Improving Diabetes Management With a Patient Portal: A Qualitative Study of Diabetes Self-Management Portal

Emerging adults have been raised in the digital age and are therefore prime candidates for using a patient portal to manage chronic conditions. The limited body of research both identifies the underutilization of the patient portal and suggests increased use of the portal for the chronically ill as a tool to alleviate caregiver stress, as well as a potential modality to assist emerging adults to manage their chronic illnesses. This qualitative study was completed to obtain an understanding of emerging adults familiarity with the electronic patient portal and to elicit the perception of the usefulness of the portal to support self-management of type I diabetes. Findings provide a preliminary understanding of how a sampling of emerging adults with type I diabetes uses, perceives the benefits of, and wants to improve technology for diabetes self-management.

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Abstract 311: Facilitators and Barriers to Self-management of Patients with Type 2 Diabetes in Communities in China, a Qualitative Study

Hypertension ◽

10.1161/hyp.60.suppl_1.a311 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Xiang Y Chen ◽

Peng Yue ◽

Yong L Wang ◽

Shu Q Xiao ◽

Xin W Feng ◽

...

Keyword(s):

Type 2 Diabetes ◽

Qualitative Study ◽

Management Practices ◽

Diabetes Management ◽

Financial Burden ◽

Chinese Patients ◽

Self Management ◽

Difficult Time ◽

Facilitators And Barriers

Background: Self-management has become a key strategy for caring chronic patients in community. However, little is known about peoples’ self-management experiences and their perceived cues and barriers to engagement in self-management. Objective: To explore issues patients with type 2 diabetes experienced in their self-management practices,to understand cues and barriers to engagement in self-management. Design: Qualitative study (Semi-structured interviews) Setting: 11 communities in Beijing, China Participants: Type 2 diabetes patients in community, aged >18, no admission in past 90 days. Methods: 40 critical incident interviews were run during Apr to Sep in 2011 using purposive sampling (20 interviews with patients whose HbA1c well-controlled (<6.5%), while 20 badly-controlled (≥8%)).Themes from interviews were identified using content analysis, which revealed cues and barriers to self-modification for diabetes management. Results: Implications for self- management practice included objectively understanding on the severity and complications of diabetes. In addition to family support such as supervision in family and fully-use of family resource, desires/duties to be responsible for whole family life as a breadwinner was emerged as a key cue to engagement in self-control. Barriers to engagement in self-management stemmed from financial burden to monitor blood glucose daily, dissatisfaction of HbA1c level after efforts, and malignant life events. It is worth mentioning that starving experience of difficult time with natural disasters in1960s- 1970s in China was identified also as a key barrier to engagement in diet management. Discussion and Conclusion: There was a strong desire for Chinese patients to comply with Chinese cultural norms; particularly those relating to family value. It was the patients’ power to be involved in self-management that they could devote their healthy life to family duty. Everyone had his/her own history so experiences in past shaped patients’ behaviors now. The findings highlighted the importance of understanding the family value and the personal experiences as facilitators and barriers to self-management of Chinese patients with type 2 diabetes living in community.

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To Tell or Not to Tell: Disclosure and Self-Management among Adults with Early-Onset Type 2 Diabetes: A Qualitative Study

The Open Diabetes Journal ◽

10.2174/1876524602010010011 ◽

2020 ◽

Vol 10 (1) ◽

pp. 11-19

Author(s):

Maja Hykkelbjerg Nielsen ◽

Annesofie Lunde Jensen ◽

Anne Bo ◽

Helle Terkildsen Maindal

Keyword(s):

Type 2 Diabetes ◽

Qualitative Study ◽

Early Onset ◽

Diabetes Management ◽

Well Being ◽

Self Management ◽

Close Relative ◽

High Risk Population ◽

Onset Type

Background: Adults with early-onset Type 2 Diabetes Mellitus (T2DM) are an emerging high-risk population who may experience social challenges related to diabetes management. Objective: To explore the disclosure of T2DM and how disclosure affects diabetes self-management and the psychosocial adjustment to life with diabetes among adults with early-onset T2DM. Methods: A qualitative study was conducted using Systematic Text Condensation (STC). Data was derived from semi-structured interviews with 15 individuals with T2DM ≤ 46 years (10 women and 5 men) recruited from diverse settings using purposeful sampling. Results: Most informants disclosed their diabetes to a close relative shortly after receiving the diagnosis. This led to immediate emotional support and overall positive disclosure experiences. However, informants often hesitated to disclose their condition to others due to shame, fear of negative judgement or social exclusion. Over time, the majority of informants became more open about their condition, which often resulted in emotional and practical self-management support. Those most reluctant to disclosing their diabetes struggled with shame and negative diabetes-related emotions, which had negative effects on their diabetes self-management. Conclusion: Disclosure of T2DM seemed important for the social, emotional and practical management of diabetes among adults with early-onset T2DM. The disclosure was most often accompanied by feelings of shame and fear of condemnation. Professional guidance to support disclosure and interventions to address stigma may improve well-being and diabetes self-management in this population.

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Differences in Secure Messaging, Self-management, and Glycemic Control Between Rural and Urban Patients: Secondary Data Analysis

JMIR Diabetes ◽

10.2196/32320 ◽

2021 ◽

Vol 6 (4) ◽

pp. e32320

Author(s):

Stephanie A Robinson ◽

Dane Netherton ◽

Mark Zocchi ◽

Carolyn Purington ◽

Arlene S Ash ◽

...

Keyword(s):

Glycemic Control ◽

Diabetes Management ◽

The United States ◽

Diabetes Control ◽

Self Management ◽

Patient Portal ◽

Cross Sectional ◽

Secure Messaging ◽

Patients With Diabetes ◽

Rural Patients

Background Rural patients with diabetes have difficulty accessing care and are at higher risk for poor diabetes management. Sustained use of patient portal features such as secure messaging (SM) can provide accessible support for diabetes self-management. Objective This study explored whether rural patients’ self-management and glycemic control was associated with the use of SM. Methods This secondary, cross-sectional, mixed methods analysis of 448 veterans with diabetes used stratified random sampling to recruit a diverse sample from the United States (rural vs urban and good vs poor glycemic control). Administrative, clinical, survey, and interview data were used to determine patients’ rurality, use of SM, diabetes self-management behaviors, and glycemic control. Moderated mediation analyses assessed these relationships. Results The sample was 51% (n=229) rural and 49% (n=219) urban. Mean participant age was 66.4 years (SD 7.7 years). More frequent SM use was associated with better diabetes self-management (P=.007), which was associated with better glycemic control (P<.001). Among rural patients, SM use was indirectly associated with better glycemic control through improved diabetes self-management (95% CI 0.004-0.927). These effects were not observed among urban veterans with diabetes (95% CI –1.039 to 0.056). Rural patients were significantly more likely than urban patients to have diabetes-related content in their secure messages (P=.01). Conclusions More frequent SM use is associated with engaging in diabetes self-management, which, in turn, is associated with better diabetes control. Among rural patients with diabetes, SM use is indirectly associated with better diabetes control. Frequent patient-team communication through SM about diabetes-related content may help rural patients with diabetes self-management, resulting in better glycemic control.

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Unmet basic needs and family functions gaps in diabetes management practice among Indonesian communities with uncontrolled type 2 diabetes: A qualitative study

Malaysian Family Physician ◽

10.51866/oa1123 ◽

2021 ◽

Vol 16 (3) ◽

pp. 23-35

Author(s):

Rian Adi Pamungkas ◽

Kanittha Chamroonsawasdi ◽

Andi Mayasari Usman

Keyword(s):

Qualitative Study ◽

Management Practices ◽

Unmet Needs ◽

Diabetes Management ◽

Management Practice ◽

Self Management ◽

Diabetic Patients ◽

Problem Solving Skills ◽

Family Function ◽

Key Informants

Family members play a vital role in both helping and undermining diabetes mellitus self-management practices. This qualitative study aimed to explore the potentially unmet needs of family function to support diabetes self-management (DSM) practices. In-depth interviews and focus group discussions (FGDs) were conducted among different key informants, including uncontrolled T2DM patients, caretakers and healthcare providers (HCPs) at community health centres. An open-ended approach was applied to elicit responses from the key informants. A total of 22 participants were involved in this study. All interview and FGD processes were audio-recorded and transcribed verbatim. The results found that all key informants addressed six core themes, with sub-themes to describe the unmet needs of family function to support DSM practice. The critical unmet needs of family function include: 1) Lack of problem-solving skills to deal with poor diabetes management; 2) Ineffective communication and refusal to share the burden of diabetes management; 3) Lack of affective responsiveness to encourage patients’ compliance; 4) Lack of affective involvement in DSM; 5) Insufficient family roles in supporting patients; 6) Poor behaviour control of T2DM. Our findings provide insights into how family function may influence the adoption and maintenance of healthy behaviours among diabetic patients. Since health providers seek new approaches to improve DSM practices, this valuable finding was essential to understand how family function can improve and empower patients in DSM practice.

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Trust in hybrid closed loop among people with diabetes: Perspectives of experienced system users

Journal of Health Psychology ◽

10.1177/1359105317718615 ◽

2017 ◽

Vol 25 (4) ◽

pp. 429-438 ◽

Cited By ~ 10

Author(s):

Molly L Tanenbaum ◽

Esti Iturralde ◽

Sarah J Hanes ◽

Sakinah C Suttiratana ◽

Jodie M Ambrosino ◽

...

Keyword(s):

Type 1 Diabetes ◽

Qualitative Study ◽

Closed Loop ◽

Diabetes Management ◽

New Technology ◽

Self Management ◽

Closed Loop Systems ◽

Trial Participants ◽

User Trust

Automated closed loop systems will greatly change type 1 diabetes management; user trust will be essential for acceptance of this new technology. This qualitative study explored trust in 32 individuals following a hybrid closed loop trial. Participants described how context-, system-, and person-level factors influenced their trust in the system. Participants attempted to override the system when they lacked trust, while trusting the system decreased self-management burdens and decreased stress. Findings highlight considerations for fostering trust in closed loop systems. Systems may be able to engage users by offering varying levels of controls to match trust preferences.

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Differences in Secure Messaging, Self-management, and Glycemic Control Between Rural and Urban Patients: Secondary Data Analysis (Preprint)

10.2196/preprints.32320 ◽

2021 ◽

Author(s):

Stephanie A Robinson ◽

Dane Netherton ◽

Mark Zocchi ◽

Carolyn Purington ◽

Arlene S Ash ◽

...

Keyword(s):

Glycemic Control ◽

Diabetes Management ◽

The United States ◽

Diabetes Control ◽

Self Management ◽

Patient Portal ◽

Cross Sectional ◽

Secure Messaging ◽

Patients With Diabetes ◽

Rural Patients

BACKGROUND Rural patients with diabetes have difficulty accessing care and are at higher risk for poor diabetes management. Sustained use of patient portal features such as secure messaging (SM) can provide accessible support for diabetes self-management. OBJECTIVE This study explored whether rural patients’ self-management and glycemic control was associated with the use of SM. METHODS This secondary, cross-sectional, mixed methods analysis of 448 veterans with diabetes used stratified random sampling to recruit a diverse sample from the United States (rural vs urban and good vs poor glycemic control). Administrative, clinical, survey, and interview data were used to determine patients’ rurality, use of SM, diabetes self-management behaviors, and glycemic control. Moderated mediation analyses assessed these relationships. RESULTS The sample was 51% (n=229) rural and 49% (n=219) urban. Mean participant age was 66.4 years (SD 7.7 years). More frequent SM use was associated with better diabetes self-management (P=.007), which was associated with better glycemic control (P<.001). Among rural patients, SM use was indirectly associated with better glycemic control through improved diabetes self-management (95% CI 0.004-0.927). These effects were not observed among urban veterans with diabetes (95% CI –1.039 to 0.056). Rural patients were significantly more likely than urban patients to have diabetes-related content in their secure messages (P=.01). CONCLUSIONS More frequent SM use is associated with engaging in diabetes self-management, which, in turn, is associated with better diabetes control. Among rural patients with diabetes, SM use is indirectly associated with better diabetes control. Frequent patient-team communication through SM about diabetes-related content may help rural patients with diabetes self-management, resulting in better glycemic control.

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Pharmacists’ perceived role in supporting diabetes education and self-management in Ireland: a qualitative study

HRB Open Research ◽

10.12688/hrbopenres.13192.1 ◽

2021 ◽

Vol 4 ◽

pp. 20

Author(s):

Eva Cooney ◽

David O'Riordan ◽

Jennifer McSharry

Keyword(s):

Qualitative Study ◽

Diabetes Management ◽

Diabetes Education ◽

Community Pharmacists ◽

Self Management ◽

Structured Interviews ◽

Level Of Involvement ◽

The Relationship ◽

Inductive Thematic Analysis

Background: Support for people with diabetes is necessary for optimal self-management. Structured diabetes education programmes fulfil this need, but attendance rates are consistently low. The role of pharmacists has expanded but the profession remains underutilised in chronic disease management. The objective of this study is to explore pharmacists’ perceived role in the support of diabetes education and self-management behaviours. Methods: A qualitative study using semi-structured interviews of community pharmacists in Ireland was conducted. Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis. Results: Ten pharmacists were interviewed. The four themes identified illustrate the juxtaposition of pharmacists’ potential in diabetes care with the realities of current pharmaceutical practice. One theme outlined the relationship between the person with diabetes and the pharmacist, ‘Patient or customer: the nature of the pharmacist relationship’. Two themes described the pharmacists’ role in supporting diabetes education and self-management, ‘Beyond medication: pharmacists’ current and potential role in diabetes management’ and ‘Need for diabetes education’. The final theme highlighted the barriers to a more engaged role in patient care, ‘Barriers: “all the stuff that gets in the way”’. Conclusion: The relationship between pharmacists and people with diabetes could facilitate pharmacists in supporting diabetes self-management. However, variability across pharmacists’ level of involvement and consistent resource barriers were noted. Pharmacists were poorly informed about structured diabetes education programmes. Further research is needed to explore this variability but there may be potential to enhance the pharmacist role in promoting attendance at structured diabetes education programmes.

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Digital Diabetes Management: A Literature Review of Smart Insulin Pens

Journal of Diabetes Science and Technology ◽

10.1177/1932296820983863 ◽

2021 ◽

pp. 193229682098386 ◽

Cited By ~ 1

Author(s):

Lutz Heinemann ◽

Oliver Schnell ◽

Bernhard Gehr ◽

Nanette C. Schloot ◽

Sven W. Görgens ◽

...

Keyword(s):

Patient Preference ◽

Diabetes Management ◽

Electronic Device ◽

Digital Health ◽

Memory Function ◽

Near Field ◽

Self Management ◽

Published Data ◽

Technical Accuracy ◽

Insulin Pens

Digital health management is increasingly pivotal in the care of patients with diabetes. The aim of this review was to evaluate the clinical benefits of using smart insulin pens with connectivity for diabetes management. The search was performed using PubMed and PubMed Central on May 15, 2019, to identify publications investigating the use of insulin pens. Studies evaluating insulin pens with connectivity via Bluetooth/Near Field Communication, with an associated electronic device enabling connectivity, or with a memory function were included in the review. Nine studies were identified in the search. Overall, these studies lacked data on smart insulin pens with a connectivity function, with eight of the available studies investigating only pens with a memory function. The studies focused primarily on assessing patient preference, usability, and technical accuracy. The number of studies assessing clinical outcomes was small ( n = 3). However, the majority of studies ( n = 8) reported that patients preferred smart insulin pens because they increased confidence with regard to diabetes self-management. These results suggest a lack of published data regarding smart insulin pens with connectivity for the management of diabetes. However, the available published data on usability and patient preference suggest that the use of smart insulin pens holds promise for improving and simplifying diabetes self-management.

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Young adults’ perceptions of living with atopic dermatitis in relation to the concept of self-management: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2020-044777 ◽

2021 ◽

Vol 11 (6) ◽

pp. e044777

Author(s):

Susanne Lundin ◽

Marina Jonsson ◽

Carl-Fredrik Wahlgren ◽

Emma Johansson ◽

Anna Bergstrom ◽

...

Keyword(s):

Young Adults ◽

Atopic Dermatitis ◽

Qualitative Study ◽

Healthcare Providers ◽

Transition Process ◽

Population Based ◽

Self Management ◽

School Age ◽

Perceived Availability ◽

Semistructured Interviews

ObjectivesLearning to take control of one’s health is an important part of the transition from adolescence to adulthood. This study aimed to explore young adults’ perceptions of living with atopic dermatitis (AD) in relation to the concept of self-management.DesignA qualitative study with an inductive approach was performed through semistructured interviews (n=15). The interviews were recorded, transcribed verbatim and analysed with systematic text condensation.ParticipantsYoung adults (mean age 23,4 years) with persistent AD in a longitudinal population-based birth cohort. To capture experience of living with persistent AD (preschool/school-age onset) of different severity (mild to severe/very severe), a purposive selection was performed. In total, 15 young adults were included. Persistent AD (preschool/school-age onset) was defined as dry skin in combination with itchy rash of typical localisation in the 12 months preceding the 16-year and the 24-year follow-ups. Severity was self-assessed using the Patient Oriented Eczema Measure.ResultsDespite having experience of AD since childhood, the respondents expressed uncertainty about treatment and how it affected their bodies. Their uncertainties and feelings affected how they used topical corticosteroids. The respondents emphasised that they perceived availability of healthcare and knowledge about treatment of AD among healthcare providers to be limited. The participants did not state any experiences of support to self-management from healthcare, which affect young adults’ possibilities to take full control of their AD care.ConclusionsYoung adults with preschool/school-age onset of AD are unsure how to treat and manage the disease. One explanation may be insufficient transition process.

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