Bjørg Karlsen

The relationship between clinical indicators, coping styles, perceived support and diabetes-related distress among adults with type 2 diabetes

AIM This article is a report of a cross-sectional study examining the degree to which clinical indicators, coping styles and perceived support from healthcare professionals and family are related to diabetes-related distress. BACKGROUND Many people with type 2 diabetes experience high levels of distress stemming from concerns and worries associated with their disease. Diabetes-related distress has predominantly been studied in relation to diabetes management and metabolic control, and to some extent in relation to coping styles and perceived social support. To date, little is known about the relative contribution of clinical indicators, coping styles and perceptions of social support to perceived distress among people with type 2 diabetes. METHODS A sample comprising 425 Norwegian adults, aged 30-70, with type 2 diabetes, completed questionnaires assessing coping styles, perceived social support from health professionals and family and diabetes-related distress assessed by the Problem Areas in Diabetes Scale. Demographical and clinical data were collected by self-report. Data were collected in October 2008. FINDINGS   Results from the regression analyses showed a greater variance in emotional distress accounted for by coping styles (21·3%) and perceived support (19·7%) than by clinical indicators (5·8%). CONCLUSION FINDINGS may indicate that healthcare providers should pay more attention to non-clinical factors such as coping styles and social support, when addressing diabetes-related distress. They should also be aware that interventions based on psychosocial approaches may primarily influence distress, and not necessarily metabolic control.

Perceived support from healthcare practitioners among adults with type 2 diabetes.

AIM This paper is a report of a study of how adults with type 2 diabetes perceive different attributes of support provided by healthcare practitioners and how various attributes of support can influence peoples motivation to self-manage their disease. BACKGROUND Motivational problems seem to be a major reason for poor diabetes management. According to well-known theories of motivation, expectations of being able to perform certain behaviours are a key element. Different attributes of support from healthcare practitioners are likely to influence such expectations. To date, no researchers have specifically examined how people with type 2 diabetes perceive different attributes of support from healthcare practitioners and how these may influence their motivation to manage their disease themselves. METHODS A descriptive/explorative qualitative design and focus groups were used to collect data. The sample consisted of 19 adults with type 2 diabetes, and the data were collected in 2007 and analysed using qualitative content analysis. FINDINGS Five themes were identified, reflecting perceived attributes of support from healthcare practitioners: (1) an empathetic approach, (2) practical advice and information, (3) involvement in decision-making, (4) accurate and individualized information and (5) ongoing group-based support. CONCLUSION Healthcare practitioners may strengthen the self-management motivation among adults with type 2 diabetes by enhancing expectations of being able to perform the necessary diabetes care, and through the provision of empathetic, individualized, practical and ongoing group-based support.

Coping styles among adults with Type 1 and Type 2 diabetes

This study identified and compared different coping styles among adults with Type 1 and Type 2 diabetes. A sample comprising 534 Norwegian adults with both types of diabetes aged between 25-70 participated in the study. Diabetes-related coping styles were assessed by self-reports, using the Diabetes Coping Measure and sub-scales from the COPE scale. A clear majority of the respondents reported to integrate their diabetes. Other encouraging findings indicated that only a small minority responded to diabetes-related problems by denial and/or mental disengagement and resignation. On the other hand, a substantial proportion of the respondents reported that they seldom used active task-oriented coping, such as seeking social support, seeking knowledge and planning. This lack of active task-orientation was more evident among people with Type 2 diabetes than among those with Type 1. The differences found between types of diabetes and coping were mainly related to higher age and lower educational level among people with Type 2 diabetes. Moreover, 40% of the respondents reported that they often blamed themselves. In addition, self-blame correlated significantly with both the active and passive coping styles. The present results indicate that there is ample potential for improving active task orientation among adults with diabetes. It should, however, be of some concern that improving active coping may be associated with an increase in self-blaming.

Diabetes-related emotional distress in adults: reliability and validity of the Norwegian versions of the Problem Areas in Diabetes Scale (PAID) and the Diabetes Distress Scale (DDS).

BACKGROUND Regular assessment of diabetes-related emotional distress is recommended to identify high-risk people with diabetes and to further prevent negative effects on self-management. Nevertheless, psychological problems are greatly under diagnosed. Translating and testing instruments for psychosocial assessment across languages, countries and cultures allow for further research collaboration and enhance the prospect of improving treatment and care. OBJECTIVES To examine the psychometric properties of the Norwegian versions of the Problem Areas in Diabetes Scale and the Diabetes Distress Scale. DESIGN Cross-sectional survey design. SETTINGS A sample comprising adults with diabetes (response rate 71%) completed the Problem Areas in Diabetes Scale and the Diabetes Distress Scale, which were translated into Norwegian with standard forward-backwards translation. PARTICIPANTS The study included 292 participants with type 1 (80%) and type 2 diabetes (20%) aged 18-69 years, 58% males, mean diabetes duration 17.3 years (11.6), mean HbA(1c) 8.2% (1.6). METHODS We used exploratory factor analysis with principal axis factoring and varimax rotation to investigate the factor structure and performed confirmatory factor analysis to test the best fit of a priori-defined models. Convergent and discriminate validity were examined using the Short Form-36 Health Survey, Hospital Anxiety and Depression Scale and demographic and disease-related clinical variables. We explored reliability by internal consistency and test-retest analysis. RESULTS Exploratory factor analysis supported a four-factor model for the Diabetes Distress Scale. Confirmatory factor analysis indicated that the data and the hypothesized model for the Diabetes Distress Scale fit acceptably but not for the Problem Areas in Diabetes Scale. Greater distress assessed with both instruments correlated moderately with lower health-related quality of life and greater anxiety and depression. The instruments discriminated between those having additional health conditions or disabilities, foot problems or neuropathy. Women and participants with higher HbA(1c) levels reported significantly higher diabetes-related emotional distress. CONCLUSIONS The Norwegian versions of the Problem Areas in Diabetes Scale and the Diabetes Distress Scale have satisfactory psychometric properties and can be used to map diabetes-related emotional distress for diagnostic or clinical use. The Diabetes Distress Scale also contributes to identifying sub-domains of distress and seems promising for use in clinical trials.

Perceptions of support, diabetes-related coping and psychological well-being in adults with type 1 and type 2 diabetes

The purpose of this cross-sectional study is to examine the relationship between support from health care professionals and the family, diabetes-related coping, and psychological well-being by testing a model hypothesizing the structure of these relations in adults with type 1 and type 2 diabetes. A sample comprising 534 Norwegian adults with both types of diabetes aged 25 to 70 completed questionnaires assessing perceptions of support, diabetes-related coping styles and psychological well-being. Results indicate that perceptions of support from the family are more closely linked to diabetes-related coping than support from the health care professionals. Moreover, results suggest that association between perceptions of support and psychological well-being is mainly mediated by coping. Only associations of emotion-focused coping and self-blame with psychological well-being, however, were detected. Differences in patterns of associations among the sub samples of people with type 1 and type 2 diabetes were identified. The findings are discussed in the light of previous research and assumptions. Suggestions are given regarding implications for the health care of people with diabetes.

Motivation for diet and exercise management among adults with type 2 diabetes

AIM The aim of this study was to investigate diet and exercise management and how indicators of intrinsic motivation such as ability expectations and values are associated with diet and exercise management among adults with type 2 diabetes. BACKGROUND Motivational problems are probably one of the main reasons for poor diabetes management. However, the mechanisms involved in the motivation for adequate self-management are still unclear. DESIGN AND METHODS A cross-sectional design including a postal questionnaire that investigated diet and exercise management as well as intrinsic motivational factors such as ability expectations and values related to these behaviours was used to collect the data. A sample comprising 425 adults with type 2 diabetes aged between 30 and 70 completed the questionnaire. RESULTS Reported diet management was more in accordance with recommendations than reported exercise management. Yet results indicated equally high ability expectations and positive values for exercise and diet management. Moreover, results demonstrated that ability expectations and values explained more variance in exercise (21.6%) than in diet management (7.6%). CONCLUSIONS The modest association between intrinsic motivational factors and diet management may imply that there are important extrinsic factors that play a significant role in determining dietary behaviour. The combination of lower exercise activity than recommended and high ability expectations and values for such activity may reflect that subjective exercise norms are formed individually in accordance with what most people recognise as the appropriate level of physical activity. Finally, results may indicate that there is potential for improving exercise management by stimulating intrinsic motivation as well as by more clearly communicating recommendations for such management.

Shock Anxiety among Implantable Cardioverter Defibrillator Recipients with Recent Tachyarrhythmia

Background: Shock anxiety has been documented irrespective of shock exposure in implantable cardioverter defibrillator (ICD) recipients. The presence of tachyarrhythmia may lead to an anticipation of receiving a shock and thereby give rise to shock anxiety. The aims were to assess: (1) the level of shock anxiety in a sample of ICD recipients, (2) the relationship between such anxiety and shock exposure, and (3) the relationship between recent tachyarrhythmia and shock anxiety.

Self-Reported Psychological Well-Being and Disease-Related Strains among Adults with Diabetes

The study was designed to describe self-reported psychological well-being among adults with Type 1 and Type 2 diabetes and to explore associations of psychological well-being with disease-related strains, such as self-reported long-term complications, frequency of hypoglycaemia and disablement or sick-leave. A sample comprising 534 Norwegian adults with Type 1 and Type 2 diabetes aged 25-70 years participated in the study. Psychological well-being was assessed using three different scales; the WHO (Ten) Well-Being Index, the Short Zung Depression Rating Scale and four items from the anxiety sub-scale of the Hopkins Symptom Checklist. Findings indicate that adults with both types of diabetes reported relatively poor psychological well-being. There was a tendency for younger persons to report the worst psychological well-being. For symptoms of anxiety this tendency was most evident among people with Type 2 diabetes. People being disabled due to diabetes reported relatively markedly impaired psychological well-being, whereas self-reported diabetes-related complications and the number of episodes with hypoglycaemia were weakly associated with psychological well-being. Findings may indicate that healthcare practitioners should pay more attention to the psychological needs of people with diabetes. This applies especially to younger people with Type 2 diabetes.

Perceived support from healthcare professionals, shock anxiety and post-traumatic stress in implantable cardioverter defibrillator recipients

AIMS AND OBJECTIVES To investigate (1) the extent to which shock anxiety and perceived support from healthcare professionals are related to post-traumatic stress disease (PTSD) symptoms and (2) the extent to which perceived support from healthcare professionals moderates the relationship between shock anxiety and PTSD symptoms in implantable cardioverter defibrillator recipients. An additional aim was to describe the level of PTSD symptoms and perceptions of support from healthcare professionals. BACKGROUND Studies examining PTSD symptoms among implantable cardioverter defibrillator recipients are still sparse. In addition, little is known about how perceived support from healthcare professionals is related to PTSD symptoms. DESIGN Cross-sectional survey design. METHODS Recipients (n = 167) with implantable cardioverter defibrillator attending an outpatient device clinic completed questionnaires assessing shock anxiety, PTSD symptoms and perceived support from healthcare professionals. RESULTS The results indicated that between ten and 15% of the recipients experienced moderate to severe symptoms of PTSD. Although a majority perceived constructive support from healthcare professionals, 12% perceived nonconstructive support. Regression analysis demonstrated that shock anxiety and perceived nonconstructive support from healthcare professionals had a statistically significant (p < 0·01) association with PTSD symptoms. Moreover, the results suggest that associations between shock anxiety and PTSD symptoms were significantly (p < 0·01) moderated by perceived nonconstructive support from healthcare professionals. Young age, short time since implantation and secondary prevention indication were also significantly associated with PTSD symptoms. CONCLUSIONS The results indicate that nonconstructive support from healthcare professionals can increase the tendency to develop PTSD symptoms, particularly in those who experience shock anxiety. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should pay more attention to the way in which they communicate information to the recipients during follow-up visits. Clinically based strategies and interventions targeting shock anxiety and PTSD symptoms should be carried out.

Increased confidence to engage in physical exertion: older ICD recipients’ experiences of participating in an exercise training programme

Background: Research suggests that exercise training (ET) programmes may improve both physical and psychosocial functioning in implantable cardioverter defibrillator (ICD) recipients. Most of this research has been conducted by means of quantitative methods. However, knowledge of older ICD recipients’ experiences of participating in such programmes is sparse. There is thus a need for more detailed qualitative data from the perspective of older patients. Aim: To describe older ICD recipients’ experiences of participating in an ET programme. Methods: A qualitative design with semistructured interviews involving 12 older ICD recipients who had participated in a 3-month ET programme. Mini-disc recordings of the interviews were transcribed verbatim and analysed using content analysis. Results: The analysis revealed two major themes: (1) ‘increased confidence to engage in physical exertion’; and (2) ‘increased satisfaction with life’. The first theme is illustrated by three subthemes: ‘perceived support from physiotherapists’, ‘perceiving the heart rate monitor as a motivation to exercise’, and ‘perceiving peers as motivators for enjoyment and making the effort to exercise’. The second theme was illustrated by the following subthemes: ‘perceived psychosocial benefits’, ‘perceived physical benefits’, and ‘exercise as a new health habit’. Conclusion: The findings indicate that exercising in a cardiac rehabilitation centre together with peers and supervised by skilled healthcare professionals may increase motivation to exert oneself, leading to emotional and physical benefits as well as a more social and active lifestyle for older ICD recipients.