Bjørg Oftedal

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.

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.

Medication calculation: the potential role of digital game-based learning in nurse education.

Medication dose calculation is one of several medication-related activities that are conducted by nurses daily. However, medication calculation skills appear to be an area of global concern, possibly because of low numeracy skills, test anxiety, low self-confidence, and low self-efficacy among student nurses. Various didactic strategies have been developed for student nurses who still lack basic mathematical competence. However, we suggest that the critical nature of these skills demands the investigation of alternative and/or supplementary didactic approaches to improve medication calculation skills and to reduce failure rates. Digital game-based learning is a possible solution because of the following reasons. First, mathematical drills may improve medication calculation skills. Second, games are known to be useful during nursing education. Finally, mathematical drill games appear to improve the attitudes of students toward mathematics. The aim of this article was to discuss common challenges of medication calculation skills in nurse education, and we highlight the potential role of digital game-based learning in this area.

Assessment of a web-based Guided Self-Determination intervention for adults with type 2 diabetes in general practice: a study protocol

Introduction Self-management is deemed the cornerstone in overall diabetes management. Web-based self-management interventions have potential to support adults with type 2 diabetes (T2DM) in managing their disease. Owing to somewhat ambiguous results of such interventions, interventions should be theory-based and incorporate well-defined counselling methods and techniques for behavioural change. This study is designed to assess the effectiveness of a theory-driven web-based Guided Self-Determination (GSD) intervention among adults with T2DM in general practice to improve diabetes self-management behaviours and glycosylated haemoglobin (HbA1c). Methods and analysis A complex intervention design based on the framework of the UK Medical Research Council is employed as a guide for developing the intervention, assessing its feasibility and evaluating its effectiveness. The study consists of three phases: (1) the modelling phase adapting the original GSD programme for adults with T2DM, using a qualitative design, (2) feasibility assessment of the adapted intervention on the web, employing qualitative and quantitative methods and (3) evaluating the effectiveness of the intervention on diabetes self-management behaviours and HbA1c, using a quasi-experimental design. The first phase, which is completed, and the second phase, which is underway, will provide important information about the development of the intervention and its acceptability, whereas the third phase will assess the effectiveness of this systematically developed intervention. Ethics and dissemination The Norwegian Regional Committee for Medical and Health Research Ethics (REK west number 2015/60) has approved the study design. Patients recruited in the different phases will fill out an informed consent form prior to inclusion and will be guaranteed anonymity and the right to withdraw from the study at any time. The results of the study will be published in peer-reviewed journals, electronically and in print, and presented at research conferences. Trial registration number: NCT02575599.

Digital Game-Based Learning: A Supplement for Medication Calculation Drills in Nurse Education

Student nurses, globally, appear to struggle with medication calculations. In order to improve these skills among student nurses, the authors developed The Medication Game – an online computer game that aims to provide simple mathematical and medical calculation drills, and help students practise standard medical units and expressions. The aim of this study was to examine whether baccalaureate student nurses who played The Medication Game as a supplement to lectures and task-solving during a medication calculation course improved their examination results compared to a control group who used lectures and task-solving only. The authors used a randomised controlled design to study 201 students enrolled in medication calculation courses. The main measures were examination results, gaming high scores, the number of gaming self-tests and gaming time. There was no significant difference between groups in examination pass rates: 56% of the control group and 67% of the gamers passed. However, gamers who passed the examination had higher gaming high scores (p < .01) and used the gaming self-tests more frequently (p < .01) than gamers who failed the examination. The authors concluded that The Medication Game did not significantly improve examination results, but that using the game frequently appeared to influence the examination outcome positively.

Learning to practise the Guided Self-Determination approach in type 2 diabetes in primary care: A qualitative pilot study

To describe how diabetes nurses in primary care experience the process of learning to practise the person‐centred counselling approach Guided Self‐Determination among adults with type 2 diabetes.

Written reflection in an eHealth intervention for adults with type 2 diabetes mellitus: a qualitative study

Background Individuals with type 2 diabetes mellitus (T2DM) are responsible for the daily decisions and actions necessary to manage their disease, which makes self-management the cornerstone of diabetes care. Many patients do not reach recommended treatment goals, and thus it is important to develop and evaluate innovative interventions that facilitate optimal motivation for adequate self-management of T2DM. Objective The aim of the current study was to explore how adults with T2DM experience using reflection sheets to stimulate written reflection in the context of the Guided Self-Determination (GSD) eHealth intervention and how written reflection might affect their motivation for self-management of T2DM. Methods We used a qualitative design in which data were collected through individual interviews. The sample consisted of 10 patients who completed the GSD eHealth intervention, and data were analyzed using qualitative content analysis. Results The qualitative content analysis yielded 2 main themes. We labeled the first theme as “Written reflection affects awareness and commitment in diabetes self-management”, which reflects 2 subthemes, namely, “Writing creates space and time for autonomous reflection” and “Writing influences individuals’ focus in diabetes self-management”. We labeled the second theme as “Written reflection is perceived as inapplicable in diabetes self-management”, which reflects 2 subthemes, namely, “Responding in writing is difficult” and “The timing of the writing is inappropriate”. Conclusion Our findings indicate that written reflection in the context of the GSD eHealth intervention may be conducive to motivation for diabetes self-management for some patients. However, it seems that in-person consultation with the diabetes nurse may be necessary to achieve the full potential benefit of the GSD as an eHealth intervention. We advocate further development and examination of the GSD as a “blended” approach, especially for those who consider written reflection to be difficult or unfamiliar.

Symptom burden and self-management in persons with chronic obstructive pulmonary disease

Purpose Self-management is crucial for effective COPD management. This study aimed at identifying associations between self-management and sociodemographic characteristics, clinical characteristics, and symptom burden in people with COPD. Patients and methods In this cross-sectional study with 225 participants diagnosed with COPD grades II–IV, multiple linear regression analysis was conducted, using sociodemographic and clinical characteristics and symptom burden (COPD Assessment Test) as the independent variables and the eight self-management domains of the Health Education Impact Questionnaire (heiQ) as the outcome variables. Results Higher symptom burden was significantly associated with worse scores in all self-management domains (p<0.003), except for self-monitoring and insight (p=0.012). Higher disease severity (p=0.004) and numbers of comorbidities (p<0.001) were associated with more emotional distress, and women scored higher than men on positive and active engagement in life (p=0.001). Higher score in pack-years smoking was associated with lower score in health-directed activities (p=0.006) and self-monitoring and insight (p<0.001), and participation in organized physical training was associated with higher score in health-directed activities (p<0.001). The final models explained 3.7%–31.7% of variance (adjusted R2) across the eight heiQ scales. Conclusion A notable finding of this study was that higher symptom burden was associated with worse scores in all self-management domains, except for self-monitoring and insight. In addition, sex, disease severity, comorbidity, pack-years smoking, and participation in organized physical training were associated with one or two self-management domains. The study contributes to improved understanding of self-management in COPD. However, the explained variance levels indicate that more research needs to be done to uncover what else explains self-management domains in COPD.