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Bakgrund: Diabetes är en kronisk sjukdom och drabbar allt fler i världen. Distriktssköterskan på vårdcentralerna i Sverige har en betydande uppgift att vägleda patienter med typ 2 diabetes genom att erbjuda egenvårdsutbildning för att patienten själv ska klara av att hantera sjukdomen. Sjukdomen kräver en omfattande egenvård för att hålla blodglukosnivåerna optimala och för att minska eller förebygga riskerna för komplikationer. Syfte: Syftet med studien var att beskriva distriktssköterskors erfarenheter av patientutbildning till personer med typ 2 diabetes. Metod: En kvalitativ design med induktiv ansats. Semistrukturerade intervjuer hölls individuellt med fyra distriktssköterskor på två olika vårdcentraler i Stockholm län. Resultat: Resultatet i föreliggande studie visade att distriktssköterskorna måste utgå från patientens situation och individanpassa informationen. De angav vidare att det var viktigt att skapa en god relation och använde sig av olika pedagogiska metoder för att motivera patienterna till livsstilsförändring. Distriktssköterskorna angav att de hade goda kunskaper om patentutbildning, dock hade de bristande kunskaper om kulturella skillnader hos patienter. Slutsats: Studien påvisar att distriktssköterskorna har en stödjande roll i att stärka patienternas egenvårdsförmåga. Den informationen som ges måste vara individanpassade och utgå från den enskilda individen. Att använda olika pedagogiska metoder kunde öka patientens motivation. Distriktssköterskorna upplevde brist på tid- och resurser. / Background: Diabetes is a chronic disease that affects more and more people in the world. The district nurse at the health centers in Sweden has a significant task in guiding patients with type 2 diabetes by offering self-management education to enable the patients to manage the disease themselves. The disease requires extensive self-management to keep blood glucose levels optimal and to reduce or prevent the risks for complications. Aim: The purpose of this study was to describe district nurses experiences of patient education for persons with type 2 diabetes. Method: A qualitative design with inductive approach. Semistructured interviews were performed individually with four district nurses on two different out patient clinics in Stockholm’s county. Result The result of the present study showed that district nurses has to start from the patient's situation and individualize the information. They further stated that it was important to create a good relationship and used different pedagogical methods to motivate patients to lifestyle change. The district nurses stated that they had good knowledge of patent training, but they had a lack of knowledge in cultural differences in patients. Conclusion: This study showed that the district nurses have a supporting role in strengthening the patients' ability to self-management. The given information had to be individualized. It is necessary to use different pedagogical methods to increase the patient's motivation. The district nurses experience a lack of time and resources.

Type 2 diabetes is a global health problem. Evidence indicates that type 2 diabetes can lead to serious complications, such as a cardiac event, which usually require critical nursing care. Patients with type 2 diabetes and with a history of cardiac disease are at greater risk of a further cardiac event requiring readmission to hospital. Evidence indicates that improved diabetes management assists patients with type 2 diabetes to manage their condition efficiently, reduces risks of a further cardiac event, and therefore reduces hospitalisations. However, there is limited information found regarding a diabetes management program specifically for patients who have already had cardiac complications. Difficulties in developing patients' skills in managing and modifying their daily lives also present a challenge to coronary care staff. Therefore, there is a real need to develop a special diabetes management program for patients with diabetes who have experienced a critical cardiac event, which will be commenced in the Coronary Care Unit (CCU). The aim of this research is to gain a greater understanding of the characteristics, secondly to obtain in-depth understanding of needs and experiences of patients with type 2 diabetes hospitalised for a critical cardiac event. A further aim is to develop and pilot test a diabetes management program, specific to the patients with diabetes in the context of the CCU. The design of this research employed three studies: Study I was an exploratory study, which obtained patients' demographic and disease characteristics from the hospital records of all patients with diabetes admitted to the CCU of one public hospital between 1 January 2000 to 31 December 2003. Study II used a qualitative interpretative approach and aimed to gain an in-depth understanding of the perspectives of patients with type 2 diabetes who have experienced a critical cardiac event in managing their everyday lives with both diabetes and cardiac conditions. Study III included two parts. The first utilised the information from the first two studies and the literature (self-efficacy theory) to develop a diabetes self-management program specifically for patients with diabetes who have had a critical cardiac event. The second part pilot tested the newly-developed diabetes self-management program for patients with diabetes admitted to CCU following a critical cardiac event. The pilot study used a randomised controlled trial research design to evaluate the efficacy of the program. Study I collected data from one hospital's records retrospectively from 2000 to 2003. The results of Study I showed there were 233 (14.7%) patients admitted to CCU that had diabetes out of the total 1589 CCU admissions during the study period. More than 22% of CCU patients with diabetes were readmitted to hospital within 28 days, compared to 6% of CCU patients without diabetes. Patients with diabetes who had a longer CCU stay were more likely to be readmitted. These results indicate that a significant proportion of a CCU population had type 2 diabetes and is more likely to be readmitted to hospital. Study II used an interpretive approach comprising open-ended interviews to collect data from patients with type 2 diabetes experiencing a cardiac event who had a CCU admission in 2000-2003. The findings revealed that patients with diabetes who had a critical cardiac event experienced considerable feelings of hopelessness and fatigue. Patients also had concerns in the areas of self-confidence and confidence in health professionals. Patients indicated that greater self-confidence and confidence in health professionals would help their ability to manage their daily lives. Therefore, it is very important that intervention programs for these at-risk patients need to improve patients' confidence levels, and reduce their feelings of hopelessness and fatigue. The information gathered from Study I and Study II provided important insight into the development of an effective diabetes self-management specifically designed for patients with type 2 diabetes following a critical cardiac event, which is presented in Study III in this thesis. Study III also provided a preliminary evaluation of the newly developed program. The evaluation used a randomised controlled trial research design for the new program and the current educational program provided in the CCU. The results of the program indicate the feasibility of commencing the new diabetes self-management program in the CCU, and to be continued in wards or at home. The results also showed significant improvements in patients' knowledge in the experimental group, but not in other outcome variables (self-efficacy, vitality and mental health levels). However, as a small sample size was used in this pilot study, a larger study is needed to ensure adequate testing of the intervention. Future research is also recommended to incorporate the new diabetes self-management program into the current cardiac education program. Staff's further professional development in providing such a program also needs to be examined. Improvements in quality of care, and patients' quality of life are expected in the future.

This research investigates type 2 diabetes using a psychological approach grounded in self-regulatory theory. Diabetes mellitus is usually described as a long-term illness with serious physical consequences, and biomedical perspectives predominate in published diabetes research. Findings from the present study add to accumulating knowledge about diabetes by addressing an identifiable gap in the literature, namely, an understanding of the psychological processes involved in managing type 2 diabetes. The common sense model (CSM) of illness self-regulation was used as the conceptual framework for this study. The research sample (N = 1145) was identified from a medical database. A mailed questionnaire survey was used to obtain psychological and self-report data, and this was subsequently merged with clinical data from a review of the medical database. A response rate of 55% provided a total of 629 completed questionnaires. The age, gender, and cultural composition of the sample were a close match with those reported for the New Zealand type 2 diabetes population. Research findings contribute to self-regulatory theory by testing key relationships specified in the CSM. The identification of a relationship cluster connecting emotional illness responses with cyclical symptoms, serious consequences, strong illness identity, and low coherence, highlights an emotional pathway in diabetes self-regulation. Observed relationships support the interaction between cognition and affect proposed in the CSM. Results show significant relationships between treatment perceptions and diabetes self-management, and draw attention to the importance of family relationships in explaining diet and exercise patterns. Perceived consequences of diabetes play a pertinent role in explaining variance in quality of life, and diabetes-related distress. The CSM postulates coping responses mediate between representations and illness outcomes; current findings, showing that medication use mediates the relationship between treatment representations and HbA1c, support the predicted mediating relationship. It is concluded the common sense model provides a useful theoretical framework for research investigating self-care and wellbeing among people with type 2 diabetes. Potential implications for psychological theory and clinical practice are discussed, and three areas - examining the roles of appraisal, emotion, and culture in illness management - are identified as priority targets for further research and conceptual development.

Philosophiae Doctor - PhD / Type 2 diabetes mellitus (T2DM) and pre-diabetes contribute increasingly to the global burden of disease. Along with other behavioural risk factors, diet plays a key role in the onset and management of the disease, in turn largely determined by what foods are immediately accessible in local food environments. With this in mind, this thesis aims to answer the research question: What role do local food environments play in promoting or inhibiting access to healthy foods as part of the self - management of T2DM in urban and rural communities in South Africa, and what can be learned from an international perspective? Specific research objectives include, to: 1. Understand the current national-level policy context with regard to the observed rise in NCDs, their proximal determinants (specifically an observed change in diet patterns), and contributing environmental factors; 2. Identify the current food-related environmental factors associated with the onset and/or management of T2DM in an urban and a rural setting (as well as in four additional international settings in order to provide an international perspective); 3. Explore community perspectives of the role the local food environment plays in the self-management of T2DM in an urban and a rural setting; and, consequently 4. Recommend intervention- and/or policy-related actions that can be implemented based on study findings. A review of the literature and relevant policies was conducted towards achieving the first research objective. Quantitative data were systematically collected at an urban and rural site in South Africa through the creation of an ‘environmental profile’ in an attempt to achieve the second objective – comparable urban and rural data was also collected as part of a larger study at two other international sites (Kampala, Uganda and Stockholm, Sweden) to provide an international perspective. Included in the third objective is the collection of qualitative data through a community based participatory research method at the same urban and rural sites in South Africa. Finally, intervention and/or policy-related recommendations are developed based on study findings and in consultation with relevant stakeholders through interviews. / 2018-12-14

Background: Diabetes self-management education, including nutrition education (NE) is an essential component of diabetes management. Effective NE can assist individuals with type 2 diabetes mellitus (DM) in resource limited settings to improve their dietary self-care; an area cited among the most difficult with consequent improvement in health outcomes. Aim: To develop a NE programme that is tailored to the needs of adults with type 2 DM in a resource limited setting and to evaluate the programme's effectiveness on health outcomes. Setting: Makapanstad and Mathibestad community health centres in the Moretele sub-district, North West Province (South Africa). Methods: The study was done in three phases employing mixed methods research. Qualitative methods, using focus group discussions with 31 diabetic patients (a convenience purposive sample), and an open ended self-administered questionnaire with ten health professionals serving them, assessed the NE needs and preferences (phase 1). The data were analysed according to the framework approach. The results from the needs assessment were used to plan a tailored NE programme (phase 2). A randomised controlled trial (quantitative) with a sample of 82 patients (with HbA1c ≥ 8), allocated to either intervention or control groups, evaluated the effect of the NE programme (phase 3). Outcomes [HbA1c, dietary behaviours, blood lipids, blood pressure, body mass index (BMI), diabetes knowledge and attitudes towards diabetes and its treatment] were assessed at baseline, six months and 12 months respectively. An analysis of covariance (ANCOVA) compared the groups on measured outcomes using baseline values, age, gender, and clinic as covariates. Rank ANCOVA was used for dietary intake. The level of significance for all tests was set at α < 0.05 for a two-tailed test. Results: Needs assessment Diabetes related knowledge deficits and inappropriate dietary practices, including food portion control problems, inadequate intake of vegetables and fruits and unbalanced diets, were observed. Eight barriers and two facilitators to dietary adherence were identified. Financial constraint was the major barrier while social support was the major facilitator. NE recommendations included content related to the disease and diet, group education at the clinic, a competent educator, provision of education materials and inclusion of family members. The planned NE programme consisted of eight weekly training sessions and six follow-up sessions (monthly and bi-monthly), vegetable gardening demonstrations and education materials. Nutrition education programme effects: Seventy six participants (38 per group) completed the study. The differences in HbA1c (primary outcome) between the intervention and control groups were -0.62% (p=0.15) at six months and -0.67% (p=0.16) at 12 months. Few participants, four from the intervention group and one from the control group, achieved HbA1c target (<7%) at both six and 12 months, [(p=0.20), (p=0.36)] respectively. There were no significant between group differences in BMI, lipid profile and blood pressure at six months and 12 months. Starchy foods intake (median servings) were significantly lower in the intervention group compared to the control group, 9.3 vs. 10.8 (p=0.005) at six months and 9.9 vs. 11.9 (p=0.017) at 12 months. The proportion of participants growing own vegetables significantly increased in the intervention group compared to the control group 17/41 vs. 5/40 (p=0.003) at six months and 16/38 vs. 5/38 at 12 months. No significant group differences in the intake of energy, macronutrients, vegetable and fruits, sodium, cholesterol and fibre were observed at six and 12 months. Diabetes knowledge improved in the intervention group +0.95 (p=0.033) and +2.2 (p=0.000) when compared with the control group at six and 12 months respectively. There were no significant group differences in the attitudes towards diabetes and its treatment. Conclusions: The qualitative needs assessment provided insight for planning a tailored NE programme. The NE improved some dietary behaviours (starchy foods portion control and growing own vegetables) and diabetes knowledge. A non-significant lowering of HbA1c was observed. / Thesis (Phd)--University of Pretoria, 2013. / Human Nutrition / unrestricted

Purpose: This qualitative descriptive study was undertaken to describe Eastern Woodlands Native adult perspectives, health care beliefs and type 2 diabetes management experiences. Specific Aims: The specific aims were to 1) explore and describe perceptions of type 2 diabetes among Eastern Woodland Native adults and how they relate to their understandings about the cause and treatment approaches to the disease, 2) describe how family, friends, and community intersect with type 2 diabetes management, 3) describe relationships with health care providers and 4) determine resources that would help diabetes-self management within their community. Framework: The PEN-3 Model by Airhihenbuwa was the initial framework used for the study. Methods: A qualitative descriptive design with maximum variation and snowball sampling was used and data was analyzed using qualitative content analysis. Results: The overarching theme of Together We Can Return To Balance comprised five sub-themes: Coming to Know Life Paths with T2DM, Negotiating My Way Forward, Making Important Connections, Acknowledging the Imbalance, and Sticking Closer to Mother Earth illustrating physical, spiritual, and environmental health factors influencing DSM capacities. Conclusion: Native perspectives should be viewed as a crucial contextual variation for type 2 diabetes care when developing DSMES and for improving DSM capacities in these populations.