Jan McDowell

Factors that affect health outcomes in adults with type 2 diabetes: A cross-sectional study

BACKGROUND Factors that individually influence blood sugar control, health-related quality of life, and diabetes self-care behaviors have been widely investigated; however, most previous diabetes studies have not tested an integrated association between a series of factors and multiple health outcomes. OBJECTIVES The purposes of this study are to identify risk factors and protective factors and to examine the impact of risk factors and protective factors on adaptive outcomes in people with type 2 diabetes. DESIGN A descriptive correlational design was used to examine a theoretical model of risk factors, protective factors, and adaptive outcomes. SETTINGS This study was conducted at the endocrine outpatient departments of three hospitals in Taiwan. PARTICIPANTS A convenience sample of 334 adults with type 2 diabetes aged 40 and over. METHODS Data were collected by a self-reported questionnaire and physiological examination. Using the structural equation modeling technique, measurement and structural regression models were tested. RESULTS Age and life events reflected the construct of risk factors. The construct of protective factors was explained by diabetes symptoms, coping strategy, and social support. The construct of adaptive outcomes comprised HbA1c, health-related quality of life, and self-care behaviors. Protective factors had a significant direct effect on adaptive outcomes (beta=0.68, p<0.001); however, risk factors did not predict adaptive outcomes (beta=-0.48, p=0.118). CONCLUSIONS Identifying and managing risk factors and protective factors are an integral part of diabetes care. This theoretical model provides a better understanding of how risk factors and protective factors work together to influence multiple adaptive outcomes in people living with type 2 diabetes.

Validation of the Chinese Version of the Problem Areas in Diabetes (PAID-C) Scale

OBJECTIVE To examine the psychometric properties of a Chinese version of the Problem Areas In Diabetes (PAID-C) scale. RESEARCH DESIGN AND METHODS The reliability and validity of the PAID-C were evaluated in a convenience sample of 205 outpatients with type 2 diabetes. Confirmatory factor analysis, Bland-Altman analysis, and Spearmans correlations facilitated the psychometric evaluation. RESULTS Confirmatory factor analysis confirmed a one-factor structure of the PAID-C (χ2/df ratio = 1.894, goodness-of-fit index = 0.901, comparative fit index = 0.905, root mean square error of approximation = 0.066). The PAID-C was associated with A1C (rs = 0.15; P < 0.05) and diabetes self-care behaviors in general diet (rs = −0.17; P < 0.05) and exercise (rs = −0.17; P < 0.05). The 4-week test-retest reliability demonstrated satisfactory stability (rs = 0.83; P < 0.01). CONCLUSIONS The PAID-C is a reliable and valid measure to determine diabetes-related emotional distress in Chinese people with type 2 diabetes.

Barriers and facilitators to diabetes self-management : Perspectives of older community dwellers and health professionals in China

Little is known about self-management among people with Type 2 diabetes living in mainland China. Understanding the experiences of this target population is needed to provide socioculturally relevant education to effectively promote self-management. The aim of this study was to explore perceived barriers and facilitators to diabetes self-management for both older community dwellers and health professionals in China. Four focus groups, two for older people with diabetes and two for health professionals, were conducted. All participants were purposively sampled from two communities in Shanghai, China. Six barriers were identified: overdependence on but dislike of western medicine, family role expectations, cuisine culture, lack of trustworthy information sources, deficits in communication between clients and health professionals, and restriction of reimbursement regulations. Facilitators included family and peer support, good relationships with health professionals, simple and practical instruction and a favourable community environment. The findings provide valuable information for diabetes self-management intervention development in China, and have implications for programmes tailored to populations in similar sociocultural circumstances.Little is known about self-management among people with Type 2 diabetes living in mainland China. Understanding the experiences of this target population is needed to provide socioculturally relevant education to effectively promote self-management. The aim of this study was to explore perceived barriers and facilitators to diabetes self-management for both older community dwellers and health professionals in China. Four focus groups, two for older people with diabetes and two for health professionals, were conducted. All participants were purposively sampled from two communities in Shanghai, China. Six barriers were identified: overdependence on but dislike of western medicine, family role expectations, cuisine culture, lack of trustworthy information sources, deficits in communication between clients and health professionals, and restriction of reimbursement regulations. Facilitators included family and peer support, good relationships with health professionals, simple and practical instruction and a favourable community environment. The findings provide valuable information for diabetes self-management intervention development in China, and have implications for programmes tailored to populations in similar sociocultural circumstances.

Peer-led diabetes self-management programme for community-dwelling older people in China: study protocol for a quasi-experimental design

AIM A protocol for a new peer-led self-management programme for community-dwelling older people with diabetes in Shanghai, China. BACKGROUND The increasing prevalence of type 2 diabetes poses major public health challenges. Appropriate education programmes could help people with diabetes to achieve self-management and better health outcomes. Providing education programmes to the fast growing number of people with diabetes present a real challenge to Chinese healthcare system, which is strained for personnel and funding shortages. Empirical literature and expert opinions suggest that peer education programmes are promising. DESIGN Quasi-experimental. METHODS This study is a non-equivalent control group design (protocol approved in January, 2008). A total of 190 people, with 95 participants in each group, will be recruited from two different, but similar, communities. The programme, based on Social Cognitive Theory, will consist of basic diabetes instruction and social support and self-efficacy enhancing group activities. Basic diabetes instruction sessions will be delivered by health professionals, whereas social support and self-efficacy enhancing group activities will be led by peer leaders. Outcome variables include: self-efficacy, social support, self-management behaviours, depressive status, quality of life and healthcare utilization, which will be measured at baseline, 4 and 12 weeks. DISCUSSION This theory-based programme tailored to Chinese patients has potential for improving diabetes self-management and subsequent health outcomes. In addition, the delivery mode, through involvement of peer leaders and existing community networks, is especially promising considering healthcare resource shortage in China.

Innovative self-management programme for diabetics following coronary care unit admission.

BACKGROUND Evidence indicates self-management programmes based on improving self-efficacy in managing diabetes can reduce the risk of a further cardiac event. Many current cardiac rehabilitation or diabetes self-management programmes do not address the needs of people with both type 2 diabetes and a critical cardiac condition in their transition from coronary care unit (CCU) to home. AIMS/METHODS The aim was to develop and pilot test a Cardiac-Diabetes Self-Management Program (CDSMP) using an experimental design. FINDINGS/CONCLUSION Results demonstrated the feasibility of the CDSMP for CCU patients with type 2 diabetes in their transition to home, and a full study is warranted.

Psychometric Properties of the Chinese Version of the Perceived Therapeutic Efficacy Scale for Type 2 Diabetes

BACKGROUND/PURPOSE The purpose of this study was to test the psychometric properties of the Perceived Therapeutic Efficacy Scale (PTES) for type 2 diabetes with a Taiwanese sample. The mortality rate and health care cost of diabetes have dramatically increased in Taiwan, with many people with diabetes lacking the ability to control their disease appropriately. Addressing this problem requires enhancing self-efficacy towards self-management. Thus, there is a particular need for research into developing a diabetes-specific self-efficacy measurement instrument in Taiwan. METHODS This study was undertaken in two stages. Stage 1 consisted of forward and back translation of the PTES into Chinese and examination of content validity. Stage 2 established the validity and reliability of the Chinese version of PTES (C-PTES). A total of 230 people with type 2 diabetes aged 30 years or more from a diabetes outpatient clinic and taking oral medicine were recruited for psychometric testing. RESULTS Significant criterion-related validity was demonstrated between the C-PTES and the Summary of Diabetes Self-Care Activities scores (r=0.32; p<0.01). Convergent validity was confirmed as the C-PTES converged well with the General Self-Efficacy Scale in measuring self-efficacy (r=0.42; p<0.01); construct validity using factor analysis composed a single subscale. Internal consistency showed Cronbachs alpha was 0.95 and the test-retest reliability (Pearsons correction) was 0.79 (p<0.01) and a Bland-Altman plot showed that 97% of the subjects were within two standard deviations of the mean. CONCLUSION The results of reliability and validity strengthen confidence in using the C-PTES. The C-PTES requires future studies to confirm the psychometric properties.

Psychometric Evaluation of the Chinese Version of the Diabetes Coping Measure Scale

PURPOSE To evaluate the psychometric properties of a Chinese version of the Diabetes Coping Measure scale (DCM-C). METHODS A self-administered questionnaire was completed by 205 people with type 2 diabetes from the endocrine outpatient departments of three hospitals in Taiwan. Confirmatory factor analysis, criterion validity, and internal consistency reliability were conducted to evaluate the psychometric properties of the DCM-C. FINDINGS Confirmatory factor analysis confirmed a four-factor structure (chi(2)/df ratio = 1.351, good of fit index (GFI) = .904, comparitive fit index (CFI) = .902, root mean square error of approximation (RMSEA) = .041). The DCM-C was significantly associated with hemoglobin A1c and diabetes self-care behaviors. Internal consistency reliability of the total DCM-C scale was .74. Cronbachs alpha coefficients for each subscale of the DCM-C ranged from .37 (tackling spirit) to .66 (diabetes integration). CONCLUSIONS The DCM-C demonstrated satisfactory reliability and validity to determine the use of diabetes coping strategies. The tackling spirit dimension needs further refinement when applying this scale to Chinese populations with diabetes. CLINICAL RELEVANCE Healthcare providers who treat Chinese people with diabetes can use the DCM-C to implement an early determination of diabetes coping strategies.