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Thesis (Ph.D. (Public Health)) -- University of Limpopo, 2022 / Background: The increase in diabetes prevalence is often accompanied by comorbidities and complications, which negatively impact on the quality of life of patients. Poor dietary intake and physical inactivity lead to obesity and contribute to diabetes prevalence and poor outcomes. Non-diabetic family members of patients are already at risk of developing diabetes due to a family history of the disease. Therefore, this study was aimed at developing and implementing a family-centred nutrition and exercise diabetes care programme for better outcomes and fewer new cases. Methodology: This study employed a mixed method approach, where convergent parallel design was used where quantitative and qualitative data were collected. For the quantitative strand, 400 subjects participated in the study (i.e., 200 diabetes patients and 200 family members). Diabetes patients were selected using stratified random sampling from rural clinics, while family members were selected using the sampled patients. For the qualitative strand, 17 diabetes patients were purposively sampled, and data saturation was reached. Two set of questionnaires (for patients and family members) were used to collect quantitative data, while one-on-one interviews with patients were used to collect qualitative data. Phase 2 involved development and validation of an intervention program. The validation involved a process where professional experts were used for validation using Delphi technique. Phase 3 included implementation and program evaluation wherein post-implementation quantitative survey was conducted on 100 participants (50 patients and 50 family members), who were purposively sampled from list of those who participated in Phase 1. Quantitative data was analysed using SPSS Software v27.0, while qualitative data analysed using 8 Steps of Tesch’s inductive, descriptive open coding technique. Results: In Phase 1, the results showed that over half of patients (57%), compared to 38% of family members, were obese; and that most patients (75%), compared to 55% of family members, had abdominal obesity. Close to half of patients (45%), compared to 31% of family members, had overall excellent nutrition and exercise diabetes care knowledge. The majority of patients (73%), compared with 25% of family members, had overall positive attitudes towards nutrition and exercise diabetes care. Only 15% of diabetes patients compared with 9% of family members had overall good practice vi related to nutrition and exercise diabetes care. In Phase 3, it was reported that the majority of both patients (84%) and family members (100%), respectively indicated that the organization of the educational intervention was commendable. All patients (100%) and family members (100%) indicated that the health education strategies used stimulated their interest and were very helpful to their learning. Conclusion: A family-centred nutrition and exercise diabetes care programme was developed, implemented and evaluated. Diabetes patients and family members indicated that the intervention was helpful to their learning and met their expectations. Therefore, there is an urgent need for the adoption of the family-centred nutrition and exercise diabetes care programme to achieve healthy eating and increased physical activity. The adoption of healthy eating and physical activity among diabetes patients and their non-diabetic family members will subsequently lead to better diabetes outcomes, and minimizing new cases, respectively.

Swedish health care is currently facing problems, such as lack of financial resources, staff shortage and dissatisfaction among patients and professionals. Patients’ dissatisfaction was the point of departure for the present study, and one approach dealing with this problem was investigated. It was hypothesised that a patient-centred perspective could offer a possible solution. The aim of the study was to explore health care professionals’ and medical students’ understanding of their professional role and the patient encounter. A further goal was to determine whether these understandings could be developed by educational interventions. Students and professionals have been either interviewed or responded to a survey about their professional role and the patient encounter. Qualitative analysis was used. One group- and one individualised intervention were carried out. The participants’ understandings of their professional role were taken as the starting point for learning. The results showed that a minority of medical students and professionals in diabetes care had incorporated a patient-centred perspective. Nurses in telephone advisory services recognised the patients’ needs, but experienced conflicting demands of being both carer and gatekeeper. A non-optimal match between patients’ needs and what professionals understand as their role could cause some of the problems. Competence development could be achieved by taking the participants understanding of the professionals’ role and of the patient encounter as a starting point for reflection. The results have implications for changes in organisation and education in health care, to optimise outcomes of care. Time for reflection, mentoring and professional development is needed.

Bakgrund: Diabetes mellitus typ 2 är en folksjukdom vars prevalens ökar varje år. Behandlingen består främst av patientens egenvård där sjuksköterskan har en central funktion i att stödja, ge råd och informera. Genom ökad förståelse om sjuksköterskans upplevelser av att vårda patienter med diabetes mellitus typ 2, kan det underlätta för sjuksköterskan och förbättra vården av patienter med diabetes mellitus typ 2. Syfte: Undersöka sjuksköterskors upplevelser av att vårda patienter med diabetes mellitus typ 2. Metod: En litteraturöversikt baserad på vetenskapliga artiklar med kvalitativ och kvantitativ design. Resultat: Resultatet presenteras i fyra teman; Samtalet som grund till en god relation, Se patienten ur ett helhetsperspektiv, Det finns hinder att övervinna och Organisationen begränsar. Konklusion: Resultatet visar på hur sjuksköterskan har en viktig och bärande roll i diabetesvården och hur samtalet ligger till grund för att kunna stödja patienten till egenvård. Resultatet visar också på betydelsen av att arbeta personcentrerat men även på hinder i form av arbetsbelastning, bristande kompetens och organisatoriska problem sjuksköterskan upplever i arbetet. Genom att synliggöra dessa aspekter kan sjuksköterskans utbildning och arbetsmiljö förbättras och därmed säkra en tryggare vård. / Background: Diabetes mellitus type 2 is a public disease whose prevalence increases every year. The treatment mainly consists of the patient's self-care, where the nurse has a central role in supporting, advising and informing. With increased understanding of the nurse's experiences of caring for patients with diabetes mellitus type 2, the acquired knowledge can make it easier for the nurse and thus streamline the treatment of patients with diabetes mellitus type 2. Aim: Investigate nurses’ experiences of caring for patients with Diabetes mellitus type 2. Method: A literature review based on scientific articles with qualitative and quantitative designs. Findings: The results are presented in four themes; The conversation - the basis of a good relationship, See the patient from a holistic perspective, There are obstacles to overcome and The organization limits. Conclusion: The result shows how the nurse has an important and supporting role in diabetes care and how the conversation forms the basis of being able to support the patient's self care. The results also show the importance of person-centred work but also the obstacles in form of workload, lack of competence and organizational problems the nurse experiences in her work. By making these aspects visible, the nurse's training and work environment are improved and thereby ensure safer care.

<p>Diabetes is one of the most significant global healthcare challenges of the 21st century: it is estimated that one in three adults will have diabetes in the United States in the year 2050. As a result, healthcare organizations are integrating systemic changes to address the needs of expanding chronic care patient population, including shifting towards a patient-centered medical home philosophy and introducing new health information technology tools to help share the workload for diabetes care activities. Advanced educational opportunities, collaborative-practice agreements, and a shifting model towards community-based care clinics affords opportunities for pharmacy professionals to participate in a more central role on the diabetes care team.</p><p><br></p> <p> </p> <p>This dissertation work explores the intersection of diabetes care coordination and health information technology (IT), with a specific focus on the potential for pharmacist involvement on the diabetes care team. Studies I and II aimed to define the existing diabetes care team as a system, with identifying the specific roles, information flows, tasks, and temporal and geospatial attributes for providing effective care. Study I used a questionnaire and social network analysis tools to identify the key members of the diabetes care team. The results indicated that these team members were the primary care provider, endocrinologist, nurse, pharmacist, dietitian, and social worker. Study II used semi-structured interviews and team task analysis for thirty (N=30) diabetes care team member participants (N=5 for each category indicated in Study I). The results from Study II led to the creation of a new systems engineering analytical framework, titled Diabetes care Roles Information Flows and Team Coordination (DRIFT). This framework expanded existing chronic care and healthcare systems engineering frameworks through the inclusion of granularity, temporal, and sociotechnical factors in a three-dimensional systems model. Study II also provided confirmatory support for the inclusion of pharmacists for sharing more care coordination activities on diabetes care teams.</p> <p><br></p> <p>The results from studies I and II were synthesized to identify potential engineering health IT solutions to gaps in diabetes care activities. The results synthesis was the foundation of a new health IT system prototype, eVincio, developed by the author for this dissertation work. eVincio is comprised of a patient-facing mobile application and a provider-facing desktop software that worked together to help healthcare professionals visualize patient care activities via the DRIFT analytical framework. Study III was a formative usability assessment of the eVincio prototypes with six (N=6) pharmacist participants. Results revealed that eVincio could be very beneficial for helping healthcare professionals visualize patient care activities and identify gaps in care coordination, particularly for professionals who work as case managers, population health analysts, or have some aspect of quality monitoring in their role. As the eVincio system is still in a prototype stage of development, additional studies need to be conducted to determine system requirements for interoperability, evidence-based guidelines, and fulfilling end-user requirements.</p>

This study explored the needs and challenges faced by diabetics and healthcare personnel in the context of diabetes consultations in Sweden, with the aim of identifying improvements for Clinical Decision Support Systems (CDSS). Given the global prevalence of diabetes, understanding the use and implications of CDSS in patient consultations is crucial. This research aimed to fill that knowledge gap by exploring ways to improve CDSS, considering the needs of both diabetics and healthcare workers. A qualitative approach was used, including 12 interviews, 1 observation, and 6 document reviews. A thematic analysis revealed four key themes which highlighted various challenges and needs, experienced from both diabetics and healthcare personnel. The underlying causes of these challenges were linked to recent technological advancements and the increase in available data points. This results infrustration, suboptimal care outcomes, and an increased reliance on alternative solutions by both parties. The DeLone and McLean IS Success Model was used to identify potential technological solutions and provides a clear recommendation on what needs to be improved for future solutions. The findings contribute significantly to understanding the utilization of CDSS in diabetes care and associated challenges. The study is particularly relevant for healthcare personnel, diabetics, policymakers, entrepreneurs, and scholars interested in healthcare information systems. Future studies should focus on generalizing these findings by exploring other healthcare systems and to what extent this findings are applicable for type 2 diabetics, as well as practically exploring how new systems can address the identified needs in this study. Ultimately, this study contributes to the potential for improved care and quality of life for diabetics. / Denna studie utforskade behov och utmaningar som diabetiker och sjukvårdspersonal står inför i samband med diabeteskonsultationer i Sverige, med målet att identifiera förbättringar för kliniska beslutsstödssystem (CDSS). Med tanke på diabetes globala prevalens, är det avgörande att förstå användningen och implikationerna av CDSS i patientkonsultationer. Denna forskning syftade till att fylla detta kunskapsgap genom att utforska möjligheter att förbättra CDSS, med hänsyn till både diabetikers och vårdgivares behov. Kvalitativa metoder användes, inklusive intervjuer, observationer och dokumentgranskningar. En tematisk analys identifierade fyra nyckelteman som belyste flera utmaningar och behov från både diabetiker och sjukvårdspersonal. De underliggande orsakerna till dessa utmaningar var kopplade till tekniska utveckling och ökningen av tillgängliga datapunkter. Detta resulterade i frustration, suboptimala vårdresultat och en ökad användning av alternativa lösningar från båda parter. DeLone och McLean IS Success Model användes för att översätta behoven till tekniska krav för potentiella framtida lösningar. Studiens resultat bidrar till förståelsen av användningen av CDSS inom diabetesvård och relaterade utmaningar. Studien är särskilt relevant för sjukvårdspersonal, diabetiker, politiker, entreprenörer och forskare som är intresserade av hälso- och sjukvårdsinformationssystem. Framtida studier bör fokusera på att generalisera dessa resultat genom att undersöka andra sjukvårdssystem och i samband med typ 2 diabetes, samt utforska hur mer praktiskt utveckling av nya system kan gå till för möta de identifierade behoven i denna studie. Slutligen bidrar denna studie till potentialen för förbättrad vård och livskvalitet för diabetiker.

Introduction: Evidences indicate that human immuno-deficiency virus (HIV) and diabetes (DM) impact pregnancy outcomes but no experience on the integrated service delivery of HIV, DM and pregnancy care. This study explored the domains and levels of integration among DM, HIV and pregnancy care to prepare a service delivery model in Ethiopia. Methods: A sequential exploratory mixed method and the integration theoretical framework guided the study. An exploratory qualitative phase used focused group discussion, in-depth interview and observation to explore the level of integration and to refine a questionnaire for the quantitative phase. The data were transcribed and coded for theme-based analysis. The descriptive quantitative phase described HIV, DM and pregnancy care services, and determined the burden of DM among HIV patients and the prevalence of pregnancy and pregnancy outcomes. Data was analysed using Epi-info. The findings were triangulated, discussed and interpreted. Results: Seven themes were generated: joint plan, shared budget, monitoring system, structural location, the need of policy guide, the practice of integrated service delivery and suggested integration approaches. A coordinated HIV and pregnancy care services were noted. There was a linkage between diabetes and HIV, and diabetes and pregnancy care. The 1.5% of diabetes among HIV, the low number of pregnancies per a mother in diabetes (1.8) and HIV (1.3); the high adverse pregnancy outcomes among HIV (13.4% abortion, 12.4% low birth weight (LBW), 3.5% pre-term birth, 2.1% congenital malformation) and diabetes (3.2% big baby, 3.2% LBW, 3.1% Cesarean-section); the respective absent and low (16.2%) diabetes screening service at anti-natal and HIV clinics, the absent pregnancy care service for diabetic females justified the development of the tripartite integrated service delivery model of diabetes, HIV and pregnancy care. Conclusions: The model suggests active diabetes screening, evaluation and treatment at HIV and antenatal clinics. It considers the coordination between non-communicable diseases (NCD), HIV and maternal health units. Pregnancy care could be coordinated at HIV and NCD units. Full integration can be practiced between HIV and pregnancy care units. Preparing policy guide, building the capacity of health providers, advocating and piloting the model may be prioritized before the implementation of the model. / Health Studies / D. Litt. et Phil. (Health Studies)