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Hu H, Kuang L, Dai H, Sheng Y. Effectiveness of Nurse-Led Psychological Interventions on Diabetes Distress, Depression, and Glycemic Control in Individuals With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. J Psychosoc Nurs Ment Health Serv 2024:1-8. [PMID: 39508628 DOI: 10.3928/02793695-20241029-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2024]
Abstract
PURPOSE To explore the effect of nurse-led psychological interventions on diabetes distress, depression, and glycemic control in individuals with type 2 diabetes mellitus (T2DM). METHOD Seven databases were systematically searched. Outcome measures were diabetes distress, depression, and hemoglobin A1c (HbA1c) level. RoB 2.0 was used for risk of bias assessment. Data were synthesized using Review Manager 5.4 software. RESULTS Fourteen studies were included from 2,837 articles. Five studies pooled in the meta-analysis demonstrated reduction in diabetes distress (standard mean difference = -0.36, 95% confidence interval [-0.49, -0.24], p < 0.001), favoring nurse-led psychological interventions over controls. Effects of the interventions on depression and HbA1c level were inconsistent across studies. CONCLUSION Nurse-led psychological interventions demonstrated the effect of reducing diabetes distress and some promising benefits for depression and glycemic control. Integrating nurse-led psychological interventions into usual care will be beneficial for individuals with T2DM in the future. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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Wijk I, Amsberg S, Johansson UB, Toft E, Hagquist C, Anderbro T. Psychometric Evaluation of the Swedish Acceptance and Action Diabetes Questionnaire: A Rasch Analysis. J Nurs Meas 2024; 32:227-240. [PMID: 37553160 DOI: 10.1891/jnm-2022-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Background and Purpose: The Acceptance and Action Diabetes Questionnaire (AADQ) is a tool for assessing the acceptance of thoughts and emotions related to diabetes in people living with the disease. This study aimed to examine the psychometric properties of the Swedish version of AADQ (Swe-AADQ) in a sample of adults with type 1 diabetes. Methods: To examine the psychometric properties of the Swe-AADQ, the Rasch model was used. Data for 120 individuals were included. Results: The Swe-AADQ showed an acceptable fit to the Rasch model. A sufficiently high value of the separation index indicated a capacity to distinguish between different levels of acceptance in the sample. The 7-point Likert scale was reduced to three categories suggesting an improvement in the ordering of the item thresholds. Conclusions: The Swe-AADQ possesses reasonable quality in terms of reliability and validity. However, there are some deficiencies regarding the categorization of the response rating that should be addressed.
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Affiliation(s)
- Ingrid Wijk
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Susanne Amsberg
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Unn-Britt Johansson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Eva Toft
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Ersta Hospital, Stockholm, Sweden
| | - Curt Hagquist
- Department of Education and Special Education, University of Gothenburg, Gothenburg, Sweden
| | - Therese Anderbro
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Holloway D, James S, Ekinci E, Craft J. Systematic review of the effectiveness of nurse-led care in reducing glycated haemoglobin in adults with Type 1 or 2 diabetes. Int J Nurs Pract 2023; 29:e13135. [PMID: 36733216 DOI: 10.1111/ijn.13135] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Type 1 and 2 diabetes care, especially within primary health-care settings, has traditionally involved doctor-led clinics. However, with increasing chronic disease burden, there is scope for nurses to expand their role in assisting diabetes self-management. AIMS This study aimed to determine the effectiveness of nurse-led care in reducing glycated haemoglobin in adults with Type 1 or 2 diabetes. METHODS Methodology from the Joanna Briggs Institute Method for Systematic Review Research and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, including identifying publications, assessing study quality, summarizing evidence and interpreting findings. The search strategy involved using the Medical Subject Headings and keyword variations when searching MEDLINE (Ovid), Scopus, PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Inclusion criteria were samples with Type 1 or 2 diabetes, mean age of ≥18 years, English language studies and publication date of January 2011-December 2021. RESULTS Overall, 34 articles from 16 countries met inclusion criteria. Though not always clinically significant, results indicated that nurse-led care had beneficial impacts on glycated haemoglobin values, with reductions from 0.03% to 2.0%. This was evident when nurses received formal training, used treatment algorithms, had limited medical support, utilized technology and offered defined culturally sensitive and appropriate diabetes care. CONCLUSIONS Findings support nurse-led Type 1 and 2 diabetes care. Although further research is required, changes may necessitate increased recognition of nurse-led care and funding. Nurse-led care models should differ according to health-care settings.
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Affiliation(s)
- Danielle Holloway
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Steven James
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Petrie, Queensland, Australia
| | - Elif Ekinci
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Judy Craft
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
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Yuksel M, Bektas H, Ozer ZC. The effect of nurse-led diabetes self-management programmes on glycosylated haemoglobin levels in individuals with type 2 diabetes: A systematic review. Int J Nurs Pract 2023; 29:e13175. [PMID: 37394284 DOI: 10.1111/ijn.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
AIMS This review aimed to examine the content, frequency, duration, and outcomes of nurse-led diabetes self-management programmes on glycosylated haemoglobin levels in individuals with type 2 diabetes. BACKGROUND Diabetes self-management programmes improve glycemic control in individuals with type 2 diabetes to acquire specific behavioural changes and develop effective problem-solving skills. DESIGN A systematic review was used in this study. DATA SOURCES PubMed, Science Direct, Cochrane Library, Web of Science, Ovid, CINAHL, Proquest and Scopus databases were searched for studies published in English until February 2022. The risk of bias was assessed using the Cochrane Collaboration tool. REVIEW METHODS This study followed the recommendations of the Cochrane 2022 guidelines and was reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis. RESULTS Eight studies with 1747 participants met the inclusion criteria. Interventions included telephone coaching, consultation services and individual and group education. The duration of the intervention ranged from 3 to 15 months. The results showed that nurse-led diabetes self-management programmes had positive and clinically significant effects on glycosylated haemoglobin levels in individuals with type 2 diabetes. CONCLUSION These findings highlight the important role of nurses in improving self-management and achieving glycemic control in individuals with type 2 diabetes. The positive outcomes of this review offer suggestions for health care professionals to develop effective self-management programnmes in type 2 diabetes treatment and care.
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Affiliation(s)
- Merve Yuksel
- Department of Internal Medicine Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
| | - Hicran Bektas
- Department of Internal Medicine Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
| | - Zeynep Canli Ozer
- Department of Internal Medicine Nursing, Akdeniz University Faculty of Nursing, Antalya, Turkey
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Hamasaki H. The Effects of Mindfulness on Glycemic Control in People with Diabetes: An Overview of Systematic Reviews and Meta-Analyses. MEDICINES (BASEL, SWITZERLAND) 2023; 10:53. [PMID: 37755243 PMCID: PMC10534311 DOI: 10.3390/medicines10090053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/20/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023]
Abstract
Background: Previous research has demonstrated the effectiveness of mindfulness interventions in improving glycemic control. By enhancing attention control, emotion regulation, and self-awareness, mindfulness shows promise in managing the lifestyle factors associated with cardiovascular disease risk. However, the impact of mindfulness on glycemic control in people with diabetes remains unclear. This overview aims to summarize the current evidence of the impact of mindfulness interventions on glycemic control in people with diabetes and propose suggestions for future research. Methods: The author searched electronic databases (PubMed/MEDLINE, Embase, and Cochrane Library) to identify relevant systematic reviews and meta-analyses. The current evidence regarding the effects of mindfulness on glycemic control in people with diabetes was summarized. Results: This review evaluated a total of five systematic reviews and meta-analyses of randomized controlled trials (RCTs). Mindfulness interventions show potential for improving glycemic control as measured by hemoglobin A1c (HbA1c) levels, as well as reducing stress, depression, and anxiety in people with diabetes. Four out of five systematic reviews and meta-analyses reported a significant reduction in HbA1c levels by approximately 0.3%. However, the available studies lacked adequate description of key characteristics of study subjects, such as body mass index, medication, and disease conditions, which are essential for assessing the impact of mindfulness on glycemic control. Moreover, there was significant heterogeneity in the intervention methods employed across the included RCTs. Conclusions: Mindfulness interventions are effective in improving glycemic control in people with type 2 diabetes. However, the overall quality of the reviewed studies raises uncertainty regarding the effectiveness of mindfulness as a treatment for people with diabetes. Further research is necessary to elucidate the biological effects of mindfulness on physiological, neurological, and endocrinological functions in humans.
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Li Y, Buys N, Ferguson S, Li Z, Shi YC, Li L, Sun J. The evaluation of cognitive-behavioral therapy-based intervention on type 2 diabetes patients with comorbid metabolic syndrome: a randomized controlled trial. Diabetol Metab Syndr 2023; 15:158. [PMID: 37461057 PMCID: PMC10351126 DOI: 10.1186/s13098-023-01100-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/27/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Cognitive behavior therapy (CBT) has been applied in intervention research in diabetes patients with satisfying results. However, there was no research on type 2 diabetes (T2DM) patients with comorbidities. This study aimed to investigate the effectiveness of CBT on psychological variables, behavior variables, quality of life, sleep quality, and physical variables among adult T2DM patients with comorbid metabolic syndrome (MS). METHODS 281 patients aged 18-75 years were recruited from Ningbo First Hospital in China from October 2021 to March 2022. Patients were randomized to the intervention group (IG, N = 148) or control group (CG, N = 133). Patients in the IG received 12 CBT-based sessions during a six-month intervention time. Patients in the CG received the usual care only. Univariate General Linear Model was used to analyze the effect of CBT-based interventions. The analysis was conducted by SPSS Version 28. RESULTS Results indicated that CBT-based intervention was superior in the following aspects: relieving depression symptoms: IG (4.11 ± 4.35 vs. 1.99 ± 2.12), CG (3.40 ± 3.26 vs. 2.32 ± 1.88), interaction effect (F = 4.074, P = 0.044); enhancing diabetes self-care behaviors: IG (26.79 ± 12.18 vs. 37.49 ± 10.83), CG (25.82 ± 13.71 vs. 31.96 ± 11.72), interaction effect (F = 5.242, P = 0.022); promoting the efficacy of CBT: IG (47.45 ± 6.83 vs. 50.76 ± 4.98), CG (46.74 ± 6.94 vs. 47.87 ± 5.11), interaction effect (F = 5.198, P = 0.023); improving subjective sleep quality: IG (0.93 ± 0.68 vs. 0.69 ± 0.63), CG (1.03 ± 0.72 vs. 1.01 ± 0.68), interaction effect (F = 3.927, P = 0.048). CONCLUSIONS The CBT-based intervention was beneficial in improving depression symptoms, diabetes self-care behaviors, the efficacy of CBT, and sleep quality in T2DM patients with comorbid MS. The downtrend of body mass index, systolic blood pressure, diastolic pressure, and glycated hemoglobin was larger in the intervention group but not to a significant level. TRIAL REGISTRATION This study has been prospectively registered at Australia New Zealand Clinical Trials Registry (Registration ID: ACTRN12621001348842 website: https://www.anzctr.org.au/trial/MyTrial.aspx ).
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Affiliation(s)
- Yanni Li
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Q4222, Australia
| | - Nicholas Buys
- Griffith Health, Griffith University, Gold Coast, QLD, Australia
| | | | - Zhiyong Li
- School of Mechanical, Medical & Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Yan-Chuan Shi
- Neuroendocrinology Group, Garvan Institute of Medical Research, Faculty of Medicine and Health, University of New South Wales, 384 Victoria St, Darlinghurst, Australia
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, 315010, Zhejiang Province, China.
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Q4222, Australia.
- Institute for Integrated Intelligence and Systems, Griffith University, Gold Coast, QLD, Australia.
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
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Dong N, Wang X, Yang L. The short- and long-term effects of cognitive behavioral therapy on the glycemic control of diabetic patients: a systematic review and meta-analysis. Biopsychosoc Med 2023; 17:18. [PMID: 37150826 PMCID: PMC10165773 DOI: 10.1186/s13030-023-00274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/18/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Glycemic control is an important issue in the treatment of diabetic patients. However, traditional methods, such as medication (the usual treatment), have limitations. Cognitive behavioral therapy (CBT) might be a useful option to help control the glycemic condition. The effects can be revealed by systemic review or meta-analysis of randomized clinical trials (RCT). METHODS A systematic search and a meta-analysis for the RCT were done of the short- and long-term effects of CBT on the glycemic control of diabetic patients in a comparison with the usual treatment. Nineteen RCT studies and 3,885 diabetic patients were enrolled in this meta-analysis. Subgroup analyses of types 1 and 2 diabetes and individual and group CBT were also performed. RESULTS Patients treated with CBT showed no significant difference in HbA1c when compared to the usual treatment within six months. However, CBT was more effective in reducing HbA1c when compared to usual treatment with at least six months of treatment duration [standardized mean difference: -0.44 (95% confidence interval (CI): -0.63 ~ -0.25), Z = 4.49]. Subgroup analysis of type 1 and 2 diabetic patients supported a long-term effect of CBT on glycemic control [standardized mean difference: -0.85 (95% CI: -1.19 ~ -0.10), Z = 2.23, standardized mean difference: -0.33 (95% CI:-0.47 ~ -0.19), Z = 4.52, respectively]. CONCLUSIONS CBT would be a useful option for improving the glycemic control of diabetic patients undergoing long-term treatment. The advantages of the long-term effects of CBT should be considered by clinicians and staff.
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Affiliation(s)
- Na Dong
- The Affiliated Nanhua Hospital, Department of Endocrinology, Hengyang Medical School, University of South China, Hengyang, Hunan, 421002, China
| | - Xiaowei Wang
- Department of Endocrinology, People's Hospital of Xinchang County, Zhejiang Province, Xinchang, 312500, China
| | - Liu Yang
- Department of Internal Medicine, Wuhan University Hospital, Wuhan, 430072, Hubei, China.
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Purba CIH, Johnston B, Kotronoulas G. An Exploration of Family Caregivers’ Health Care Needs When Caring for Patients With Cancer in the Resource-Challenged Context of West Java, Indonesia. Semin Oncol Nurs 2022:151369. [DOI: 10.1016/j.soncn.2022.151369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/15/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
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Correia JC, Waqas A, Huat TS, Gariani K, Jornayvaz FR, Golay A, Pataky Z. Effectiveness of Therapeutic Patient Education Interventions in Obesity and Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2022; 14:3807. [PMID: 36145181 PMCID: PMC9503927 DOI: 10.3390/nu14183807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 11/17/2022] Open
Abstract
Diabetes mellitus (DM) and obesity account for the highest burden of non-communicable diseases. There is increasing evidence showing therapeutic patient education (TPE) as a clinically and cost-effective solution to improve biomedical and psychosocial outcomes among people with DM and obesity. The present systematic review and meta-analysis present a critical synthesis of the development of TPE interventions for DM and obesity and the efficacy of these interventions across a range of biomedical, psychosocial and psychological outcomes. A total of 54 of these RCTs were identified among patients with obesity and diabetes and were thus qualitatively synthesized. Out of these, 47 were included in the quantitative synthesis. There was substantial heterogeneity in the reporting of these outcomes (I2 = 88.35%, Q = 317.64), with a significant improvement noted in serum HbA1c levels (standardized mean difference (SMD) = 0.272, 95% CI: 0.118 to 0.525, n = 7360) and body weight (SMD = 0.526, 95% CI: 0.205 to 0.846, n = 1082) in the intervention group. The effect sizes were comparable across interventions delivered by different modes and delivery agents. These interventions can be delivered by allied health staff, doctors or electronically as self-help programs, with similar effectiveness (p < 0.001). These interventions should be implemented in healthcare and community settings to improve the health outcomes in patients suffering from obesity and DM.
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Affiliation(s)
- Jorge C. Correia
- Unit of Therapeutic Patient Education, WHO Collaborating Centre, Division of Endocrinology, Diabetology, Nutrition and Therapeutic Patient Education, Geneva University Hospitals and University of Geneva, 1206 Geneva, Switzerland
| | - Ahmed Waqas
- Institute of Population Health, University of Liverpool, Liverpool L69 7ZA, UK
| | - Teoh Soo Huat
- Department of Community Health, Advanced Medical & Dental Institute, Universiti Sains Malaysia, 13200 Kepala Batas, Penang, Malaysia
| | - Karim Gariani
- Unit of Therapeutic Patient Education, WHO Collaborating Centre, Division of Endocrinology, Diabetology, Nutrition and Therapeutic Patient Education, Geneva University Hospitals and University of Geneva, 1206 Geneva, Switzerland
| | - François R. Jornayvaz
- Unit of Therapeutic Patient Education, WHO Collaborating Centre, Division of Endocrinology, Diabetology, Nutrition and Therapeutic Patient Education, Geneva University Hospitals and University of Geneva, 1206 Geneva, Switzerland
| | - Alain Golay
- Unit of Therapeutic Patient Education, WHO Collaborating Centre, Division of Endocrinology, Diabetology, Nutrition and Therapeutic Patient Education, Geneva University Hospitals and University of Geneva, 1206 Geneva, Switzerland
| | - Zoltan Pataky
- Unit of Therapeutic Patient Education, WHO Collaborating Centre, Division of Endocrinology, Diabetology, Nutrition and Therapeutic Patient Education, Geneva University Hospitals and University of Geneva, 1206 Geneva, Switzerland
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Ferreira MG, Mariano LI, Rezende JVD, Caramelli P, Kishita N. Effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms in adults: A meta-analysis. J Affect Disord 2022; 309:297-308. [PMID: 35489560 DOI: 10.1016/j.jad.2022.04.134] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/04/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND A comprehensive meta-analysis quantitatively examining the effects of group Acceptance and Commitment Therapy (ACT) on anxiety and depressive symptoms is required to advance our understanding of its efficacy and moderating factors. METHODS Four electronic databases were searched in August 2018. An update search was conducted in November 2021. Forty-eight randomised controlled trials (RCTs) were included in this review (3292 participants: anxiety = 34 RCTs, depression = 40 RCTs). RESULTS The overall effect size for anxiety symptoms was medium-to-large (g = 0.52, p < 0.001; 95% CI = 0.30-0.73), while the overall effect size was small-to-medium for depressive symptoms (g = 0.47, p < 0.001; 95% CI = 0.31-0.64). Subgroup analyses demonstrated that group ACT was significantly superior to non-active controls (e.g., waiting list) in reducing anxiety and depressive symptoms. Group ACT was only significantly superior to active controls (e.g., CBT) in reducing depressive symptoms. Subgroup analyses also demonstrated that the effect size can vary depending on the number of sessions provided and the primary condition of participants recruited. LIMITATIONS The number of studies included in each category of subgroup analyses was small and the risk of bias varied across studies. There was high heterogeneity among the included studies, and this might have affected the results. CONCLUSION The current evidence suggests that group ACT may be effective in treating anxiety and depressive symptoms, perhaps more so for depressive symptoms when compared to other well-established treatments. The intensity of treatment and the targeted population may need to be considered when delivering group ACT.
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Affiliation(s)
- Michele Gomes Ferreira
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil
| | - Luciano Inácio Mariano
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6.627, CEP: 31270-901 Belo Horizonte, MG, Brazil
| | - Junio Vieira de Rezende
- Programa de Pós-Graduação em Psicologia, Faculdade de Filosofia e Ciências Humanas, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6.627, Caixa Postal N° 253, CEP: 31270-901 Belo Horizonte, MG, Brazil
| | - Paulo Caramelli
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil; Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais. Av. Prof. Alfredo Balena, 190 - Santa Efigênia, CEP: 30130-100 Belo Horizonte, MG, Brazil.
| | - Naoko Kishita
- School of Health Science, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, United Kingdom.
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Li Y, Storch EA, Ferguson S, Li L, Buys N, Sun J. The efficacy of cognitive behavioral therapy-based intervention on patients with diabetes: A meta-analysis. Diabetes Res Clin Pract 2022; 189:109965. [PMID: 35718018 DOI: 10.1016/j.diabres.2022.109965] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/10/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Abstract
AIMS This meta-analysis aims to update former meta-analyses from randomized controlled trials (RCT) focused on the efficacy of CBT for diabetes. METHODS Five databases were searched for RCTs. Primary outcomes were glycated hemoglobin (HbA1c), fasting blood glucose (FBS), systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index (BMI). Secondary outcomes were depression, anxiety and distress symptoms, quality of life, sleep quality. RESULTS 32 RCTs were included. Results revealed that CBT could reduce HbA1c: -0.14% (95% CI: -0.25 to -0.02%, P = 0.020); FBS: -15.48 mg/dl (95% CI: -30.16 to -0.81 mg/dl, P = 0.040); DBP: -2.88 mmHg (95% CI: -4.08 to -1.69 mmHg, P < 0.001); depression symptoms: -0.90 (95% CI: -1.22 to -0.57, P < 0.001); anxiety symptoms: -0.28 (95% CI: -0.50 to -0.07, P = 0.009); improve sleep quality: -0.92 (95% CI: -1.77 to -0.07, P = 0.030). Subgroup analysis indicated that CBT has siginificantly reduced HbA1c when delivered as a group-based and face-to-face method, and psycho-education, behavioral, cognitive, goal-setting, homework assignment strategies were applied as central strategies. CONCLUSION CBT was an effective treatment for diabetes patients, significantly reduced their HbA1c, FBS, DBP, depression and anxiety symptoms, and improved sleep quality.
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Affiliation(s)
- Yanni Li
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland Q422, Australia
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
| | - Samantha Ferguson
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland Q422, Australia
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, Zhejiang Province 315010, China
| | - Nicholas Buys
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland Q422, Australia
| | - Jing Sun
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland Q422, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland Q422, Australia.
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García-Pérez L, Ramallo-Fariña Y, Vallejo-Torres L, Rodríguez-Rodríguez L, González-Pacheco H, Santos-Hernández B, García-Bello MA, Wägner AM, Carmona M, Serrano-Aguilar PG. Cost-effectiveness of multicomponent interventions in type 2 diabetes mellitus in a cluster randomised controlled trial: the INDICA study. BMJ Open 2022; 12:e058049. [PMID: 35396305 PMCID: PMC8995956 DOI: 10.1136/bmjopen-2021-058049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To analyse the cost-effectiveness of multicomponent interventions designed to improve outcomes in type 2 diabetes mellitus (T2DM) in primary care in the Canary Islands, Spain, within the INDICA randomised clinical trial, from the public health system perspective. DESIGN An economic evaluation was conducted for the within-trial period (2 years) comparing the four arms of the INDICA study. SETTING Primary care in the Canary Islands, Spain. PARTICIPANTS 2334 patients with T2DM without complications were included. INTERVENTIONS Interventions for patients (PTI), for primary care professionals (PFI), for both (combined intervention arm for patients and professionals, CBI) and usual care (UC) as a control group. OUTCOMES The main outcome was the incremental cost per quality-adjusted life-years (QALY). Only the intervention and the healthcare costs were included. ANALYSIS Multilevel models were used to estimate results, and to measure the size and significance of incremental changes. Missed values were treated by means of multiple imputations procedure. RESULTS There were no differences between arms in terms of costs (p=0.093), while some differences were observed in terms of QALYs after 2 years of follow-up (p=0.028). PFI and CBI arms were dominated by the other two arms, PTI and UC. The differences between the PTI and the UC arms were very small in terms of QALYs, but significant in terms of healthcare costs (p=0.045). The total cost of the PTI arm (€2571, 95% CI €2317 to €2826) was lower than the cost in the UC arm (€2750, 95% CI €2506 to €2995), but this difference did not reach statistical significance. Base case estimates of the incremental cost per QALY indicate that the PTI strategy was the cost-effective option. CONCLUSIONS The INDICA intervention designed for patients with T2DM and families is likely to be cost-effective from the public healthcare perspective. A cost-effectiveness model should explore this in the long term. TRIAL REGISTRATION NUMBER NCT01657227.
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Affiliation(s)
- Lidia García-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Laura Vallejo-Torres
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
| | - Leticia Rodríguez-Rodríguez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | | | | | | | - Ana María Wägner
- Department of Endocrinology and Nutrition, Insular University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
- University Institute for Biomedical and Health Research (iUIBS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Montserrat Carmona
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Health Technology Assessment Agency, Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro G Serrano-Aguilar
- Research Network on Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
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13
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Sakamoto R, Ohtake Y, Kataoka Y, Matsuda Y, Hata T, Otonari J, Yamane A, Matsuoka H, Yoshiuchi K. Efficacy of acceptance and commitment therapy for people with type 2 diabetes: Systematic review and meta-analysis. J Diabetes Investig 2022; 13:262-270. [PMID: 34486816 PMCID: PMC8847115 DOI: 10.1111/jdi.13658] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS/INTRODUCTION This systematic review and meta-analysis aimed to investigate the efficacy and safety of acceptance and commitment therapy (ACT) for people with type 2 diabetes mellitus. MATERIALS AND METHODS Several electronic databases were examined on 16 January 2021, including PubMed, CENTRAL, PsycINFO, International Clinical Trials Registry Platform and ClinicalTrials.gov. Randomized controlled trials were included to compare ACT with usual treatment for people with type 2 diabetes reported in any language. Primary outcome measures were glycated hemoglobin, self-care ability assessed by the summary of diabetes self-care activities and all adverse events. The secondary outcome measure was acceptance assessed by the acceptance and action diabetes questionnaire. RESULTS Of 678 publications initially identified, three trials were included in the meta-analysis. ACT resulted in a reduction in glycated hemoglobin (mean difference -0.62 points lower in the intervention group; 95% confidence interval -1.07 to -0.16; I2 = 0%; low-quality evidence). In addition, ACT increased the score of the summary of diabetes self-care activities (mean difference 8.48 points higher in the intervention group; 95% confidence interval 2.16-14.80; high-quality evidence). Adverse events were not measured in all trials. ACT increased scores of the acceptance and action diabetes questionnaire (mean difference 5.98 points higher in the intervention group; 95% confidence interval, 1.42-10.54; I2 = 43%; low-quality evidence). CONCLUSIONS ACT might reduce glycated hemoglobin, and increase self-care ability and acceptance among people with type 2 diabetes.
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Affiliation(s)
- Ryo Sakamoto
- Department of Psychosomatic MedicineFaculty of MedicineKindai UniversityOsakasayamaJapan
| | - Yoichi Ohtake
- Department of Internal MedicineItami Seifu HoupitalItamiJapan
- Department of Psychosomatic Internal Medicine a Palliative Care MedicineSakai City Medical CenterSakaiJapan
| | - Yuki Kataoka
- Department of Internal MedicineKyoto Min‐Iren Asukai HospitalKyotoJapan
- Systematic Review Workshop Peer Support Group (SRWS‐PSG)OsakaJapan
- Section of Clinical EpidemiologyDepartment of Community MedicineKyoto University Graduate School of MedicineKyotoJapan
- Department of Healthcare EpidemiologyGraduate School of Medicine and Public HealthKyoto UniversityKyotoJapan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal MedicineNational Hospital Organisation Kinki‐Chuo Chest Medical CenterSakaiJapan
| | - Tomokazu Hata
- Department of Psychosomatic MedicineGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Jun Otonari
- Department of Psychosomatic MedicineInternational University of Health and Welfare Narita HospitalChibaJapan
| | - Akira Yamane
- Department of Psychosomatic MedicineKansai Medical University HospitalHirakataJapan
| | | | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic MedicineGraduate School of MedicineThe University of TokyoTokyoJapan
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14
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Batalha APDB, Ponciano IC, Chaves G, Felício DC, Britto RR, da Silva LP. Behavior change interventions in patients with type 2 diabetes: a systematic review of the effects on self-management and A1c. J Diabetes Metab Disord 2021; 20:1815-1836. [PMID: 34900827 PMCID: PMC8630317 DOI: 10.1007/s40200-021-00846-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to identify the characteristics of interventions employed to promote behavior change in people with type 2 diabetes mellitus (T2DM) and their impact on disease self-management and glycated hemoglobin (A1c). METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to guide the protocol development for this systematic review. Randomized controlled clinical trials which compared behavior change interventions to controls in adults with T2DM and investigated disease self-management and glycated hemoglobin (A1c) measured by validated methods were eligible for this study. The risk of bias and quality of evidence was assessed respectively by Cochrane's tool and grading of recommendations, assessment, development, and evaluation (GRADE). RESULTS A total of 27 studies were included involving 4464 participants. Behavior change was mainly promoted by education sessions on diabetes care delivered face-to-face, monthly, or every other month, lasting more than 60 min, involving blood glucose monitoring, healthy eating, exercise, and medication. Four studies showed significant improvement in both disease self-management and A1c. The risk of bias was classified as high in most studies. A meta-analysis could not be performed for A1c and self-management due to the high differences in intervention parameters (delivery mode, number, duration, and frequency) and self-management assessments. CONCLUSION Low evidence of improvement in disease self-management and A1c considering only validated assessment methods were found for behavior change interventions, mainly promoted by education sessions on diabetes care. The quality of studies and probably the differences in intervention protocols contributed to this finding. PROSPERO NUMBER CRD42020161162.
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Affiliation(s)
- Ana Paula Delgado Bomtempo Batalha
- Graduate Program in Rehabilitation and Physical-Functional Performance Sciences, Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil
| | - Isabela Coelho Ponciano
- Graduate Program in Rehabilitation and Physical-Functional Performance Sciences, Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil
| | | | - Diogo Carvalho Felício
- Graduate Program in Rehabilitation and Physical-Functional Performance Sciences, Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil
- Faculty of Physical Therapy, UFJF, Juiz de Fora, MG Brazil
| | - Raquel Rodrigues Britto
- Graduate Program in Rehabilitation and Physical-Functional Performance Sciences, Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil
- Graduate Program in Rehabilitation Science, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG Brazil
| | - Lilian Pinto da Silva
- Graduate Program in Rehabilitation and Physical-Functional Performance Sciences, Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil
- Faculty of Physical Therapy, UFJF, Juiz de Fora, MG Brazil
- Cardiovascular Research and Exercise Physiology Unit, University Hospital, UFJF, Juiz de Fora, MG Brazil
- Faculty of Physiotherapy, Federal University of Juiz de Fora, Av. Eugenio do Nascimento S/N Bairro Dom Bosco, Juiz de Fora, MG CEP: 36038-330 Brazil
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15
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Guo J, Wang H, Ge L, Valimaki M, Wiley J, Whittemore R. Effectiveness of a nurse-led mindfulness stress-reduction intervention on diabetes distress, diabetes self-management, and HbA1c levels among people with type 2 diabetes: A pilot randomized controlled trial. Res Nurs Health 2021; 45:46-58. [PMID: 34741544 DOI: 10.1002/nur.22195] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/05/2021] [Accepted: 10/24/2021] [Indexed: 11/09/2022]
Abstract
People with diabetes frequently have elevated diabetes distress. Although mindfulness-based stress reduction (MBSR) therapy has been shown effective in reducing diabetes distress, it has only been delivered by psychologists or a multidisciplinary team with an attrition rate of up to 39%, which limits its dissemination to a broader audience. This study was aimed to pilot evaluate the feasibility of a nurse-led MBSR therapy and explore its potential efficacy amongst people with type 2 diabetes mellitus. A total of 100 participants were randomly allocated either to the intervention group (nurse-led MBSR therapy + regular diabetes education) or the control group (regular diabetes education). Data on diabetes distress, diabetes self-efficacy, and diabetes self-management were collected at baseline, 8 and 12 weeks. Hemoglobin A1c (HbA1c) was collected at baseline and 12 weeks. A generalized estimating equation analysis for repeated measures was used to determine intervention and time effects. As predicted, the nurse-led MBSR therapy had a significant time-by-group interaction effect on diabetes distress total score (95% confidence interval [CI]: 0.58-0.77, p < 0.001), diabetes self-efficacy (95% CI: -0.93 to -0.74, p < 0.001), diabetes self-management (95% CI: -10.80 to -7.83, p < 0.001), and HbA1c levels (95% CI: 0.04-1.14, p = 0.03) in the intervention group compared with the control group over 12 weeks. This is the first nurse-led MBSR therapy in a hospital setting that is feasible and has the potential to improve health outcomes. This approach may offer an innovative model to deliver MBSR therapy. A randomized controlled trial comparing the nurse-led MBSR plus usual diabetes education with usual diabetes education along with a mechanism to equalize intervention attention between the groups is indicated.
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Affiliation(s)
- Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Hongjuan Wang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Lin Ge
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.,Department of endocrinology, The Second People's Hospital of Hunan Province, Changsha, Hunan, China
| | - Maritta Valimaki
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - James Wiley
- Department of Family and Community Medicine, Institute for Health Policy Research, University of California, San Francisco, California, USA
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16
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Whitehead L, Glass C, Coppell K. The effectiveness of goal setting on glycaemic control for people with type 2 diabetes and prediabetes: A systematic review and meta-analysis. J Adv Nurs 2021; 78:1212-1227. [PMID: 34716594 DOI: 10.1111/jan.15084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/24/2021] [Accepted: 10/16/2021] [Indexed: 11/29/2022]
Abstract
AIM This review assessed the effectiveness of interventions using a goal-setting approach on glycaemic control for people diagnosed with prediabetes or type 2 diabetes. DESIGN A systematic review guided by the Joanna Briggs Institute methodology for conducting systematic reviews of primary research studies was conducted. DATA SOURCES Randomized controlled trials and experimental studies with a minimum follow-up period of 6 months were considered for inclusion. The primary outcome was change in glycaemic control as measured by glycated haemoglobin (%) and/or fasting plasma glucose (mg/dl). A systematic search of seven electronic databases was completed in October 2020. REVIEW METHODS Papers meeting the inclusion criteria were critically appraised using the Joanna Briggs Institute tools for critical appraisal followed by data extraction. A Grading of Recommendations Assessment, Development and Evaluation assessment was conducted to assess the overall certainty of the evidence. Fixed-effect meta-analyses were completed to demonstrate the mean effect for each outcome of interest. RESULTS Twenty one studies were included in this review. Goal setting was more effective than usual care for glycaemic control in prediabetes at 6 months and at 12 months for fasting plasma glucose (mg/dl) and glycated haemoglobin (%). Goal setting was more effective than usual care for glycaemic control in type 2 diabetes for fasting plasma glucose (mg/dl) at 6 months, fasting plasma glucose (mg/dl) at 12 months, glycated haemoglobin (%) at 6 months and glycated haemoglobin (%) at 12 months. CONCLUSION The evidence suggests goal setting is effective in supporting people to achieve glycaemic targets in prediabetes and type 2 diabetes.
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Affiliation(s)
- Lisa Whitehead
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Courtney Glass
- Edith Cowan University, Joondalup, Western Australia, Australia
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17
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Ferreira GRS, Viana LRDC, Pimenta CJL, Silva CRRD, Costa TFD, Oliveira JDS, Costa KNDFM. Self-care of elderly people with diabetes mellitus and the nurse-patient interpersonal relationship. Rev Bras Enferm 2021; 75:e20201257. [PMID: 34614076 DOI: 10.1590/0034-7167-2020-1257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/24/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To analyze the self-care activities of elderly people with diabetes mellitus and its correlation with the nurse-patient interpersonal relationship. METHODS Cross-sectional quantitative study, with 144 elderly people followed up in Family Health Units, with data collected by the Diabetes Self-Care Activities Questionnaire and Interpersonal Relationship Questionnaire in Nursing Care, being analyzed by descriptive and inferential statistics. RESULTS There was a greater accomplishment of the activities Take insulin injections as recommended (6.74), Take diabetes medications as recommended (6.55) and Take the indicated number of diabetes pills (6.52). The interpersonal relationship showed moderate effectiveness (80.6%). The correlation between self-care with diabetes and interpersonal relationships showed a positive and significant value in the dimension Specific feeding. CONCLUSION The effectiveness of the interpersonal relationship in nursing care resulted in greater compliance with activities related to specific food.
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18
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Rashidi A, Whitehead L, Newson L, Astin F, Gill P, Lane DA, Lip GYH, Neubeck L, Ski CF, Thompson DR, Walthall H, Jones ID. The Role of Acceptance and Commitment Therapy in Cardiovascular and Diabetes Healthcare: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8126. [PMID: 34360420 PMCID: PMC8345942 DOI: 10.3390/ijerph18158126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 12/16/2022]
Abstract
Acceptance and commitment therapy (ACT) is an adapted form of cognitive behavioural therapy. ACT focuses on how thinking affects behaviour and promotes psychological flexibility. The prevalence of psychological distress among people living with cardiovascular disease (CVD) and/or type 2 diabetes mellitus (T2DM) is high, and ACT may offer an alternative treatment approach. This scoping review explored the use of ACT as an intervention to support adults living with CVD and/or T2DM. A systematic search of the literature resulted in the inclusion of 15 studies. Studies were reviewed using the Joanna Briggs Institute approach to conducting scoping reviews. Most studies (n = 13) related to people living with T2DM, and most (n = 10) used a pre-post design, four studies were randomised controlled trials, and one was a qualitative study. Eight studies reported an improvement in the outcome(s) assessed post-intervention, suggesting that ACT was an acceptable and valid intervention to support people living with CVD or T2DM. However, studies were underpowered and only limited studies involved people living with CVD. ACT was assessed as a valuable approach to improve a range of patient-reported outcomes for those living with CVD or T2DM, and further research involving robust study designs and larger cohorts are warranted.
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Affiliation(s)
- Amineh Rashidi
- School of Nursing and Midwifery, Joondalup Campus, Edith Cowan University, Perth 6207, Australia;
| | - Lisa Whitehead
- School of Nursing and Midwifery, Joondalup Campus, Edith Cowan University, Perth 6207, Australia;
| | - Lisa Newson
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool L3 3AF, UK;
| | - Felicity Astin
- Centre for Applied Research in Health, University of Huddersfield and Calderdale and Huddersfield National Health Service Foundation Trust, Huddersfield HD1 3DH, UK; or
| | - Paramjit Gill
- Division of Health Sciences, University of Warwick, Coventry CV4 7AL, UK;
| | - Deirdre A. Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L7 8TX, UK; (D.A.L.); (G.Y.H.L.)
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L7 8TX, UK; (D.A.L.); (G.Y.H.L.)
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK;
| | - Chantal F. Ski
- Integrated Care Academy, University of Suffolk, Ipswich IP4 1QJ, UK;
| | - David R. Thompson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK;
| | - Helen Walthall
- NIHR Oxford Biomedical Research Centre, The Joint Research Office, Second Floor, OUH Cowley, Unipart House Business Centre, Garsington Road, Oxford OX4 2PG, UK;
| | - Ian D. Jones
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L2 2ER, UK;
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19
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Martos-Cabrera MB, Gómez-Urquiza JL, Cañadas-González G, Romero-Bejar JL, Suleiman-Martos N, Cañadas-De la Fuente GA, Albendín-García L. Nursing-Intense Health Education Intervention for Persons with Type 2 Diabetes: A Quasi-Experimental Study. Healthcare (Basel) 2021; 9:832. [PMID: 34356210 PMCID: PMC8307700 DOI: 10.3390/healthcare9070832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/04/2022] Open
Abstract
Type 2 diabetes mellitus (DM2) is a highly prevalent disease, the progression of which depends on high blood glucose levels, which are reflected in the level of glycosylated haemoglobin (HbA1c). Appropriate health education equips patients with the knowledge and skills to control their glucose and HbA1c levels to avoid long-term complications. This study was set up to compare the results of an intensive (360 min) educational intervention to improve HbA1c parameters in patients with DM2 with those of a usual 90 min intervention. For this purpose, healthcare personnel led a quasi-experimental study of 249 diabetics: 171 in the control group, and 78 in the intervention group. In the control group, the mean HbA1c value decreased from 6.97 to 6.75, while in intervention group it fell from 8.97 to 8.06. The before and after mean difference between both groups was compared with a Wilcoxon test, and the results statistically significant (W = 4530; p < 0.001), indicating a higher reduction of HbA1c in the intervention group. We concluded that the intensive health education provided by nurses during the consultation helped improve HBA1c levels in persons with DM2.
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Affiliation(s)
- María Begoña Martos-Cabrera
- Neonatal Intensive Care Unit, University Hospital San Cecilio, Avenida del Conocimiento, 18016 Granada, Spain;
| | - José Luis Gómez-Urquiza
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración, 60, 18016 Granada, Spain; (J.L.G.-U.); (N.S.-M.); (G.A.C.-D.l.F.)
| | - Guillermo Cañadas-González
- Support Device South Area of Cordoba, Andalusian Health Service, Av. Góngora, 9B, Cabra, 14940 Córdoba, Spain;
| | - José Luis Romero-Bejar
- Department of Statistics and Operational Research, University of Granada, 18071 Granada, Spain
| | - Nora Suleiman-Martos
- Faculty of Health Sciences, University of Granada, Avenida de la Ilustración, 60, 18016 Granada, Spain; (J.L.G.-U.); (N.S.-M.); (G.A.C.-D.l.F.)
| | | | - Luis Albendín-García
- Casería de Montijo Health Center, Granada Metropolitan District, Andalusian Health Service, Calle Virgen de la Consolación, 12, 18015 Granada, Spain;
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20
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Daly BM, Arroll B, Scragg RKR. Trends in diabetes care and education by primary health care nurses in Auckland, New Zealand. Diabetes Res Clin Pract 2021; 177:108903. [PMID: 34102248 DOI: 10.1016/j.diabres.2021.108903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/04/2021] [Accepted: 06/03/2021] [Indexed: 11/24/2022]
Abstract
AIMS To examine trends in the management of patients with diabetes by primary health care nurses, its association with diabetes education and how valued and supported nurses feel in Auckland, New Zealand. METHODS Two representative cross-sectional surveys of all nurses providing community-based care, and patients with diabetes they consult, were conducted in 2006-8 and 2016. All participants completed a self-administered questionnaire on biographical details and a telephone interview on their provision of diabetes care. RESULTS Significantly more nurses discussed serum glucose and medications with patients, planned follow-up and scheduled practice nurse appointments in 2016 compared with 2006-8, and fewer specialist diabetologist appointments were made (12% versus 2%). Fewer nurses in 2016 than in 2006-8 felt valued (62% versus 75%) and supported (78% versus 89%) when managing patients (p-values = 0.0004). Nurses diabetes education was associated with recommended practice and feeling valued. Significantly more patients were prescribed metformin (81%) and insulin (46%) in 2016 compared with 58% and 30% in 2006-8. Despite this, HbA1c levels remained unchanged. CONCLUSIONS Prescribed glycaemic-related medications increased, and more nurses engaged with patients about glycaemic control and medications in 2016 compared with 2006-8. Nurses undertaking diabetes education was strongly associated with best management practices and nurses feeling valued.
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Affiliation(s)
- Barbara M Daly
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1142, New Zealand.
| | - Bruce Arroll
- School of Population Health, University of Auckland, New Zealand
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21
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Anderson G, Casasanta D, Motta PC, Sacco E, Cocchieri A, Damiani G, Rega ML. Diabetic education in nursing: A Rodgers' evolutionary concept analysis. Nurs Forum 2021; 56:986-992. [PMID: 34076893 DOI: 10.1111/nuf.12620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022]
Abstract
AIM This concept analysis aims to clarify the concept of diabetic education in nursing to provide guidance for the further conceptualization and clarification of diabetic education in nursing. BACKGROUND Patient education is a fundamental component of diabetes care. Nurses have taken up a major role in educating people with diabetes to manage their conditions. However, the exact meaning of diabetic education in nursing remains challenging. DESIGN Rodgers' evolutionary method of concept analysis was performed to explore the concept of diabetic education in nursing. DATA SOURCE We conducted a literature search on Cumulative Index to Nursing and Allied Health Literature (CINAHL), MedLine, and PsycInfo for works published until October 2020 using "patient education," "diabetes," and "nursing" as key terms. RESULTS The concept analysis revealed that key attributes of diabetic education in nursing include patient-centered and interactive approaches, planning, and problem solving. Antecedents related to individuals with diabetes are their backgrounds, needs, and motivations, while the antecedents related to nurses are experience and attitude. Finally, three different consequences of the concept emerged: an increase in knowledge and skills, a behavioral change, and the improvement of clinical outcomes.
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Affiliation(s)
- Gloria Anderson
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Daniela Casasanta
- Department of Occupational Medicine Unit, UdR & HTA Research Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Paolo Carlo Motta
- Department of Public Health, University of Brescia vl., Brescia, Italy
| | - Eugenio Sacco
- Azienda Ospedaliera-Universitaria Sant'Andrea, Rome, Italy
| | - Antonello Cocchieri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Damiani
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Luisa Rega
- School of Nursing, Università Cattolica del Sacro Cuore, Rome, Italy
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Ngan HY, Chong YY, Chien WT. Effects of mindfulness- and acceptance-based interventions on diabetes distress and glycaemic level in people with type 2 diabetes: Systematic review and meta-analysis. Diabet Med 2021; 38:e14525. [PMID: 33438251 DOI: 10.1111/dme.14525] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 12/24/2022]
Abstract
AIM For people with type 2 diabetes, self management and fear of disease complication often cause psychological distress. Mindfulness and acceptance might be beneficial for reducing diabetes-related distress and glycaemic level. We systematically review the effects of mindfulness- and acceptance-based interventions on diabetes distress and glycaemic level in community-dwelling adults with type 2 diabetes. METHODS Seven electronic databases (English and Chinese) were searched comprehensively from inception to June 2020. Data extraction and methodological quality assessment were independently performed by two reviewers using Grading of Recommendations, Assessment, Development and Evaluations criteria. RESULTS Nine RCTs (801 participants) examining the effects of acceptance and commitment therapy, mindfulness-based cognitive therapy, mindfulness-based stress reduction and self-directed mindfulness practice were included. In the reviewed RCTs, the majority of participants (mean age: 50-66 years, average disease duration: 4-10 years) had suboptimal diabetes control (HbA1c >7.0%, 53 mmol/mol). Compared with controls, the interventions significantly reduced diabetes distress (standardised mean difference, SMD = -0.37, 95% confidence intervals, CI: -0.63, -0.12; p < 0.01) and HbA1c (mean difference, MD = -0.35, 95% CI: -0.67, -0.04; p = 0.03) up to 1-month post-intervention. However, the underpowered studies may have led to overestimation, the interventions for diabetes distress and HbA1c were heterogeneous. CONCLUSIONS Within evidenced-based diabetes education programmes, mindfulness- and acceptance-based approaches may reduce distress and HbA1c levels and promote self care in people with type 2 diabetes. Further controlled trials are recommended to examine the clinical effectiveness of such programmes for people with type 2 diabetes of diverse clinical, cultural and socio-demographic backgrounds.
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Affiliation(s)
- Hau Yi Ngan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yuen Yu Chong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Zhang HZ, Zhang P, Chang GQ, Xiang QY, Cao H, Zhou JY, Dong ZM, Qiao C, Xu CR, Qin Y, Lou PA. Effectiveness of cognitive behavior therapy for sleep disturbance and glycemic control in persons with type 2 diabetes mellitus: A community-based randomized controlled trial in China. World J Diabetes 2021; 12:292-305. [PMID: 33758648 PMCID: PMC7958479 DOI: 10.4239/wjd.v12.i3.292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/09/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus (T2DM), and often negatively related with glycemic control. Cognitive behavioral therapy (CBT) may improve sleep quality and reduce blood sugar levels in patients with T2DM. However, it is not entirely clear whether CBT delivered by general practitioners is effective for poor sleep quality in T2DM patients in community settings.
AIM To test the effect of CBT delivered by general practitioners in improving sleep quality and reducing glycemic levels in patients with T2DM in community.
METHODS A cluster randomized controlled trial was conducted from September 2018 to October 2019 in communities of China. Overall 1033 persons with T2DM and poor sleep quality received CBT plus usual care or usual care. Glycosylated hemoglobin A1c (HbAlc) and sleep quality [Pittsburgh Sleep Quality Index (PSQI)] were assessed. Repeated measures analysis of variance and generalized linear mixed effects models were used to estimate the intervention effects on hemoglobin A1c and sleep quality.
RESULTS The CBT group had 0.64, 0.50, and 0.9 lower PSQI scores than the control group at 2 mo, 6 mo, and 12 mo, respectively. The CBT group showed 0.17 and 0.43 lower HbAlc values than the control group at 6 mo and 12 mo. The intervention on mean ΔHbAlc values was significant at 12 mo (t = 3.68, P < 0.01) and that mean ΔPSQI scores were closely related to ΔHbAlc values (t = 7.02, P < 0.01). Intention-to-treat analysis for primary and secondary outcomes showed identical results with completed samples. No adverse events were reported.
CONCLUSION CBT delivered by general practitioners, as an effective and practical method, could reduce glycemic levels and improve sleep quality for patients with T2DM in community.
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Affiliation(s)
- Huai-Zhong Zhang
- Department of Psychiatry, Xuzhou Third People’s Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Pan Zhang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
| | - Gui-Qiu Chang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
| | - Quan-Yong Xiang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu Province, China
| | - Huan Cao
- Department of Psychiatry, Xuzhou Third People’s Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Jin-Yi Zhou
- Department of Control and Prevention of Chronic Non-communicable Diseases, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu Province, China
| | - Zong-Mei Dong
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
| | - Cheng Qiao
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
| | - Chun-Rong Xu
- Department of Psychiatry, Xuzhou Third People’s Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Yu Qin
- Department of Control and Prevention of Chronic Non-communicable Diseases, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu Province, China
| | - Pei-An Lou
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
- Department of Epidemiology and Health Statistics, Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
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24
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Yuan Z, Jiao N, Liu X, Liu C. The effect of web-based educational intervention on psychological status and blood glucose in newly diagnosed patients with diabetes type 2 in rural China: A protocol for randomized trial. Medicine (Baltimore) 2021; 100:e24937. [PMID: 33663132 PMCID: PMC7909169 DOI: 10.1097/md.0000000000024937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND No studies were located which used a web-based educational intervention to improve the knowledge about newly diagnosed type 2 diabetes mellitus (T2DM). Therefore, the primary objective of the present study was to evaluate the efficacy of web-based educational intervention on psychological outcomes and glycemic control in newly diagnosed T2DM in rural China. METHODS This work is a part of a comprehensive research project to assess and provide educational intervention that potentially improve psychological status and blood glucose among patients with T2DM. Eligibility criteria for the study includes newly diagnosed with T2DM, adult patients (age ≥30 years) regardless of gender; speak and understand Chinese languages; having no significant comorbidity; being not involved in any trial/study related to diabetes during last 3 months and able to attend regular visits. Eligible participants were divided into 2 groups according to completely randomized design: education group and control group. The outcomes included fasting blood glucose level, EQ-5D-3L questionnaire, Self-rating Anxiety Scale, and Self-rating Depression Scale. RESULTS This protocol will provide a reliable theoretical basis for the following research. CONCLUSION The sample came from a single health centre. Therefore, the results can not be generalized for the entire population. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry6511).
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Affiliation(s)
| | | | - Xiaoli Liu
- Department of Endocrinology, Chengyang People's Hospital, Qingdao, China
| | - Changjiang Liu
- Department of Endocrinology, Chengyang People's Hospital, Qingdao, China
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25
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Arabiat D, Whitehead L, Abu Sheikh B, Afrifa-Yamoah E. Confirmatory Factor Analysis and Reliability of the Diabetes Treatment Satisfaction Questionnaire (DTSQ) for Arabic Speaking Patients with Type II Diabetes. J Multidiscip Healthc 2020; 13:953-961. [PMID: 33061402 PMCID: PMC7520120 DOI: 10.2147/jmdh.s266913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/06/2020] [Indexed: 11/23/2022] Open
Abstract
Background Treatment satisfaction is an important indicator for treatment compliance and glycemic control. Although psychometric properties of the Diabetes Treatment Satisfaction Questionnaire have been confirmed in several languages, it remains unclear the extent to which the factorial structure of this tool is valid for Arabic speaking populations. Purpose This study set out to confirm the construct validity of the Arabic version of the Diabetes Treatment Satisfaction Questionnaire (DTSQ) by investigating the fit of published factor structures and the reliability of responses in patients diagnosed with type 2 diabetes. Methods Data were from a large cross-sectional study of 1002 patients with diabetes in Jordan. Confirmatory factor analysis was used to compare three different models of the 8-item questionnaire (one factor, two factors, three factors) across patients treated with insulin and patients treated with oral hypoglycaemic medications. Results Statistics covered the factorial validity and omega reliability coefficient (Ωw) of the DTSQ. We were able to replicate the three different models of the 8-item Diabetes Treatment Satisfaction Questionnaire reported in previous studies, yet a two-factor model provided the best fit to the data in our sample with omega reliability coefficient (Ωw) of the subscales above 0.70. Conclusion The finding suggests a cross-cultural invariance of the factor structure of the Arabic version of the Diabetes Treatment Satisfaction Questionnaire, as we were able to replicate the same factor structure using the Arabic translated version of the tool and using non-English speaking participants. Within known limitations and gaps in the literature, healthcare professionals working with Arabic speaking patients may find this tool useful for identification of high-risk patients and those in need for interventions to promote glycemic control.
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Affiliation(s)
- Diana Arabiat
- Edith Cowan University, School of Nursing and Midwifery, Joondalup, Perth, WA 6027, Australia.,Maternal and Child Nursing Department, The University of Jordan, Amman 11942, Jordan
| | - Lisa Whitehead
- Edith Cowan University, School of Nursing and Midwifery, Joondalup, Perth, WA 6027, Australia.,University of Otago, Postgraduate Centre for Nursing Studies, Christchurch, New Zealand
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26
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Are diabetes self-management programmes for the general diabetes population effective for people with severe mental illness?: a systematic review. BMC Psychiatry 2020; 20:386. [PMID: 32711492 PMCID: PMC7382073 DOI: 10.1186/s12888-020-02779-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 07/05/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diabetes self-management education programmes are effective in improving health outcomes in the general population with diabetes. However, it is not known if these programmes include people who also have a severe mental illness (SMI) and, if so, what their outcomes are. The aim of this review was to examine if evaluations of diabetes self-management education programmes included people with SMI, and if so, whether the interventions were beneficial for this population. METHODS The inclusion criteria for this systematic review, defined by PICOS criteria, were: Population - Adults with type 2 diabetes; Intervention - self-management education programme; Comparator - another active intervention or usual care; Outcomes of interest - inclusion of people with SMI and the clinical, behavioural and psychosocial outcomes in this population; Study design - randomised controlled trials. The following bibliographic databases were searched from January 2004 to April 2018: Cochrane Library, Medline, Embase, PsychINFO, Allied and Complimentary Medicine Database, Health Technology Assessment, NHS Economic Evaluations Database and CINAHL. Data were extracted on study characteristics, inclusion and exclusion criteria, participant and intervention characteristics, number of participants with SMI, and outcomes for people with SMI, if reported. Authors were contacted by email for missing data. RESULTS A total of 410 trials were included. At least 42% of trials did not recruit any participants with SMI. Only nine confirmed inclusion of participants with SMI, of which six provided data on the number recruited. These six trials recruited a total of 1009 participants, of whom 31 (3.1%) had SMI. It was not possible to assess intervention effectiveness for people with SMI as none of the trials reported outcomes for these participants. CONCLUSIONS This systematic review confirms that people with SMI are often excluded from trials of diabetes self-management education, resulting in a lack of an evidence base on which to base treatment paths for this vulnerable population. It cannot be assumed that programmes developed for the general diabetes population meet the needs of people with SMI. Future research needs to examine if and how these programmes could be adapted for people with SMI or if new programmes are required.
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27
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Philpot LM, Khokhar BA, DeZutter MA, Loftus CG, Stehr HI, Ramar P, Madson LP, Ebbert JO. Creation of a Patient-Centered Journey Map to Improve the Patient Experience: A Mixed Methods Approach. Mayo Clin Proc Innov Qual Outcomes 2019; 3:466-475. [PMID: 31993565 PMCID: PMC6978601 DOI: 10.1016/j.mayocpiqo.2019.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective To use a mixed methods approach to focus quality improvement efforts to enhance patient experience through human-centered design. Patients and Methods A mixed method approach began with returned Press Ganey Medical Practice Surveys from a large, multidisciplinary, outpatient medicine practice from July 1, 2016, through June 30, 2017, using correlation and gap analysis. The second phase deployed human-centered design approaches to process map patient journeys and generate opportunities for care improvement and to generate a theoretical framework for designing optimal care experiences. Results Our outpatient medical practices have the greatest ability to improve patient experience scores by focusing on how care teams deliver and educate patients on medications, instructions for follow-up care, and explanations about problems or conditions. By leveraging communication, the expertise of our care team members, and connection between patients and care team members, we can employ a variety of observed opportunities to enhance patient experience. Specific opportunities include leveraging tools in the electronic health record, fostering connection through empathy between patients and members of the care team, and capitalizing on the expertise of nurses on the care team. Conclusion A mixed methods approach to the analysis and observation of clinical care and business operations allows for the detection of opportunities with the highest potential impact for improvement when resources are constrained.
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Affiliation(s)
- Lindsey M Philpot
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.,Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Bushra A Khokhar
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Meredith A DeZutter
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Conor G Loftus
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Heidi I Stehr
- Office of Patient Experience, Mayo Clinic, Rochester, MN
| | - Priya Ramar
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Lukas P Madson
- Office of Patient Experience, Mayo Clinic, Rochester, MN
| | - Jon O Ebbert
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.,Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN
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28
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Massey CN, Feig EH, Duque-Serrano L, Wexler D, Moskowitz JT, Huffman JC. Well-being interventions for individuals with diabetes: A systematic review. Diabetes Res Clin Pract 2019; 147:118-133. [PMID: 30500545 PMCID: PMC6370485 DOI: 10.1016/j.diabres.2018.11.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/19/2018] [Accepted: 11/21/2018] [Indexed: 12/25/2022]
Abstract
In patients with diabetes, psychological well-being constructs (e.g., optimism, positive affect) have been associated with superior medical outcomes, including better glucose control and lower mortality rates. Well-being interventions may be well-suited to individuals with diabetes, as they are simple to deliver, broadly applicable across a range of psychological distress, and may help increase self-efficacy and motivation for diabetes self-care. This systematic review, completed using PRISMA guidelines, examined peer-reviewed studies indexed in PubMed, PsycINFO, and/or Scopus between database inception and October 2017 that investigated the effects of well-being interventions (e.g., positive psychology interventions, mindfulness-based interventions, resilience-based interventions) on psychological and physical health outcomes in individuals with Type 1 or Type 2 diabetes. The search yielded 34 articles (N = 1635 participants), with substantial variability in intervention type, measures used, and outcomes studied; the majority found the intervention to provide benefit. Overall, results indicate that a range of well-being interventions appear to have promise in improving health outcomes in this population, but the literature does not yet provide definitive data about which specific interventions are most effective. The variability in interventions and outcomes points to a need for further rigorous, controlled, and well-powered studies of specific interventions, with well-accepted, clinically relevant outcome measures.
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Affiliation(s)
- Christina N Massey
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emily H Feig
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Laura Duque-Serrano
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Deborah Wexler
- Harvard Medical School, Boston, MA, USA; Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Judith Tedlie Moskowitz
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Amsberg S, Wijk I, Livheim F, Toft E, Johansson UB, Anderbro T. Acceptance and commitment therapy (ACT) for adult type 1 diabetes management: study protocol for a randomised controlled trial. BMJ Open 2018; 8:e022234. [PMID: 30498037 PMCID: PMC6278833 DOI: 10.1136/bmjopen-2018-022234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Integrating diabetes self-management into daily life involves a range of complex challenges for affected individuals. Environmental, social, behavioural and emotional psychological factors influence the lives of those with diabetes. The aim of this study is to evaluate the impact of a stress management group intervention based on acceptance and commitment therapy (ACT) among adults living with poorly controlled type 1 diabetes. METHODS AND ANALYSIS This study will use a randomised controlled trial design evaluating treatment as usual (TAU) and ACT versus TAU. The stress management group intervention will be based on ACT and comprises a programme divided into seven 2-hour sessions conducted over 14 weeks. A total of 70 patients who meet inclusion criteria will be recruited over a 2-year period with follow-up after 1, 2 and 5 years.The primary outcome measure will be HbA1c. The secondary outcome measures will be the Depression Anxiety Stress Scales, the Swedish version of the Hypoglycemia Fear Survey, the Swedish version of the Problem Areas in Diabetes Scale, The Summary of Self-Care Activities, Acceptance Action Diabetes Questionnaire, Swedish Acceptance and Action Questionnaire and the Manchester Short Assessment of Quality of Life. The questionnaires will be administered via the internet at baseline, after sessions 4 (study week 7) and 7 (study week 14), and 6, 12 and 24 months later, then finally after 5 years. HbA1c will be measured at the same time points.Assessment of intervention effect will be performed through the analysis of covariance. An intention-to-treat approach will be used. Mixed-model repeated measures will be applied to explore effect of intervention across all time points. ETHICS AND DISSEMINATION The study has received ethical approval (Dnr: 2016/14-31/1). The study findings will be disseminated through peer-reviewed publications, conferences and reports to key stakeholders. TRIAL REGISTRATION NUMBER NCT02914496; Pre-results.
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Affiliation(s)
- Susanne Amsberg
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Ingrid Wijk
- Department of Nursing Science, Sophiahemmet University College, Stockholm, Sweden
| | - Fredrik Livheim
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eva Toft
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Ersta Hospital, Stockholm, Sweden
| | - Unn-Britt Johansson
- Department of Nursing Science, Sophiahemmet University College, Stockholm, Sweden
- Department of Clinical Sciences and Education, Södersjukhuset, Stockholm, Sweden
| | - Therese Anderbro
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
- Department of psychology, Stockholm University, Stockholm, Sweden
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30
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Whitehead L. Interventions to increase attendance for diabetic retinopathy screening: A cochrane review summary. Int J Nurs Stud 2018; 100:103229. [PMID: 30352706 DOI: 10.1016/j.ijnurstu.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Western Australia, Australia.
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31
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Affiliation(s)
- Lisa Whitehead
- a School of Nursing and Midwifery , Edith Cowan University , Joondalup , Western Australia , Australia
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