing their medication regimen. Sessions were audio- and video-recorded, fully transcribed, and subjected to computer-aided qualitative content analysis, guided by the Self- and Family Management Framework (SFMF). Results Patients with T2DM experienced numerous challenges affecting medication self-management arising from their personal situation, health status and resources, characteristics of their regimen, and how health care is currently organized. Patients’ self-initiated strategies included activating health care, community, social, and online resources; taking ownership of medication-related needs; and integrating medication-taking into daily life. Patients drew on self-help groups, family, and friends to discuss concerns regarding medication safety and receive experience-based information and advice for navigating within the health care system as well as practical hands-on support with daily medication self-management. Conclusions Understanding the challenges and building on strategies patients with T2DM devised help diabetes educators to better address patients’ needs and priorities and guide patient-centered interventions to support patients’ self-management activities. Community and social support networks operating in patients’ lives need to be engaged in the self-management support.

The Role of Digital Engagement in the Self-Management of Type 2 Diabetes

2016 ◽  
Vol 31 (12) ◽  
pp. 1557-1565 ◽  
Author(s):  
Sora Park ◽  
Sally Burford ◽  
Christopher Nolan ◽  
Leif Hanlen
Keyword(s):  
Type 2 Diabetes ◽  
The Self ◽  
Self Management ◽  
Digital Engagement

scholarly journals Using the Self-Management Assessment Scale for Screening Support Needs in Type 2 Diabetes: Qualitative Study (Preprint)

2019 ◽  
Author(s):  
Ulrika Öberg ◽  
Carl Johan Orre ◽  
Åsa Hörnsten ◽  
Lena Jutterström ◽  
Ulf Isaksson
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Primary Health Care ◽  
Qualitative Study ◽  
Screening Instrument ◽  
The Self ◽  
Self Management ◽  
Management Support ◽  
Primary Health

BACKGROUND Globally, most countries face a common challenge by moving toward a population-based structure with an increasing number of older people living with chronic conditions such as type 2 diabetes. This creates a considerable burden on health care services. The use of digital tools to tackle health care challenges established views on traditional nursing, based on face-to-face meetings. Self-management is considered a key component of chronic care and can be defined as management of the day-to-day impact of a condition, something that is often a lifelong task. The use of a screening instrument, such as the Self-Management Assessment Scale (SMASc), offers the potential to guide primary health care nurses into person-centered self-management support, which in turn can help people strengthen their empowerment and self-management capabilities. However, research on self-management screening instruments is sparse, and no research on nurses’ experiences using a digitalized scale for measuring patients’ needs for self-management support in primary health care settings has been found. OBJECTIVE This paper describes diabetes specialist nurses’ (DSNs) experiences of a pilot implementation of the SMASc instrument as the basis for person-centered digital self-management support. METHODS This qualitative study is based on observations and interviews analyzed using qualitative content analysis. RESULTS From the perspectives of DSNs, the SMASc instrument offers insights that contribute to strengthened self-management support for people with type 2 diabetes by providing a new way of thinking and acting on the patient’s term. Furthermore, the SMASc was seen as a screening instrument with good potential that embraces more than medical issues; it contributed to strengthening person-centered self-management support, and the instrument was considered to lead both parts, that is, DSNs and patients, to develop together through collaboration. CONCLUSIONS Person-centered care is advocated as a model for good clinical practice; however, this is not always complied with. Screening instruments, such as the SMASc, may empower both nurses and patients with type 2 diabetes with more personalized care. Using a screening instrument in a patient meeting may also contribute to a role change in the work and practice of DSNs.

scholarly journals Application of the National Institute for Health and Care Excellence Evidence Standards Framework for Digital Health Technologies in Assessing Mobile-Delivered Technologies for the Self-Management of Type 2 Diabetes Mellitus: Scoping Review (Preprint)

2020 ◽  
Author(s):  
Jessica R Forsyth ◽  
Hannah Chase ◽  
Nia W Roberts ◽  
Laura C Armitage ◽  
Andrew J Farmer
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Type 2 Diabetes Mellitus ◽  
Digital Health ◽  
The Self ◽  
Self Management ◽  
Health Care Settings ◽  
Health Technologies

BACKGROUND There is a growing role of digital health technologies (DHTs) in the management of chronic health conditions, specifically type 2 diabetes. It is increasingly important that health technologies meet the evidence standards for health care settings. In 2019, the National Institute for Health and Care Excellence (NICE) published the <i>NICE Evidence Standards Framework for DHTs</i>. This provides guidance for evaluating the effectiveness and economic value of DHTs in health care settings in the United Kingdom. OBJECTIVE The aim of this study is to assess whether scientific articles on DHTs for the self-management of type 2 diabetes mellitus report the evidence suggested for implementation in clinical practice, as described in the <i>NICE Evidence Standards Framework for DHTs</i>. METHODS We performed a scoping review of published articles and searched 5 databases to identify systematic reviews and primary studies of mobile device–delivered DHTs that provide self-management support for adults with type 2 diabetes mellitus. The evidence reported within articles was assessed against standards described in the NICE framework. RESULTS The database search yielded 715 systematic reviews, of which, 45 were relevant and together included 59 eligible primary studies. Within these, there were 39 unique technologies. Using the NICE framework, 13 technologies met <i>best practice</i> standards, 3 met <i>minimum</i> standards only, and 23 technologies did not meet <i>minimum</i> standards. CONCLUSIONS On the assessment of peer-reviewed publications, over half of the identified DHTs did not appear to meet the minimum evidence standards recommended by the NICE framework. The most common reasons for studies of DHTs not meeting these evidence standards included the absence of a comparator group, no previous justification of sample size, no measurable improvement in condition-related outcomes, and a lack of statistical data analysis. This report provides information that will enable researchers and digital health developers to address these limitations when designing, delivering, and reporting digital health technology research in the future.

scholarly journals Using the Self-Management Assessment Scale for Screening Support Needs in Type 2 Diabetes: Qualitative Study

JMIR Nursing ◽  
10.2196/16318 ◽  
2020 ◽  
Vol 3 (1) ◽  
pp. e16318
Author(s):  
Ulrika Öberg ◽  
Carl Johan Orre ◽  
Åsa Hörnsten ◽  
Lena Jutterström ◽  
Ulf Isaksson
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Primary Health Care ◽  
Qualitative Study ◽  
Screening Instrument ◽  
The Self ◽  
Self Management ◽  
Management Support ◽  
Primary Health

Background Globally, most countries face a common challenge by moving toward a population-based structure with an increasing number of older people living with chronic conditions such as type 2 diabetes. This creates a considerable burden on health care services. The use of digital tools to tackle health care challenges established views on traditional nursing, based on face-to-face meetings. Self-management is considered a key component of chronic care and can be defined as management of the day-to-day impact of a condition, something that is often a lifelong task. The use of a screening instrument, such as the Self-Management Assessment Scale (SMASc), offers the potential to guide primary health care nurses into person-centered self-management support, which in turn can help people strengthen their empowerment and self-management capabilities. However, research on self-management screening instruments is sparse, and no research on nurses’ experiences using a digitalized scale for measuring patients’ needs for self-management support in primary health care settings has been found. Objective This paper describes diabetes specialist nurses’ (DSNs) experiences of a pilot implementation of the SMASc instrument as the basis for person-centered digital self-management support. Methods This qualitative study is based on observations and interviews analyzed using qualitative content analysis. Results From the perspectives of DSNs, the SMASc instrument offers insights that contribute to strengthened self-management support for people with type 2 diabetes by providing a new way of thinking and acting on the patient’s term. Furthermore, the SMASc was seen as a screening instrument with good potential that embraces more than medical issues; it contributed to strengthening person-centered self-management support, and the instrument was considered to lead both parts, that is, DSNs and patients, to develop together through collaboration. Conclusions Person-centered care is advocated as a model for good clinical practice; however, this is not always complied with. Screening instruments, such as the SMASc, may empower both nurses and patients with type 2 diabetes with more personalized care. Using a screening instrument in a patient meeting may also contribute to a role change in the work and practice of DSNs.

scholarly journals Social Network Analysis of Support Exchanges on a Virtual Environment for Diabetes Self-Management Education and Support (Preprint)

2020 ◽  
Author(s):  
Carlos A Pérez-Aldana ◽  
Allison A Lewinski ◽  
Constance M Johnson ◽  
Allison Vorderstrasse ◽  
Sahiti Myneni
Keyword(s):  
Social Support ◽  
Type 2 Diabetes ◽  
Social Interactions ◽  
Virtual Environments ◽  
Virtual Communities ◽  
Management Education ◽  
Support Networks ◽  
Self Management ◽  
Instrumental Support

BACKGROUND Diabetes remains a major health problem in the US affecting an estimated 10.5% of the population. Diabetes self-management interventions improve diabetes knowledge, self-management behaviors, and metabolic control. Widespread Internet connectivity facilitates the use of eHealth interventions, which positively impacts knowledge, social support, clinical, and behavioral outcomes. Particularly, diabetes interventions based in virtual environments have the potential to improve diabetes self-efficacy and support while being highly feasible and usable. However, little is known about the pattern of social interactions and support taking place within type 2 diabetes-specific virtual communities. OBJECTIVE The objective of this study was to examine social support exchanges from a type 2 diabetes self-management education and support intervention that was delivered via a virtual environment (VE). METHODS Data comprised VE-meditated synchronous interactions among participants and between participants and providers from an intervention for type 2 diabetes self-management education and support. Network data derived from such social interactions were used to create networks to analyze patterns of social support exchange with the lens of social network analysis. Additionally, network correlations were used to explore associations between social support networks. RESULTS Findings reveal structural differences between support networks as well as key network characteristics of supportive interactions facilitated by the intervention. Emotional and appraisal support networks are the larger, most centralized, and most active networks, suggesting that virtual communities can be good sources for these types of support. In addition, appraisal and instrumental support networks are more connected, suggesting that members of virtual communities are more likely to engage in larger group interactions where these types of support can be exchanged. Lastly, network correlations suggest participants that exchanged emotional support are likely to exchange appraisal or instrumental support, and participants that exchanged appraisal support are likely to exchange instrumental support. CONCLUSIONS Social interaction patterns from disease-specific virtual environments can be studied using a social network analysis approach to better understand the exchange of social support. Network data can provide valuable insights into the design of novel and effective eHealth interventions given the unique opportunity virtual environments have facilitating realistic environments that are effective and sustainable where social interactions can be leveraged to achieve diverse health goals.

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