A qualitative thematic analysis of online UK diabetes health forums to assess experiences and perspectives of insulin therapy in Type 2 Diabetes (Preprint)

2021 ◽  
Author(s):  
Maya Allen-Taylor ◽  
Laura Ryan ◽  
Rebecca Upsher ◽  
Kirsty Winkley-Bryant
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Insulin Therapy ◽  
Health Care Providers ◽  
Thematic Analysis ◽  
Self Management ◽  
Search Term ◽  
Care Providers ◽  
Study Results

BACKGROUND Despite the advent of newer therapeutic agents, many individuals with T2D will require insulin treatment. Insulin refusal and cessation of treatment in this group is common and their needs under explored. OBJECTIVE To understand the experiences and perspectives of individuals with type 2 diabetes who have been recommended or prescribed insulin therapy, expressed on online health forums. METHODS Setting: Retrospective archived forum threads from the two largest, freely and publicly accessible diabetes health forums in the UK were screened over a 12-month period (August 2019-20). Design: Within the Diabetes UK forum, the search term ‘insulin (title only)’ was employed to identify relevant threads. Within Diabetes.co.uk, threads were screened within an existing ‘Type 2 with insulin’ message board. Three independent researchers coded the forum threads and posts. Pertinent themes and subthemes were identified and have been illustrated by paraphrasing of members quotes, to ensure anonymity. Participants: n=299 posts from 29 threads from Diabetes UK and n=295 posts from 28 threads from Diabetes.co.uk, were analysed over the study period. Fifty-seven threads in total met the inclusion criteria and were included in the thematic analysis. RESULTS Four overarching themes with subthemes were generated to illustrate the unmet needs that had prompted members to seek information, advice and support outside of their usual care provision, via the forums: (1) unmet practical needs and self-management support; including insulin injection technique, titration, travel, driving with insulin and utilising new technology, (2) psychological and peer support; advice, encouragement and empathy, which was readily offered and well received, (3) seeking and providing extended lifestyle advice; discussions around alternative diet strategies, types of activity and their effects on glycaemia and body weight, and (4) relationships with health care professionals (HCPs); including recounting of problematic experiences such as paternalism, lack of HCP knowledge and inadequate provision of effective insulin focused diabetes self-management education. CONCLUSIONS This is the first study to utilise data from online health forums, to characterise the experiences and perspectives of people with T2D who are recommended or prescribed insulin therapy. The observed naturalistic conversations have generated useful insights. Our findings suggest there are additional needs that are not being currently met by health care providers. They also suggest that problematic relationships with HCPs remain a barrier to effective insulin therapy. The study results will help to directly inform insulin focused diabetes self-management and support strategies, in order to enable individuals to achieve their best outcomes.

scholarly journals An integrated model to evaluate the impact of social support on improving self-management of type 2 diabetes mellitus

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaojia Wang ◽  
Linglan He ◽  
Keyu Zhu ◽  
Shanshan Zhang ◽  
Ling Xin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Social Support ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Health Care Providers ◽  
Integrated Model ◽  
Self Management ◽  
Care Providers ◽  
The Impact

Abstract Background Type 2 Diabetes Mellitus (T2DM) is a chronic disease closely related to personal life style. Therefore, achieving effective self-management is one of the most important ways to control it. There is evidence that social support can help to improve the self-management ability of patients with T2DM, but which social support is more effective has been rarely explored. The purpose of this study is to construct an integrated model to analyze which social support has more significant impact on self-management of T2DM, and provide reasonable suggestions to health care providers on how to effectively play the role of social support. Methods We established a social support indicator evaluation system and proposed an integrated model that combines ANP (Analytical Network Process) and CRITIC (CRiteria Importance through Intercriteria Correlation) methods to evaluate the impact of social support on T2DM self-management from both subjective and objective perspectives. The weights calculated by the model will serve as the basis for us to judge the importance of different social support indicators. Results Informational support (weighting 49.26%) is the most important criteria, followed by tangible support (weighting 39.24%) and emotional support (weighting 11.51%). Among 11 sub-criteria, guidance (weighting 23.05%) and feedback (weighting 14.68%) are two most relevant with T2DM self-management. This result provides ideas and evidence for health care providers on how to offer more effective social support. Conclusion To our knowledge, this is the first study in which Multi-Criteria Decision Making (MCDM) tools, specifically ANP and CRITIC, are used to evaluate the impact of social support on improving self-management of type 2 diabetes. The study suggests that incorporating two sub-indicators of guidance and feedback into the diabetes care programs may have great potential to improve T2DM self-management and further control patient blood glucose and reduce complications.

scholarly journals Preferences for mHealth Technology and Text Messaging Communication in Patients With Type 2 Diabetes: Qualitative Interview Study (Preprint)

2020 ◽  
Author(s):  
Julie C Lauffenburger ◽  
Renee A Barlev ◽  
Ellen S Sears ◽  
Punam A Keller ◽  
Marie E McDonnell ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Mobile Technology ◽  
Diabetes Care ◽  
Technology Use ◽  
Text Messages ◽  
Self Management ◽  
Care Providers ◽  
Mhealth Technology

BACKGROUND Individuals with diabetes need regular support to help them manage their diabetes on their own, ideally delivered via mechanisms that they already use, such as their mobile phones. One reason for the modest effectiveness of prior technology-based interventions may be that the patient perspective has been insufficiently incorporated. OBJECTIVE This study aims to understand patients’ preferences for mobile health (mHealth) technology and how that technology can be integrated into patients’ routines, especially with regard to medication use. METHODS We conducted semistructured qualitative individual interviews with patients with type 2 diabetes from an urban health care system to elicit and explore their perspectives on diabetes medication–taking behaviors, daily patterns of using mobile technology, use of mHealth technology for diabetes care, acceptability of text messages to support medication adherence, and preferred framing of information within text messages to support diabetes care. The interviews were digitally recorded and transcribed. The data were analyzed using codes developed by the study team to generate themes, with representative quotations selected as illustrations. RESULTS We conducted interviews with 20 participants, of whom 12 (60%) were female and 9 (45%) were White; in addition, the participants’ mean glycated hemoglobin A<sub>1c</sub> control was 7.8 (SD 1.1). Overall, 5 key themes were identified: patients try to incorporate <i>cues</i> into their routines to help them with consistent medication taking; many patients leverage some form of technology as a cue to support adherence to medication taking and diabetes self-management behaviors; patients value simplicity and integration of technology solutions used for diabetes care, managing medications, and communicating with health care providers; some patients express reluctance to rely on mobile technology for these diabetes care behaviors; and patients believe they prefer positively framed communication, but communication preferences are highly individualized. CONCLUSIONS The participants expressed some hesitation about using mobile technology in supporting diabetes self-management but have largely incorporated it or are open to incorporating it as a cue to make medication taking more automatic and less burdensome. When using technology to support diabetes self-management, participants exhibited individualized preferences, but overall, they preferred simple and positively framed communication. mHealth interventions may be improved by focusing on integrating them easily into daily routines and increasing the customization of content.

scholarly journals Health Care Providers’ Perceptions of Responsibilities and Resources to Reduce Type 2 Diabetes Risk After Gestational Diabetes Mellitus

2018 ◽  
Vol 36 (2) ◽  
pp. 160-167
Author(s):  
Sumali S. Hewage ◽  
Shweta R. Singh ◽  
Claudia Chi ◽  
Jerry K.Y. Chan ◽  
Tong Wei Yew ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Health Care Providers ◽  
Diabetes Risk ◽  
Care Providers

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 A socioecological perspective : the "ups and downs" of living with type 2 diabetes among working adults in the rural south

2019 ◽  
Author(s):  
◽  
Lynn E. Glenn
Keyword(s):  
Type 2 Diabetes ◽  
Health Services ◽  
Health Care Providers ◽  
Preventive Health Services ◽  
Patient Activation ◽  
Preventive Health ◽  
Self Management ◽  
Care Providers ◽  
Working Adults

Persons with higher patient activation levels are more likely to engage in preventive health behaviors. This qualitative study addressed a population that may be particularly vulnerable to poor diabetes outcomes: rural, working adults with type 2 diabetes (T2 DM) with low levels of patient activation. This study sought to gain a better understanding of the individual, interpersonal, health system, and community spheres of influence on engagement in diabetes self-management and recommended preventive health services among rural, working adults. A socioecological approach, based on Fisher's (2005) Resources and Supports for Self-Management Model, guided the study. The Patient Activation Measure (PAM-10) was used to identify individuals with low patient activation. Participants (N = 20) had PAM-10 scores less than 75 (M = 59.4) and were predominately African American (n = 12) and female (n = 14), earning incomes less than $50,000 (n = 13). The overarching theme, "ups and downs" of living with diabetes, emerged from the data. Four other major themes emerged: "the struggle", "you don't talk about it", "diabetes is not the priority", and "we're lucky to have what we have". Most participants had social support, employer health benefits, and a trusting, satisfactory relationship with health care providers. However, a lack of equitable workplace and community resources may have contributed to lack of engagement in diabetes self-management and preventive health services.

scholarly journals Case Report: Type 2 Diabetes Mellitus

2018 ◽  
Vol 1 (2) ◽  
pp. 45
Author(s):  
Shofi Hesfianto
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Chronic Disease ◽  
Health Care Providers ◽  
The Other ◽  
Shared Understanding ◽  
Care Providers ◽  
Patient’S Expectation

.......A patient who was first diagnosed with a chronic disease often does not fully understand the meaning or significanceof the chronic disease with which his/ her body suffers, against the risk of future complications if the disease is not well-controlled. On the other hand, in this reported case, the patient’s expectation was that her chronic disease, the T2DM, can be cured. Therefore, a shared understanding between health care providers and patient is likely the key to commencing the course of managing any chronic disease in a patient effectively.......

scholarly journals Needs and resources of people with type 2 diabetes in peri-urban Cochabamba, Bolivia: A people-centred perspective.

2021 ◽  
Author(s):  
Christine Leyns ◽  
Niek Couvreur ◽  
Sara Willems ◽  
Ann Van Hecke
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Health System ◽  
Health Care Providers ◽  
Treatment Plan ◽  
Public Healthcare ◽  
Care Providers ◽  
Low Literacy ◽  
Traditional Use

Abstract Background: The rising prevalence of type 2 diabetes results in a worldwide public healthcare crisis, especially in low- and middle-income countries (LMICs) with unprepared and overburdened health systems mainly focused on infectious diseases and maternal and child health. Studies regarding type 2 diabetes in LMICs describe specific interventions ignoring a comprehensive analysis of the local factors people see influential to their health. This study aims to meet this research gap by exploring what people with type 2 diabetes in Bolivia need to maintain or improve their health, how important they perceive those identified needs and to what extent these needs are met.Methods: From March until May 2019, 33 persons with type 2 diabetes from three periurban municipalities of the department of Cochabamba participated in this study. The concept mapping methodology by Trochim, a highly structured qualitative brainstorming method, was used to generate and structure a broad range of perspectives on what the participants considered instrumental for their health.Results: The brainstorming resulted in 156 original statements condensed into 72 conceptually different needs and resources, structured under nine conceptual clusters and four action domains. These domains illustrated with vital needs were: (1) self-management with use of plants and the possibility to measure sugar levels periodically; (2) healthcare providers with the need to trust and receive a uniform diagnosis and treatment plan; (3) health system with opportune access to care and (4) community with community participation in health and safety, including removal of stray dogs.Conclusions: This study identifies mostly contextual factors like low literacy levels, linguistic problems in care, the need to articulate people's worldview including traditional use of natural remedies with the Bolivian health system and the lack of expertise on type 2 diabetes by primary health care providers. Understanding the needs and structuring them in different areas wherein action is required serves as a foundation for the planning and evaluation of an integrated people centred care program for people with type 2 diabetes. This participative method serves as a tool to implement the often theoretical concept of integrated people centred health care in health policy and program development.

Diabetes Self-Management Education and Self-Efficacy Among African American Women Living With Type 2 Diabetes in Rural Primary Care

2017 ◽  
Vol 10 (1) ◽  
pp. 11-16
Author(s):  
Cynthia Harrington ◽  
Heather D. Carter-Templeton ◽  
Susan J. Appel
Keyword(s):  
Type 2 Diabetes ◽  
African American ◽  
African American Women ◽  
Health Care Providers ◽  
Self Efficacy ◽  
Self Management ◽  
Health Clinic ◽  
Care Providers ◽  
American Women

African American women suffer the highest prevalence of type 2 diabetes (T2D). Self-efficacy is important for optimal diabetes self-management (DSM). Purpose: To evaluate DSM by comparing pre- and postintervention responses to a diabetes self-efficacy scale. Design: Descriptive pilot study. Sample: Participants for this study were N = 15 African American women aged 25–65 years (M = 47.4 years) and recruited from a rural health clinic in the Southeastern United States, who received a 4-hr DSM class. Method: Data were collected using the Stanford Self-Efficacy for Diabetes (SED). Results: The increase in the pre- and posttest SED scores were statistically significant, (p < .001). Implications for Nursing: Health care providers should tailor a diabetes education program for these individuals living with T2D. Through a collaborative patient–provider relationship to care, individuals may ultimately experience increased self-efficacy leading to improved DSM.

scholarly journals Barriers to and facilitators of diabetes self-management practices in Rupandehi, Nepal- multiple stakeholders’ perspective

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mandira Adhikari ◽  
Hridaya Raj Devkota ◽  
Tomris Cesuroglu
Keyword(s):  
Type 2 Diabetes ◽  
Health Care Providers ◽  
Low Income ◽  
Management Practices ◽  
Self Management ◽  
Care Providers ◽  
Structured Interviews ◽  
Multiple Stakeholders ◽  
Adherence To Medication

Abstract Background Self-management of diabetes is associated with glycaemic control and adherence to medication and healthy lifestyle practices. There is lack of information on the barriers to and facilitators of diabetes self-management practices in low income country, Nepal. This study aimed to explore the barriers to and facilitators of Type 2 diabetes self-management practices taking multiple stakeholders’ perspectives in Nepal. Methods Four focus group discussions and 16 semi-structured interviews with people with Type 2 diabetes, caregivers, health care providers and health managers were conducted from April to May 2018 in Rupandehi district of Western Nepal. They were audio-recorded, transcribed, and analysed using a thematic approach. Results Five main themes emerged that influenced diabetes self-management practices: individual factors, socio-cultural and economic factors, health system and policy factors, availability and accessibility of resources, and environmental factors. The important barriers were: lack of knowledge about diabetes self-management practices, cultural practices, insufficient counselling, lack of guidelines and protocols for counselling, and financial problems. The major facilitators were: motivation; support from family, peers, and doctors; and availability of resources in the community. Conclusion Based on our findings, a multilevel approach is needed to address these barriers and facilitators. These findings will help guide strategies to develop programs that impart knowledge and skills to improve the diabetes self-management practices of people with Type 2 diabetes.

scholarly journals Needs and resources of people with type 2 diabetes in peri-urban Cochabamba, Bolivia: a people-centred perspective

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Christine Cécile Leyns ◽  
Niek Couvreur ◽  
Sara Willems ◽  
Ann Van Hecke
Keyword(s):  
Type 2 Diabetes ◽  
Health Care ◽  
Health System ◽  
Health Care Providers ◽  
Treatment Plan ◽  
Public Healthcare ◽  
Care Providers ◽  
Low Literacy ◽  
Traditional Use

Abstract Background The rising prevalence of type 2 diabetes results in a worldwide public healthcare crisis, especially in low- and middle-income countries (LMICs) with unprepared and overburdened health systems mainly focused on infectious diseases and maternal and child health. Studies regarding type 2 diabetes in LMICs describe specific interventions ignoring a comprehensive analysis of the local factors people see influential to their health. This study aims to meet this research gap by exploring what people with type 2 diabetes in Bolivia need to maintain or improve their health, how important they perceive those identified needs and to what extent these needs are met. Methods From March until May 2019, 33 persons with type 2 diabetes from three periurban municipalities of the department of Cochabamba participated in this study. The concept mapping methodology by Trochim, a highly structured qualitative brainstorming method, was used to generate and structure a broad range of perspectives on what the participants considered instrumental for their health. Results The brainstorming resulted in 156 original statements condensed into 72 conceptually different needs and resources, structured under nine conceptual clusters and four action domains. These domains illustrated with vital needs were: (1) self-management with use of plants and the possibility to measure sugar levels periodically; (2) healthcare providers with the need to trust and receive a uniform diagnosis and treatment plan; (3) health system with opportune access to care and (4) community with community participation in health and safety, including removal of stray dogs. Conclusions This study identifies mostly contextual factors like low literacy levels, linguistic problems in care, the need to articulate people’s worldview including traditional use of natural remedies with the Bolivian health system and the lack of expertise on type 2 diabetes by primary health care providers. Understanding the needs and structuring them in different areas wherein action is required serves as a foundation for the planning and evaluation of an integrated people centred care program for people with type 2 diabetes. This participative method serves as a tool to implement the often theoretical concept of integrated people centred health care in health policy and program development.

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