Robin Whittemore

Validity in Qualitative Research

Much contemporary dialogue has centered on the difficulty of establishing validity criteria in qualitative research. Developing validity standards in qualitative research is challenging because of the necessity to incorporate rigor and subjectivity as well as creativity into the scientific process. This article explores the extant issues related to the science and art of qualitative research and proposes a synthesis of contemporary viewpoints. A distinction between primary and secondary validity criteria in qualitative research is made with credibility, authenticity, criticality, and integrity identified as primary validity criteria and explicitness, vividness, creativity, thoroughness, congruence, and sensitivity identified as secondary validity criteria.

Depression in type 1 diabetes in children: Natural history and correlates

The combination of diabetes and depression in children and adolescents is largely unstudied. The purpose of this article is to review the literature on the natural history and correlates of comorbid diabetes and depression in children and adolescents. Children with diabetes have a two-fold greater prevalence of depression, and adolescents up to three-fold greater, than youth without diabetes. Correlates of depression and diabetes include gender, poorer metabolic control, and family behaviors. Very little is known about treatment in these youth, and more studies are indicated.

Processes of Self‐Management in Chronic Illness

PURPOSE Self-management is a dynamic process in which individuals actively manage a chronic illness. Self-management models are limited in their specification of the processes of self-management. The purpose of this article is to delineate processes of self-management in order to help direct interventions and improve health outcomes for individuals with a chronic illness. DESIGN Qualitative metasynthesis techniques were used to analyze 101 studies published between January 2000 and April 2011 that described processes of self-management in chronic illness. METHODS Self-management processes were extracted from each article and were coded. Similar codes were clustered into categories. The analysis continued until a final categorization was reached. FINDINGS Three categories of self-management processes were identified: focusing on illness needs; activating resources; and living with a chronic illness. Tasks and skills were delineated for each category. CONCLUSIONS This metasynthesis expands on current descriptions of self-management processes by specifying a more complete spectrum of self-management processes. CLINICAL RELEVANCE Healthcare providers can best facilitate self-management by coordinating self-management activities, by recognizing that different self-management processes vary in importance to patients over time, and by having ongoing communication with patients and providers to create appropriate self-management plans.

Combining evidence in nursing research: methods and implications.

BackgroundThe knowledge explosion in health care coupled with recent evidence-based practice initiatives has increased both the need for and the production of reviews of past research. The proliferation of such reviews has contributed to inconsistency in methods and terminology. Differing methods for integrative reviews, systematic reviews, meta-analyses, and qualitative reviews have been proposed, yet are not clearly differentiated in published reports. Although there are common features to these methods, each method has a distinct purpose, sampling frame, definition, and type of analysis. ApproachThe literature on research review methods was analyzed and synthesized. Specific attention was directed toward the issues specific to combining primary nursing research studies. ResultsThe defining characteristics of different research review methods, the common stages of all research reviews, and criteria for evaluating quality are described. DiscussionGreater clarity regarding research review methods has the potential to enhance methodological rigor and subsequently the applicability of findings of all review methods to practice and policy.

Translating the Diabetes Prevention Program to Primary Care: A Pilot Study

Background: Research on the translation of efficacious lifestyle change programs to prevent type 2 diabetes into community or clinical settings is needed. Objective: The objective of this study was to examine the reach, implementation, and efficacy of a 6-month lifestyle program implemented in primary care by nurse practitioners (NPs) for adults at risk of type 2 diabetes. Methods: The NP sites (n = 4) were randomized to an enhanced standard care program (one NP and one nutrition session) or a lifestyle program (enhanced standard care and six NP sessions). These NPs recruited adults at risk of diabetes from their practice (n = 58), with an acceptance rate of 70%. Results: The program reached a diverse, obese, and moderately low income sample. The NPs were able to successfully implement the protocols. The average length of the program was 9.3 months. Attendance was high (98%), and attrition was low (12%). The NPs were able to adopt the educational, behavioral, and psychosocial strategies of the intervention easily. Motivational interviewing was more difficult for NPs. Mixed-model repeated-measures analysis indicated significant trends or improvement in both groups for nutrition and exercise behavior. Participants of the lifestyle program demonstrated trends for better high-density lipoprotein (HDL) and exercise behavior compared with the enhanced standard care participants. Twenty-five percent of lifestyle participants met treatment goals of 5% weight loss compared with 11% of standard care participants. Discussion: A lifestyle program can be implemented in primary care by NPs, reach the targeted population, and be modestly successful. Further research is indicated.

Psychological Experience of Parents of Children With Type 1 Diabetes A Systematic Mixed-Studies Review

Purpose The purpose of this review is to describe the prevalence of psychological distress in parents of children with type 1 diabetes (T1DM), the relationship between parental psychological distress and health outcomes, and parents’ psychological experience of having a child with T1DM. Clinical and research implications are presented. Method A systematic mixed-studies review was undertaken to review the quantitative and qualitative research on the parental experience of having a child with T1DM. A total of 34 articles met the inclusion criteria and were included in the review. Results The prevalence of parental psychological distress across all studies ranged from 10% to 74%, with an average of 33.5% of parents reporting distress at diagnosis and 19% of parents reporting distress 1 to 4 years after diagnosis. Parental psychological distress in parents of children with T1DM, regardless of how it was defined, was associated with higher child self-report of stress and depressive symptoms, more problematic child behavior, and lower child self-report of quality of life. Parental psychological distress also had negative effects on diabetes management. Themes of the qualitative synthesis indicated that parents perceived T1DM as a difficult diagnosis that contributed to significant family disruption. Adjustment occurred over time; however, ongoing stress was experienced. Conclusions Screening for psychological distress in parents of children with T1DM is indicated, and preventive interventions are needed.

A nurse-coaching intervention for women with type 2 diabetes.

PURPOSE The purpose of this pilot study was to determine the efficacy of a 6-month nurse-coaching intervention that was provided after diabetes education for women with type 2 diabetes. METHODS In this pilot study, 53 women were randomized to the nurse-coaching intervention or a standard care control condition. The nurse-coaching intervention consisted of 5 individualized sessions and 2 follow-up phone calls over 6 months. The nurse-coaching sessions included educational, behavioral, and affective strategies. Data were collected on physiologic adaptation (hemoglobin A1c [A1C] and body mass index [BMI]), self-management (dietary and exercise), psychosocial adaptation (diabetes-related distress and integration), and treatment satisfaction at baseline, 3 months, and 6 months. RESULTS Women in the treatment group demonstrated better diet self-management, less diabetes-related distress, better integration, and more satisfaction with care, and had trends of better exercise self-management and BMI. The A1C levels improved in both groups at 3 months, yet the difference between the groups was not significant. Attendance at nurse-coaching sessions was 96%. CONCLUSIONS This nurse-coaching intervention demonstrates promise as a means of improving self-management and psychosocial outcomes in women with type 2 diabetes.

Culturally competent interventions for Hispanic adults with type 2 diabetes: a systematic review.

Culturally competent interventions have been developed to improve outcomes for Hispanic adults with type 2 diabetes. The purpose of this systematic review is to synthesize the research on culturally competent interventions for this vulnerable population. A systematic approach was used to locate empirical reports (n = 11). Interventions were multifaceted with the majority demonstrating significant improvements in clinical outcomes, behavioral outcomes, and diabetes-related knowledge. Culturally competent interventions have the potential to improve outcomes in Hispanic adults with type 2 diabetes. However, improvements were modest and attrition was moderate to high in many studies. Addressing linguistic and cultural barriers to care are important beginnings to improving health outcomes for Hispanic adults with type 2 diabetes.

A systematic review of the translational research on the Diabetes Prevention Program

ABSTRACTInternational clinical trials have demonstrated compelling evidence on the prevention or delay of type 2 diabetes (T2D) by lifestyle change programs. Numerous studies have translated the Diabetes Prevention Program (DPP) protocol to “real-world” settings. The purpose of this paper is to review the translational research of the DPP protocol in adults at-risk for T2D. This study is a systematic review based on the guidelines from the Cochrane Handbook for Systematic Reviews. There were 16 studies that translated the DPP protocol in four distinct settings: (a) hospital outpatient, (b) primary care, (c) community, and (d) work and church. Settings varied considerably in terms of reach, efficacy, adoption, implementation, and maintenance. There were strengths and limitations to each setting. Better understanding of program adaptation and mediators and moderators to program efficacy are indicated. Future research also needs to continue to explore mechanisms to improve access and long-term outcomes.

Lifestyle change in type 2 diabetes a process model.

BackgroundIntegration is an emerging concept in the study of self-management and chronic illness, yet this process and how it occurs is not well understood. ObjectivesThis investigation, part of a triangulated study, focused on the experience of integrating type 2 diabetes treatment recommendations into an existing lifestyle while participating in a nurse-coaching intervention. MethodAn interpretive method elicited data from nurse-coaching sessions (4), field notes, and an interview in 9 women with type 2 diabetes. The process of data reduction and analysis (Miles & Huberman, 1994) was used to interpret data. ResultsThe core process of integrating lifestyle change in type 2 diabetes was multifaceted and complex. Challenges to the process of integrating lifestyle change included reconciling emotions, composing a structure, striving for satisfaction, exploring self and conflicts, discovering balance, and developing a new cadence to life. These challenges required acknowledgment in order for participants to progress toward integration. DiscussionBalance was an integral component to the experience of integration, between structure and flexibility, fear and hope, conflict and acceptance, diabetes and life. Conceptualizations identified with this investigation extend understanding of theories of integration and lifestyle change and invite the development and testing of nursing interventions.