scholarly journals Proposal of an integrative model of adjustment to chronic conditions: An understanding of the process of psychosocial adjustment to living with type 2 diabetes

2016 ◽  
Vol 23 (8) ◽  
pp. 1063-1074 ◽  
Author(s):  
Lis D Hammond ◽  
Sarah Hirst-Winthrop
Keyword(s):  
Type 2 Diabetes ◽  
Grounded Theory ◽  
Focus Groups ◽  
Psychosocial Adjustment ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Personal Narratives ◽  
Integrative Model ◽  
Individual Interviews

Psychosocial adjustment to living with a chronic condition was explored in this grounded theory study, focusing on type 2 diabetes. Despite a range of relevant theories, there is limited understanding of the process of adjustment. The study aimed to address this issue. That was achieved through collecting and analysing personal narratives using individual interviews and focus groups. This allowed for the development of a normative integrative model of adjustment to chronic conditions based on biopsychosocial principles. The integrative model of adjustment to chronic condition has the potential to lead to improved understanding of adjustment processes.

scholarly journals Validation of the integrative model of adjustment to chronic conditions: Applicability to adult-onset epilepsy

2019 ◽  
Vol 6 (2) ◽  
pp. 205510291988429 ◽  
Author(s):  
LD Hammond ◽  
AP Farrington ◽  
S Kılınç
Keyword(s):  
Psychosocial Adjustment ◽  
Chronic Conditions ◽  
Phenomenological Study ◽  
Clinical Intervention ◽  
Integrative Model ◽  
Adult Onset ◽  
Framework Analysis ◽  
Original Contribution ◽  
Further Development

Adapting to life with adult-onset epilepsy is a challenge and there is a need for better interventions to support people, who have difficulty with psychosocial adjustment to the condition. The integrative model of adjustment to chronic conditions was developed for type 2 diabetes. This study aimed to demonstrate the applicability of the model to adult-onset epilepsy and thus make an original contribution to the development of relevant interventions. Qualitative data from a previous phenomenological study on the experience of adult-onset epilepsy were mapped onto the integrative model of adjustment to chronic conditions using framework analysis. Ten of the original 39 datasets were selected. All 10 datasets were from females diagnosed with epilepsy within 5 years before participation in the original study. The results demonstrated applicability of the integrative model of adjustment to chronic conditions after minor revisions to the model. These findings support further development of the integrative model of adjustment to chronic conditions for use as a clinical intervention for people with adult-onset epilepsy.

scholarly journals Medication as Infrastructure: Decentring Self-care

2012 ◽  
Vol 4 (3) ◽  
pp. 513-532 ◽  
Author(s):  
Peter Danholt ◽  
Henriette Langstrup
Keyword(s):  
Type 2 Diabetes ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Science And Technology Studies ◽  
Daily Life ◽  
Self Care ◽  
The Self ◽  
Healthcare It ◽  
Is Management

Drawing on science and technology studies (STS), and specifically the concept of infrastructure as conceptualised by Bowker and Star (2000; Star 1999), this paper argues and empirically demonstrates that self-care may be considered a practice that is thoroughly sociotechnical, material, distributed and de-centred. Comparing the practices related to medication in the treatment of asthma, type 2 diabetes and haemophilia, we show that in practice there is no ’self’ in self-care. More specifically, the ’self’ in self-care is an actor who is highly dependent on, and intertwined with infrastructures of care, in order to be self-caring. Infrastructures of care are the more or less embedded ’tracks’ along which care may ’run’, shaping and being shaped by actors and settings along the way. Obtaining prescriptions, going to the pharmacy, bringing medication home and administering it as parts of daily life are commonplace activities embedded in the fabric of life, especially for those living with a chronic condition. However, this procurement and emplacement of medication involves the establishment and ongoing enactment of infrastructures of care, that is, the connections between various actors and locations that establish caring spaces and caring selves. Locations and actors are included as allies in treating chronic conditions outside the clinical setting, but these infrastructures may also be ambiguous, with respect to their effects; they may simultaneously contribute to the condition’s management and neglect. Particularly precarious is management at the fringes of healthcare infrastructure, where allies, routines and general predictability are scarce. We conclude by arguing that these insights may induce a greater sensitivity to existing infrastructures and practices, when seeking to introduce new infrastructures of care, such as those promoted under the headings of ’telemedicine’ and ’healthcare IT’.

Relationship between medication adherence and psychosocial adjustment in patients with type 2 diabetes: A cross-sectional study

2020 ◽  
Vol 40 (3) ◽  
pp. 116-122
Author(s):  
Duygu Kes ◽  
Feray Gökdoğan
Keyword(s):  
Type 2 Diabetes ◽  
Psychosocial Adjustment ◽  
Large City ◽  
Psychosocial Care ◽  
Self Report ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Adherence To Medication ◽  
The Relationship

Adherence to drug treatment is a multidimensional concept. It is affected by many factors, such as physiological, psychological, family, environmental and social conditions. However, relatively little is known about the relationship between adherence to medication and psychosocial adjustment. The aim was to explore the relationship between adherence to antidiabetic drugs and the psychosocial adjustment of patients with type 2 diabetes mellitus. This cross-sectional descriptive correlational study was conducted between March and June 2018. A convenience sample of participants was recruited from seven internal disease outpatient clinics at a public tertiary hospital, located in a large city that serves as a gateway to nearby rural and urban areas in the north-west region of Turkey. Data were collected using the Adherence to Refills and Medications Scale (ARMS-7), and the Psychosocial Adjustment to Illness Scale–Self Report (PAIS–SR). This study is reported in accordance with STROBE. Pearson’s correlation analysis found a significant weak positive correlation between all domains of the PAIS–SR and the total scores on the ARMS‐7. The participants’ scores on medication refill were found to be significantly and positively correlated with all of the PAIS–SR domain scores except the sexual relationships domain. Psychosocial care could play a crucial role in improving drug regimen adherence among patients with diabetes. Therefore, nurses should integrate psychosocial care into daily practice.

scholarly journals Medication understanding and health literacy among patients with multiple chronic conditions: a study conducted in Bangladesh

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Fahad Imtiaz Rahman ◽  
Farina Aziz ◽  
Sumaiya Huque ◽  
Sadia Afruz Ether
Keyword(s):  
Health Literacy ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Healthcare Providers ◽  
Poor Health ◽  
Multiple Chronic Conditions ◽  
Multiple Chronic Condition ◽  
Convenience Sample ◽  
Individual Interviews ◽  
Reduce Medication Error

Objectives: Medication understanding is critical for patients who suffer from multiple chronic conditions in order to reduce medication error and is often associated with poor health outcomesand low adherence. This study aims to identify the gap of medication knowledge among multiple chronic condition patients in Bangladesh, in order to aid physicians and other healthcare providers in improving health literacy.Methods: Individual interviews of a convenience sample of multiple chronic condition patients in Bangladesh were heldwhere they were asked a number of questions for assessing medication related literacy.Results: More than 26% patients failed to cite the brand name of all their prescribed medications while the rate of patients not knowing the generic names was far worse (88.1%). Nearly 1 out of every 4 patients did not know the purpose of all their medications and more than half of the participants (55%) did not know the strengths of their drugs. While knowledge about medication routes and regimen was satisfactory, awareness regarding risk factors of medicine was lowest of all. Only 1 out of every 4 patients had a habit of reading drug information leaflet. Patient’s ability to correctly state the purpose of their medication seemed to be positively associated with age (p=0.004) and negatively associated with number of medicines taken (p=0.03).Conclusions: Many patients demonstrated poor health literacy regarding medication. Routine review of medications from physician or health provider can significantly improve their health literacy, leading to better treatment outcome and medication adherence.

scholarly journals User Experience and Potential Health Effects of a Conversational Agent-Based Electronic Health Intervention: Protocol for an Observational Cohort Study

10.2196/16641 ◽  
2020 ◽  
Vol 9 (4) ◽  
pp. e16641
Author(s):  
Marian Z M Hurmuz ◽  
Stephanie M Jansen-Kosterink ◽  
Harm op den Akker ◽  
Hermie J Hermens
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Chronic Pain ◽  
User Experience ◽  
Chronic Conditions ◽  
Healthy Lifestyle ◽  
Observational Cohort Study ◽  
Potential Health ◽  
Observational Cohort

Background While the average human life expectancy has increased remarkably, the length of life with chronic conditions has also increased. To limit the occurrence of chronic conditions and comorbidities, it is important to adopt a healthy lifestyle. Within the European project “Council of Coaches,” a personalized coaching platform was developed that supports developing and maintaining a healthy lifestyle. Objective The primary aim of this study is to assess the user experience with and the use and potential health effects of a fully working Council of Coaches system implemented in a real-world setting among the target population, specifically older adults or adults with type 2 diabetes mellitus or chronic pain. Methods An observational cohort study with a pretest-posttest design will be conducted. The study population will be a dynamic cohort consisting of older adults, aged ≥55 years, as well as adults aged ≥18 years with type 2 diabetes mellitus or chronic pain. Each participant will interact in a fully automated manner with Council of Coaches for 5 to 9 weeks. The primary outcomes are user experience, use of the program, and potential effects (health-related factors). Secondary outcomes include demographics, applicability of the virtual coaches, and user interaction with the virtual coaches. Results Recruitment started in December 2019 and is conducted through mass mailing, snowball sampling, and advertisements in newspapers and social media. This study is expected to conclude in August 2020. Conclusions The results of this study will either confirm or reject the hypothesis that a group of virtual embodied conversational coaches can keep users engaged over several weeks of interaction and contribute to positive health outcomes. Trial Registration The Netherlands Trial Register: NL7911; https://www.trialregister.nl/trial/7911 International Registered Report Identifier (IRRID) PRR1-10.2196/16641

scholarly journals Healthcare utilisation and out-of-pocket expenditure of type 2 diabetes patients with and without comorbidity: A study in primary care in Bhubaneswar, India.

2020 ◽  
Author(s):  
Sandipana Pati ◽  
Subhashisa Swain ◽  
Marjan van den Akker ◽  
F. (François) G. Schellevis ◽  
Jako S. Burgers
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Chronic Conditions ◽  
Healthcare Expenditure ◽  
Healthcare Utilisation ◽  
Comorbid Conditions ◽  
Healthcare Facilities ◽  
Number Of Visits ◽  
Diabetes Patients

Abstract Background: Globally, non-communicable diseases (NCD) demand a higher healthcare expenditure. Amongst the NCDs, diabetes mellitus, is often associated with multiple, co-existing chronic conditions. In low- and middle-income countries where most of the healthcare expenditure is borne out of pocket, diabetes management may pose a significant financial stress.Methods: A cross-sectional study was conducted in 17 urban primary healthcare facilities of Bhubaneswar to assess the healthcare utilisation and out-of-pocket expenditure among type 2 diabetes patients attending these facilities. Healthcare utilisation was determined by the number of visits to healthcare facilities in the last six months, and out-of-pocket expenditure was assessed by outpatient consultation fees, medicines, travels to health care facilities and diagnostic tests. Total out-of-pocket expenditure was defined as the sum of these costs.Results: The median number of visits in 6 months for diabetes patients with any comorbidity was 4 and 5 for diabetes patients with more than 4 comorbidities. Among the comorbid conditions, depression, stroke, auditory impairment and acid peptic disease were associated with higher healthcare utilisation. The total out-of-pocket expense was 2.3 times higher among diabetes patients with any comorbid condition compared to patients with diabetes only. The total median expenditure was higher for diabetes patients having stroke, heart diseases, kidney diseases and cancer compared to other comorbid conditions. The association of comorbidity in diabetes patients with health care utilization and out-of-pocket expenditure is statistically significant after adjustment for sociodemographic characteristics and diabetes duration.Conclusion: Considerable expenditure is incurred by diabetes patients attending primary healthcare facilities for the management of diabetes and other chronic conditions. This is a significant burden for diabetes patients below the poverty line and with limited or no insurance cover. There is a need to increase the coverage of insurance schemes to address the chronic conditions management expenditure of outpatients.

scholarly journals Developing a Shared Patient-Centered, Web-Based Medication Platform for Type 2 Diabetes Patients and Their Health Care Providers: Qualitative Study on User Requirements (Preprint)

2017 ◽  
Author(s):  
Gerda Bernhard ◽  
Cornelia Mahler ◽  
Hanna Marita Seidling ◽  
Marion Stützle ◽  
Dominik Ose ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Self Management ◽  
Care Providers ◽  
Patient Centered ◽  
Web Based ◽  
Access Methods

BACKGROUND Information technology tools such as shared patient-centered, Web-based medication platforms hold promise to support safe medication use by strengthening patient participation, enhancing patients’ knowledge, helping patients to improve self-management of their medications, and improving communication on medications among patients and health care professionals (HCPs). However, the uptake of such platforms remains a challenge also due to inadequate user involvement in the development process. Employing a user-centered design (UCD) approach is therefore critical to ensure that user’ adoption is optimal. OBJECTIVE The purpose of this study was to identify what patients with type 2 diabetes mellitus (T2DM) and their HCPs regard necessary requirements in terms of functionalities and usability of a shared patient-centered, Web-based medication platform for patients with T2DM. METHODS This qualitative study included focus groups with purposeful samples of patients with T2DM (n=25), general practitioners (n=13), and health care assistants (n=10) recruited from regional health care settings in southwestern Germany. In total, 8 semistructured focus groups were conducted. Sessions were audio- and video-recorded, transcribed verbatim, and subjected to a computer-aided qualitative content analysis. RESULTS Appropriate security and access methods, supported data entry, printing, and sending information electronically, and tracking medication history were perceived as the essential functionalities. Although patients wanted automatic interaction checks and safety alerts, HCPs on the contrary were concerned that unspecific alerts confuse patients and lead to nonadherence. Furthermore, HCPs were opposed to patients’ ability to withhold or restrict access to information in the platform. To optimize usability, there was consensus among participants to display information in a structured, chronological format, to provide information in lay language, to use visual aids and customize information content, and align the platform to users’ workflow. CONCLUSIONS By employing a UCD, this study provides insight into the desired functionalities and usability of patients and HCPs regarding a shared patient-centered, Web-based medication platform, thus increasing the likelihood to achieve a functional and useful system. Substantial and ongoing engagement by all intended user groups is necessary to reconcile differences in requirements of patients and HCPs, especially regarding medication safety alerts and access control. Moreover, effective training of patients and HCPs on medication self-management (support) and optimal use of the tool will be a prerequisite to unfold the platform’s full potential.

scholarly journals Type 2 Diabetes Mellitus and COVID-19: A Narrative Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Salvatore Corrao ◽  
Karen Pinelli ◽  
Martina Vacca ◽  
Massimo Raspanti ◽  
Christiano Argano
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Severe Acute Respiratory Syndrome ◽  
Chronic Conditions ◽  
Narrative Review ◽  
Pathophysiological Mechanisms ◽  
Clinical Recommendations ◽  
Patients With Diabetes

The pandemic of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has involved more than one hundred million individuals, including more than two million deaths. Diabetes represents one of the most prevalent chronic conditions worldwide and significantly increases the risk of hospitalization and death in COVID-19 patients. In this review, we discuss the prevalence, the pathophysiological mechanisms, and the outcomes of COVID-19 infection in people with diabetes. We propose a rationale for using drugs prescribed in patients with diabetes and some pragmatic clinical recommendations to deal with COVID-19 in this kind of patient.

scholarly journals The Internal Realities of Individuals With Type 2 Diabetes: Mediators Influencing Self-Management Beliefs via Grounded Theory Approach

2020 ◽  
Vol 11 ◽  
pp. 215013271990071
Author(s):  
Yogarabindranath Swarna Nantha ◽  
Shamsul Haque ◽  
Azriel Abisheg Paul Chelliah ◽  
Anuar Zaini Md Zain ◽  
Gan Kim Yen
Keyword(s):  
Type 2 Diabetes ◽  
Grounded Theory ◽  
Management Practices ◽  
Primary Care Clinic ◽  
Self Management ◽  
Theory Approach ◽  
Care Clinic ◽  
Psychosocial Mediators ◽  
Grounded Theory Approach

Background: There has been an unabated rise in the prevalence of type 2 diabetes (T2D) worldwide. Although T2D is highly preventable, these trends suggest that a paradigm change is much needed in the way both clinicians and policy makers view what effective T2D strategies conventionally entail. Hence, it is becoming increasingly clear that T2D patients require more than just a pharmacological approach to their disease. Evidence indicate that culturally specific mediators can help foster better self-management practices. We intend to discover psychosocial mediators that influence and support self-management beliefs in T2D patients. Methods: We adopted the grounded theory approach to guide in-depth interviews with T2D patients and health care professionals (HCP) at a regional primary care clinic in Malaysia. Twenty-four T2D patients and 10 HCPs were recruited through purposive sampling method to examine the inner psychological narratives about how they perceive and what they believe beliefs about the disease. Two focus group discussions were also were conducted for data triangulation. Results: A functional framework for the psychosocial mediators influencing self-management beliefs in T2D patients was designed and characterized by 4 major processes: (1) health promotion, (2) personal expectations, (3) person-centered care, and (4) psychosocial support. The fulfillment of patients’ personal expectations is central to better self-management beliefs. Conclusions: Positive emotional states are important in providing a positive environment to nurture self-management practices. A person-centered consultation that focuses on empathy and cultural sensitivities has the potential to foster behavioral change required to sustain self-care practices.

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