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Variation of patients’ views on Type 2 diabetes management over time
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. (Health Services Research)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. (Health Services Research)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
2007 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 24, no 4, 408-414 p.Article in journal (Refereed) Published
Abstract [en]

Aims The aim of the study was to examine the relationship between participants' views about their role in diabetes treatment and their glycaemic control 3–7 years after having entered an educational intervention, and to investigate whether people's attitudes towards diabetes management change over an extended period of time.

Methods The present study is a long-term follow-up analysis of data collected from 193 persons with Type 2 diabetes. A qualitative content analysis of three open-ended questions about participants' self-perceived role in diabetes treatment was used. The related outcome measure was haemoglobin A1c (HbA1c).

Results The way people viewed their role in diabetes management affected glycaemic control. Individuals in the Disease Manager or Compliant categories had significantly lower HbA1c compared with those in the Disheartened category. Furthermore, in people whose attitudes towards diabetes treatment was variable, weight and age influenced why participants changed their views and thus switched categories. Paradoxically, when people changed their views, this change did not produce a change in blood glucose control, which would have been expected.

Conclusions From the health-care provider's perspective, it is important to know how the person with diabetes perceives his/her role in disease management and to determine if a change in perception would be followed by intervention to adjust glycaemic control. Consequently, individuals' perception of disease management should be incorporated in patient education programmes and routine diabetes care to enable customized care and prevent stagnation in negative roles.

Place, publisher, year, edition, pages
2007. Vol. 24, no 4, 408-414 p.
Keyword [en]
haemoglobin A1c, long-term follow-up, qualitative content analysis, self-perception, Type 2 diabetes
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-94815DOI: 10.1111/j.1464-5491.2006.02064.xISI: 000245101400013PubMedID: 17298592OAI: oai:DiVA.org:uu-94815DiVA: diva2:168804
Available from: 2006-09-08 Created: 2006-09-08 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Teaching and Learning in Type 2 Diabetes: The Importance of Self-Perceived Roles in Disease Management
Open this publication in new window or tab >>Teaching and Learning in Type 2 Diabetes: The Importance of Self-Perceived Roles in Disease Management
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The major part of care in type 2 diabetes is in the hands of the patient so the focus of educational interventions should be on the person behind the disease. An experience-based group education programme that actively promotes participants’ reflection and understanding has been designed and implemented in cooperation with the Swedish Pharmacy.

The regression model presented in Paper I revealed the importance of self-perceived role in diabetes management. Blood glucose control two years after baseline was improved for participants who described themselves as having an active role in their treatment, compared to those taking on a passive or a compliant role.

Paper II described the resulting categories from content analysis of three open-ended questions about participants’ role, goal and support needs in diabetes management. The people taking care of diabetes most effectively and needing least support were called Disease Managers; those following the health professionals’ orders and depending on regular controls were categorised as Compliant, whereas the Disheartened had difficulties in achieving good metabolic control and often described both medical and social obstacles. These three self-management profiles were strongly correlated to metabolic outcomes.

In Paper III perceptions of diabetes management were reassessed: perceptions were only stable in approximately half of participants, thus providing evidence for a dynamic model of learning self-management in diabetes. The three self-management profiles still correlated with metabolic outcomes.

In paper IV the long-term metabolic outcome (HbA1c) of the study population was investigated. Metabolic control was stable up to seven years following the intervention, in contrast to the metabolic deterioration often present in diabetes.

The main message of this thesis is that participants’ self-perceived role had a major influence on metabolic outcomes. Assessing self-management profiles both in diabetes and possibly other chronic conditions can help health care providers to tailor their educational efforts accordingly. Furthermore, this experience-based patient education programme outside the framework of routine diabetes care has the potential to stabilise metabolic control on the long run effectively.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2006. 66 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 169
Keyword
Health services research, Typ 2 diabetes, HbA(1c), Self-perception, Disease Management, Experience-based group education, Reflective learning, Hälso- och sjukvårdsforskning
Identifiers
urn:nbn:se:uu:diva-7122 (URN)91-554-6642-7 (ISBN)
Public defence
2006-09-29, Fåhraeussalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala Science Park, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2006-09-08 Created: 2006-09-08 Last updated: 2009-10-14Bibliographically approved

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Vég, AnikóRosenqvist, UrbanSarkadi, Anna

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