Background: In order to provide good diabetes care it is important for the health care professionals to share patients’ personal understanding of living with diabetes, which differs from a professional understanding of the illness. Patients’ beliefs about health, illness, control and cure are predictive of the outcome of lifestyle changes and pharmacological treatment. Narratives about illness could be used to elucidate what people believe to be central to their experience of an illness and its management. The overall aim of this thesis was to investigate experiences of diabetes and diabetes care among people with type 2 diabetes and district nurses responsible for diabetes care within primary health care. Methods: Forty-four patients diagnosed with diabetes during the previous 2 years were interviewed about their personal understanding of illness and experiences of care. They also participated in an intervention study consisting of group sessions during 9 months. The intervention focused on the patients’ understanding of living with diabetes and was directed at the patients and their nurses (n = 5). The outcome variables haemoglobin A1c (HbA1c), lipids, blood pressure (BP) and body mass index (BMI) as well as well-being, treatment satisfaction and diabetes symptoms of the intervention group were compared with those in a control group (n = 60). Another ten patients were interviewed about their views of their lives. Seventeen nurses in diabetes care were interviewed about their views of their work with patients. The narrative, thematic interviews and focus group interviews were analysed using qualitative content analysis. Findings: Patients’ personal understanding of illness included the categories “image of the disease”; “meaning of the diagnosis”; “integration of the illness”; “space for the illness”; “responsibility for care”; and “future prospects”. Patients’ narratives about their lives included views of knowledge, and capacity, motivation and courage, aspects important for effective self-management. Patients’ views on clinical encounters in diabetes care, interpreted as satisfying or not, included the themes “being in agreement v. in disagreement about the goals”; “being autonomous and equal v. being forced into adaptation and submission”; “feeling worthy as a person v. feeling worthless”; “being attended to and feeling welcome v. being ignored”; and “feeling safe and confident v. feeling unsafe and lacking confidence”. The results of the intervention study with group sessions showed improvements in metabolic balance and treatment satisfaction in the intervention group. At the 1-year follow-up the mean difference between groups in HbA1c was 0.94% (95% confidence interval (CI) 0.58–1.29). Nurses’ views of their work included the themes “Perspectives on illness and caring are not easily integrated into views of disease and its treatment”; “Nurses view their knowledge as more important than the patients’ knowledge”; Nurses’ conscience is challenged by some of their nursing decisions”; “The individuality of each patient is undermined when patients are regarded as a collective group”; and “Nurses are confirmed in their role of nurses by patients who assume a traditional patient role”. Conclusion: These results demonstrate that the understanding of illness and care differs between patients and nurses working in diabetes care; furthermore, that an intervention involving patients and their nurses based on patients’ personal understanding of illness is effective with regard to metabolic control and treatment satisfaction. The cost of the intervention is moderate. Also, we believe that it is possible to clinically implement this intervention within the existing resources for primary health care.

Die doel van hierdie navorsingstudie is om riglyne vir 'n groepsterapeutiese program te ontwikkel waarin adolessente in rou (in besonder na die afsterwe van 'n betekenisvolle ander) die geleentheid kry om hul emosies rondom sterwe en rou te verwerk. In 'n omvattende literatuurstudie is bestaande teorieë aangaande die ontwikkelingsfase adolessensie, rou-, verdriet- en verliesreaksies asook terapeutiese groepe en groepsprogramme, bespreek. Die navorsingsprosedures is vervolgens bespreek gedurende die eerste en laaste sessies is vir die doel van evaluering 'n persoonlike vraelys, die Beck Depressie-vraelys en spesifieke T.A.T.-kaarte aan die groeplede voorgelê. Die groepsprosedures is op oudioband opgeneem vir analise en interpretasie van prosesnotas. Die verwerking van die data wat ingesamel is, is kwalitatief ontleed. Elf Afrikaanssprekende adolessente is op 'n hoërskoolkamp genader om vrywillig aan die program deel te neem. Vyf het aan die program deelgeneem. Die studie het die volgende resultate opgelewer: <ul> <li> Groepsterapie en die -programme beinvloed die emosionele verliese van adolessente in rou.</li> <li> Groepsterapie en die -programme dra by tot die konstruktiewe vermindering van gevoelens van rou, verlies en gepaardgaande depressie by adolessente.</li> <li> Groepsterapie dra by tot 'n adolessent se hernude ingesteldheid op hoop en die toekoms.</li></ul> Op grond van hierdie bevindings word riglyne vir 'n groepsterapeutiese program vir adolessente in rou voorgestel. ENGLISH : The purpose of this research study is to develop guidelines for a group therapy programme for adolescents in mourning (especially after the death of a significant other). The programme offers an opportunity to come to terms with emotions relating to death and bereavement. In a comprehensive literature study of existing theories regarding the development phase of adolescence, mourning-, grief- and loss reactions as well as therapeutic groups and group programmes are discussed. The research procedures are subsequently discussed. For evaluations purposes a personal questionnaire, the Beck Depression questionnaire as well as specific T.A.T. cards were submitted to the group members at their first and final sessions. Audio tapes were used during the group procedures. The processing of the collected data was analysed qualitatively. Eleven Afrikaans speaking adolescents were approached at a high school camp to participate in the programme on a voluntary basis. Five of them participated. The following results were obtained from the study: <ul> <li> Group therapy and the -programme influence the emotional losses of adolescents in the process of mourning.</li> <li> Group therapy and the -programme alleviate feelings of grief, loss and depression in adolescents.</li> <li> Group therapy contributes to an adolescents' renewed feelings of hope and the future.</li></ul> On the basis of these findings guidelines for a group therapy programme for adolescents in mourning are suggested. / Dissertation (MA)--University of Pretoria, 1997. / Psychology / unrestricted