Richard A. Kanter

The Family and Type 2 Diabetes: A Framework for Intervention:

Four broad groups of factors have been linked with self-management behavior in type 2 diabetes over time: (1) characteristics of patients, (2) amount and management of stress, (3) characteristics of providers and provider-patient relationships, and (4) characteristics of the social network/context in which disease management takes place. Of these four, social network/context has received the least amount of study and has been described in terms not easily applicable to intervention. In this paper, we identified the social network/context of diabetes management as residing within the family. We defined the family for clinical purposes, reviewed the literature concerning what is known about the link between properties of the family context of care and outcomes in type 2 diabetes and other chronic diseases, and identified areas of family life that are relevant to diabetes management. This information was then used to demonstrate how a family context of care can serve as a clinical framework for integrating all four groups of factors that affect disease management. Implications of this approach for practice and research are described.

Patient-appraised couple emotion management and disease management among Chinese American patients with type 2 diabetes.

Family context exerts a strong influence on disease management among patients with chronic disease, but it is not clear which aspects of family life are most influential. This study examined the linkages between patient-appraised couple emotion management (conflict resolution, expressiveness, and respect) and disease management (biological, morale/depression, quality of life, and behavioral) among a relatively understudied group, Chinese American patients with type 2 diabetes. Significant main effects were found between patient-appraised couple emotion management, especially conflict resolution, and the morale component of disease management, but not the biological or behavioral components; both diabetes-specific and general relationship qualities (marital satisfaction) were independently linked to disease management. Acculturation did not qualify the findings. Similarities among ethnic groups in family and disease management relationships may be more common than differences.

Disease Management Status: A Typology of Latino and Euro-American Patients With Type 2 Diabetes

Abstract The number of indicators of chronic disease management is large and no practical framework is available to guide selection for use in intervention programs. In addition, it is often difficult to integrate multiple disease management indicators into a comprehensive picture of patient functioning. The authors present a heuristic framework for creating a profile of disease management and an empirically based descriptive typology of disease management behavior. From the literature, they identified 5 domains of disease management indicators: biologic, general health and functional status, emotional tone, quality of life, and behavioral. They selected 11 scales and assessed 187 patients with type 2 diabetes. Five statistically replicable patient disease management types were derived from exploratory and confirmatory cluster analyses and a descriptive narrative was created for each: balanced (33%), problematic (6%), coasters (34%), discouraged (16%), and distressed (11%). The typology describes different presentations of disease management that can be linked with patient-tailored interventions for patients with type 2 diabetes.