A solution-focused approach to understanding patient motivation in diabetes self-management: Gender differences and implications for primary care

Objective Healthcare providers often neglect to recognize the role they play in motivating patients with diabetes to perform self-management. Our aims were to understand what motivates patients with diabetes to implement recommended self-management practices and understand the role of the primary care team in patient motivation. Methods We use a solution-focused qualitative approach, supplemented with a quantitative scale. We used a purposive sampling strategy to invite patients with uncontrolled diabetes. Semi-structured telephone interviews were conducted and analyzed using content and thematic analysis. Results Key motivators were strong support systems that included family and friends, the physician’s communication style and message, fear of deterioration, and other intrinsic factors. Female family members were described as supportive; not all married women felt supported by their husbands. Women were more influenced by empathy and concern from their doctor, compared to men who were motivated by improved health literacy. Women with few family or friends were more disadvantaged, regardless of race/ethnicity. Discussion While physicians play a vital role in motivating their patients, female patients may depend on this empathy more than males. The interdisciplinary care team can play an important role in helping patients create a support network where it may not exist.

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Controlled trial of a collaborative primary care team model for patients with diabetes and depression: Rationale and design for a comprehensive evaluation

BMC Health Services Research ◽

10.1186/1472-6963-12-258 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 19

Author(s):

Jeffrey A Johnson ◽

Fatima Al Sayah ◽

Lisa Wozniak ◽

Sandra Rees ◽

Allison Soprovich ◽

...

Keyword(s):

Primary Care ◽

Comprehensive Evaluation ◽

Controlled Trial ◽

Care Team ◽

Primary Care Team ◽

Patients With Diabetes ◽

Team Model ◽

Collaborative Primary Care

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Impact of Motivational Interviewing on Self-Management in Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial (Preprint)

10.2196/preprints.15709 ◽

2019 ◽

Author(s):

Man Kin Wong ◽

Sai Yip Ronald Cheng ◽

Tsun Kit Chu ◽

Fung Yee Lam ◽

Shiu Kee Lai ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Health Behaviors ◽

Usual Care ◽

Diabetic Control ◽

Self Management ◽

Randomized Controlled ◽

Patients With Diabetes ◽

Care Outcomes

BACKGROUND The nonpharmacological approach to diabetic control in patients with diabetes focuses on a healthy diet, physical activity, and self-management. Therefore, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns and include brief advice and counseling services. Within this context, motivational interviewing (MI) has proven to be effective in changing health behaviors for specific cases. However, stronger evidence is needed on the effectiveness of MI in treating chronic pathologies such as diabetes. OBJECTIVE This study will obtain preliminary data on the impact of a nurse-led MI intervention in improving glycemic control, as well as clinical, psychosocial, and self-care outcomes for individuals with type 2 diabetes mellitus when compared with usual care, with the aim of improving diabetic control in patients with diabetes. METHODS An open, two-arm, parallel, randomized controlled, pilot exploratory trial will be performed. Two government outpatient clinics in the New Territories West Cluster in Hong Kong will be involved. In total, 20 to 25 participants will be invited in each arm. Intervention participants will receive face-to-face MI interventions in addition to their usual care from the clinic. Control participants will only receive usual care. Outcomes are assessed at baseline, 6 months, and 12 months. The primary outcome measure is glycated hemoglobin levels. Secondary outcomes include blood pressure, BMI, hip and waist circumference, fasting blood, and psychosocial and self-care measures. RESULTS This study is currently underway with funding support from the Hong Kong College of Family Physician Research Seed Fund 2017. CONCLUSIONS MI skills constitute the main strategies primary care nurses use on their patients. Having economical, simple, effective, and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of MI. It will be performed with strict control over the data collection, ensuring the maintenance of therapeutic integrity. CLINICALTRIAL Centre for Clinical Research and Biostatistics CUHK_CCRB00614; https://tinyurl.com/v9awzk6 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/15709

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Diabetes-Related Behavior Change Knowledge Transfer to Primary Care Practitioners and Patients: Implementation and Evaluation of a Digital Health Platform (Preprint)

10.2196/preprints.9629 ◽

2017 ◽

Author(s):

Samina Abidi ◽

Michael Vallis ◽

Helena Piccinini-Vallis ◽

Syed Ali Imran ◽

Syed Sibte Raza Abidi

Keyword(s):

Primary Care ◽

Health Care ◽

Clinical Practice ◽

Behavior Change ◽

Self Management ◽

Change Strategies ◽

Educational Support ◽

Behavior Change Interventions ◽

Patients With Diabetes ◽

Primary Care Practitioners

BACKGROUND Behavioral science is now being integrated into diabetes self-management interventions. However, the challenge that presents itself is how to translate these knowledge resources during care so that primary care practitioners can use them to offer evidence-informed behavior change support and diabetes management recommendations to patients with diabetes. OBJECTIVE The aim of this study was to develop and evaluate a computerized decision support platform called “Diabetes Web-Centric Information and Support Environment” (DWISE) that assists primary care practitioners in applying standardized behavior change strategies and clinical practice guidelines–based recommendations to an individual patient and empower the patient with the skills and knowledge required to self-manage their diabetes through planned, personalized, and pervasive behavior change strategies. METHODS A health care knowledge management approach is used to implement DWISE so that it features the following functionalities: (1) assessment of primary care practitioners’ readiness to administer validated behavior change interventions to patients with diabetes; (2) educational support for primary care practitioners to help them offer behavior change interventions to patients; (3) access to evidence-based material, such as the Canadian Diabetes Association’s (CDA) clinical practice guidelines, to primary care practitioners; (4) development of personalized patient self-management programs to help patients with diabetes achieve healthy behaviors to meet CDA targets for managing type 2 diabetes; (5) educational support for patients to help them achieve behavior change; and (6) monitoring of the patients’ progress to assess their adherence to the behavior change program and motivating them to ensure compliance with their program. DWISE offers these functionalities through an interactive Web-based interface to primary care practitioners, whereas the patient’s self-management program and associated behavior interventions are delivered through a mobile patient diary via mobile phones and tablets. DWISE has been tested for its usability, functionality, usefulness, and acceptance through a series of qualitative studies. RESULTS For the primary care practitioner tool, most usability problems were associated with the navigation of the tool and the presentation, formatting, understandability, and suitability of the content. For the patient tool, most issues were related to the tool’s screen layout, design features, understandability of the content, clarity of the labels used, and navigation across the tool. Facilitators and barriers to DWISE use in a shared decision-making environment have also been identified. CONCLUSIONS This work has provided a unique electronic health solution to translate complex health care knowledge in terms of easy-to-use, evidence-informed, point-of-care decision aids for primary care practitioners. Patients’ feedback is now being used to make necessary modification to DWISE.

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Primary care organizational characteristics are linked to the self-management behaviors of patients with diabetes

PsycEXTRA Dataset ◽

10.1037/e554832010-008 ◽

2010 ◽

Keyword(s):

Primary Care ◽

The Self ◽

Organizational Characteristics ◽

Self Management ◽

Patients With Diabetes ◽

Management Behaviors

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Knowledge mobilisation: a UK co-creation study to devise strategies to amend lay and practitioner atopic eczema mindlines to improve consultation experiences and self-management practices in primary care

BMJ Open ◽

10.1136/bmjopen-2019-036520 ◽

2020 ◽

Vol 10 (9) ◽

pp. e036520

Author(s):

Fiona Cowdell ◽

Taheeya Ahmed ◽

Carron Layfield

Keyword(s):

Primary Care ◽

Atopic Eczema ◽

Management Practices ◽

Self Management ◽

Dry Skin ◽

Remote Communication ◽

Knowledge Mobilisation ◽

Inaccurate Information ◽

Lay People ◽

Conference Centre

ObjectiveTo devise strategies to amend lay and practitioner atopic eczema mindlines ‘collectively reinforced, internalised tacit guidelines’, to improve consultation experiences and self-management practices in primary care.DesignCo-creation workshops informed by the Co:Create Coproduction Matrix.SettingConference centre in central England and via remote communication.ParticipantsLay people with, and parents of children with, atopic eczema, practitioners, a researcher and a facilitator (n=22).ResultsEczema mindline amendment needs to address people and parents of children with the condition, practitioners and wider society in parallel. For lay people trust and ‘realness’ of amendment activity was vital and practitioners wanted practical, locally relevant, hints and tips, tailored, ‘no faff’ approaches. To improve consultation experiences and self-management practices, five key, consistent, evidence-based messages need to be instilled into eczema mindlines: (1) eczema is more than just dry skin, (2) eczema does not just go away, (3) moisturisers are for every day, (4) steroid creams are okay when you need them and (5) you know your child’s eczema best.ConclusionThis co-creation study provides original insights into what eczema knowledge should be mobilised, who needs to have this knowledge, how this should be achieved to amend existing mindlines to improve consultation experiences and self-management practices in primary care.The remaining challenge is to refine, implement and evaluate the effectiveness of strategies developed to instil the five core messages and erase outdated or inaccurate information.

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Primary Care Provider Perceptions of the Effectiveness of Two Self-Management Support Programs for Vulnerable Patients with Diabetes

Journal of Diabetes Science and Technology ◽

10.1177/193229681200600114 ◽

2012 ◽

Vol 6 (1) ◽

pp. 116-124 ◽

Cited By ~ 10

Author(s):

Neda Ratanawongsa ◽

Vijay K. Bhandari ◽

Margaret Handley ◽

Thomas Rundall ◽

Hali Hammer ◽

...

Keyword(s):

Primary Care ◽

Care Provider ◽

Primary Care Provider ◽

Support Programs ◽

Self Management ◽

Management Support ◽

Provider Perceptions ◽

Vulnerable Patients ◽

Patients With Diabetes

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Occupational Therapy in Primary Care -- Barriers, Pivots, and Outcomes: A pilot study

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2021.1982 ◽

2021 ◽

Author(s):

Sue Dahl-Popolizio ◽

Gretchen Anne Roman ◽

Felicia Trembath ◽

Bradley Doebbeling ◽

Alyssa Concha-Chavez

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Health Behaviors ◽

Health Outcomes ◽

Lifestyle Modification ◽

Care Team ◽

Primary Care Team ◽

Interprofessional Team ◽

Patients With Diabetes ◽

Lifestyle Modification Program

Purpose: Habits, roles, and routines are important behaviors that affect lifestyle and can lead to the development of chronic disease such as diabetes mellitus. Primary care physicians (PCPs) have limited time, suggesting an interprofessional team approach would be beneficial in helping patients modify behaviors for the prevention and treatment of chronic disease. Occupational therapists (OTs) specialize in addressing health behaviors, and literature supports including OTs on the primary care team to improve the self-management techniques of patients with chronic disease. This study was guided by Lifestyle Redesign®, an evidence-based program that addresses the health behaviors of patients with diabetes in primary care. We aimed to improve health outcomes by combining an OT-led lifestyle modification program with patient-centered treatment recommendations from an external interprofessional team. We hypothesized that the health outcomes of patients with diabetes in primary care would improve after participating in an OT-led interprofessional lifestyle modification program, and that reimbursement for services would be obtainable. Method: Two PCPs in community practice initially agreed to involve an OT on their primary care team. Due to reimbursement concerns, the PCPs later preferred to refer patients to receive the OT-led intervention at an offsite clinic, rather than onsite at the primary care practice. Health outcomes were measured pre- and post-intervention using industry standard assessments and biometrics. Descriptive and non-parametric statistics were used to evaluate change. Results: Thirty-one patients with diabetes were referred, and three (9.7%) participated in the offsite lifestyle modification program. While statistical significance was not achieved (p≥0.10), trends toward individual improvement were noted for occupational performance and satisfaction and empowerment, and reimbursement was received from the third-party payers. Conclusions: Patient participation in this study was consistent with participation rates for offsite behavioral health referrals. An offsite OT-led interprofessional lifestyle modification program demonstrated potential for meaningful change and services were reimbursed. These findings support practice redesign efforts to include OTs as part of an integrated primary care model. Offering onsite services will increase patient accessibility to care and improve referral completion rates, thus providing OTs the opportunity to further demonstrate the efficacy of delivering chronic disease management in primary care.

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