Sue Shea

Diabetes self-management arrangements in Europe: a realist review to facilitate a project implemented in six countries

BackgroundSelf-management of long term conditions can promote quality of life whilst delivering benefits to the financing of health care systems. However, rarely are the meso-level influences, likely to be of direct relevance to these desired outcomes, systematically explored. No specific international guidelines exist suggesting the features of the most appropriate structure and organisation of health care systems within which to situate self-management approaches and practices. This review aimed to identify the quantitative literature with regard to diabetes self-management arrangements currently in place within the health care systems of six countries (The United Kingdom, The Netherlands, Norway, Spain, Bulgaria, and Greece) and explore how these are integrated into the broader health care and welfare systems in each country.MethodsThe methodology for a realist review was followed. Publications of interest dating from 2000 to 2013 were identified through appropriate MeSH terms by a systematic search in six bibliographic databases. A search diary was maintained and the studies were assessed for their quality and risk of bias.ResultsFollowing the multi-step search strategy, 56 studies were included in the final review (the majority from the UK) reporting design methods and findings on 21 interventions and programmes for diabetes and chronic disease self-management. Most (11/21, 52%) of the interventions were designed to fit within the context of primary care. The majority (11/21, 52%) highlighted behavioural change as an important goal. Finally, some (5/21, 24%) referred explicitly to Internet-based tools.ConclusionsThis review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as fundamental principles in the design of relevant programmes. Socio-economic circumstances are relevant to the capacity to self-manage and suggest that any gains and progress will be hard to maintain during economic austerity. This realist review should be interpreted within the wider context of a whole systems approach regarding self-care support and chronic illness management.

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries

BackgroundIrrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the “OTC SOCIOMED”, conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region.MethodsThis feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs’ intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs.ResultsMedian intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale.ConclusionsEvidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries.

Eliciting general practitioners' salient beliefs towards prescribing: a qualitative study based on the theory of planned behaviour in Greece

Prescribing represents an important medical action especially in primary care. However, irrational prescribing is common and has an impact on clinical and economic outcomes. Therefore, there is a growing need to rationalize prescribing. Knowledge of influential factors is crucial for achieving this. The aim of the present study was to identify the behavioural, normative and control beliefs of GPs regarding prescribing in Greece.

Impact of religiosity/spirituality on biological and preclinical markers related to cardiovascular disease. Results from the SPILI III study

AbstractOBJECTIVEThis study aimed at exploring to what extent psychosocial factors, such as religiosity/spirituality and sense of coherence, mediate the negative effects of stress on a variety of cardiometabolic indicators, i.e., hypertension, diabetes, cardiovascular and cerebrovascular disease, and atherosclerotic bio-clinical markers.DESIGNA total of 220 subjects (66.2±16.0 years) of the SPILI III cohort (1988–2012) attending a primary care setting in Spili, a rural town in crete, represented the target group for the present study. Of these, 195 (88.6%) participated in the re-examination (67.2±15.2 years). All participants underwent a standardized procedure including evaluation of anthropometric measurements, biochemical indicators of atherosclerosis, stress hormones, in parallel with ultrasound measurements of carotid intima media thickness (IMT). Religiosity, spirituality and sense of coherence were evaluated with the use of international questionnaires translated into the Greek language and linguistically validated. RESULTSParticipants with higher levels of religious and spiritual beliefs presented lower levels of carotid IMT (1.01±0.101 vs 1.53±0.502 mm, p<0.001). Patterns of inverse relationships were also observed between religiosity/spirituality and prevalence of diabetes (35.1% vs. 2%, p<0.001) with an estimated diabetes risk, fully adjusted odds ratio, 95% CI: 0.91 (0.87–0.94). Highly religious participants presented lower serum cortisol levels (12.3±5.8 vs. 18.2±5.1 µg/dl, p<0.001). Sense of coherence was positively associated with religiosity/spirituality [mean SOC (SD): 123±20 vs. 158±15) p<0.001]. CONCLUSIONSThese findings may be associated with a possible favourable effect of religiosity/spirituality on several cardio-metabolic determinants, therefore deserving further attention by healthcare practitioners and researchers.

Effect of religiosity/spirituality and sense of coherence on depression within a rural population in Greece: the Spili III project

BackgroundRecent research has addressed the hypothesis that religiosity/spirituality and sense of coherence buffer the negative effects of stress on numerous health issues. The aim of the current study was to further this work by exploring potential links between psycho-social factors such as religiosity/spirituality and sense of coherence with depression.MethodsA total number of 220 subjects of the SPILI III cohort (1988–2012) attending a primary care setting in the town of Spili on rural Crete represented the target group. All participants underwent a standardized procedure. Validated questionnaires were used to evaluate sense of coherence, depression levels and religious and spiritual beliefs. A multiple linear regression analysis of the Beck Depression Inventory Scale (BDI) in relation to demographic characteristics, scores on the Royal Free Interview for Spiritual and Religious Beliefs scale (RFI-SRB) and Sense of Coherence scale (SOC) was performed.ResultsA significant inverse association was found between BDI and RFI-SRB scale (B-coef = −0.6999, p < 0.001), as well as among BDI and SOC scale (B-coef = −0.556, p < 0.001).ConclusionsThe findings of the current observational study indicate that highly religious participants are less likely to score high in the depression scale. Furthermore, participants with high SOC scored significantly lower in the BDI scale. Further research is required in order to explore the potential effect of SOC and religiosity/spirituality on mental health.

Exploring the Association of Sense of Coherence, and Spiritual and Religious Beliefs in a Rural Population Group on the Island of Crete, Greece

Objectives/Aim: This article reports the results of an observation study, aimed at exploring an association between spirituality, religiousness, and sense of coherence in a population group residing in a rural area of Crete, Greece. Study Design and Methods: The study was conducted during the period 2007–2009. Subjects aged 65 years and older (n = 118) living in two remote and rural villages in the Heraklion county (Crete) were eligible. Eighty-nine people (51 women and 38 men) participated. Demographic data were obtained, and all participants were asked to complete the Greek version of the self-reported Royal Free Interview for Spiritual and Religious Beliefs, and the Sense of Coherence Scale. Results: Most participants reported strong religious beliefs and this was found to be related with increased age. Widowed participants expressed greater religiousness and spirituality (p = 0.029). The total score for Sense of Coherence was negatively correlated with gender (women have lower scores, p < 0.05), marital status (widows presented lower scores, p < 0.001), and increased age. A strong positive correlation of the Sense of Coherence score with the Spiritual Scale as measured by three questions of the Royal Free Interview was also identified (p = 0.039). Conclusions: The impact of gender and marital status seem to be emerging determinants in defining sense of coherence among inhabitants of rural Crete. The positive association between religious/spiritual beliefs and sense of coherence deserves further attention to promote a multidimensional approach in its study.

European refugee crisis: psychological trauma of refugees and care givers

Purpose In recent years, the number of refugees and migrants entering Europe has increased dramatically. Such trauma may affect not only refugees themselves, but also care givers and rescue workers. The purpose of this paper is to discuss the intensity and psychological impact of the refugee crisis, with a view to suggesting ways of moving forward. Design/methodology/approach Based on recent literature, this paper briefly looks at the importance of attention to health and social issues, before discussing the psychological trauma of refugees and potential emotional trauma of those involved in rescue operations. Findings The provision of psychological support which is both compassionate and culturally competent should be viewed as essential. Furthermore, the development of resources and tools to assist with the current refugee crisis could enable care givers, rescue workers, and healthcare professionals to provide psychological support to migrants and refugees. Such resources could also encourage, and support, frontline responders in caring for their own personal psychological well-being. Originality/value The content of this paper could help to encourage further research in this field, including research into the emotional trauma of rescue workers. Furthermore, it is intended that this paper could contribute to an on-line knowledge base when considering the development of tools and resources to assist with the current refugee crisis.

‘Meaningful meetings’ – A pilot study to improve the diabetes clinical encounter for nurses and patients using The Diabetes MyQuest Consultation Tool©

Background: The clinical encounter between nurse and patient is an important and growing strategy in the management of Type 2 Diabetes Mellitus in primary care settings. However, due to time pressures, lack of knowledge, training and skills, the meeting can be a frustrating experience for both the nurse and the patient, and the potential to improve diabetes self-management may be sub-optimal. The Diabetes MyQuest Consultation Tool© (DMCT©) has been designed in collaboration with both patients and nurses to improve the consultation by using a person centred approach, identifying psychological problems which may affect self-management, and promoting a more meaningful meeting between both parties. Methods: The DMCT© was piloted using a randomised control trial to gauge how feasible, practical and acceptable the application of the questionnaire would be in primary care settings to both nurses and patients. The pilot further explored whether the tool would promote diabetes knowledge, increase consultation satisfaction and improve diabetes self-efficacy in patients compared to usual care. The study used a mixed methods approach of qualitative interviews and three measures: a diabetes knowledge questionnaire (DKQ); satisfaction with the consultation questionnaire (DCPNI) and a diabetes empowerment scale (DES-SF). All participants were given the WHO-5 Well-Being Index to complete. Results: The age range of the sample (n = 106) was 40–90 years (m = 67 years) and comprised of 66 males, and 40 females. The average duration of diabetes was 9 years, and at the pre-study visit the mean values for BMI, cholesterol and HbA1c were 30.7 kg/m2; 4.2 mmols/l and 55.0 mmols/mol, respectively. Fifty-six patients were randomised to use the DMCT© tool as part of their consultation. There were no significant differences to HbA1c, Cholesterol or BMI between the control and intervention groups. There were minor but noted improvements in the control group between the pre and post measure for DKQ (mean increase 1.10; p > 0.001), whereas the intervention group demonstrated significant improved changes for all three measures: DKQ (mean increase = 1.41; p > 0.000), DCPNI (mean increase = 2.1; p > 0.002; DES-SF mean increase = 2.5; p > 0.000). All participants completed the WHO-5 Well-Being Index with 34% (n = 36) scoring on or below the clinical cut-off score of 13 – indicating a need for further depression screening. Conclusion: Patients in the intervention group overwhelmingly found the DMCT© tool helpful with their diabetes consultations and nurses’ derived good practical use from the tool in determining the kinds of issues patients may have. The tool seems to have promoted a more patient centred approach to the consultation, empowering patients to discuss management aspects relevant to their individual needs. The results of this pilot indicate that the DMCT© is a feasible, practical tool for use by both patients and nurses. A larger and longer scale study in varied primary care settings to determine further efficacy and using measurable hard end points is now warranted.