Self-Care Coping Strategies in People With Diabetes: A Qualitative Exploratory Study
One of the greatest challenges of managing type 1 and 2 diabetes is that it is a lifestyle-related disease and as such must largely be monitored by the patient. “Diabetes self-care requires the patient to make many dietary and lifestyle changes” (Collins, Bradley, O’Sullivan, & Perry 2009). It can be extremely difficult for the patient to undertake such changes on a daily basis when returned to the environment which has many temptations to eschew eating healthfully and exercising. According to the study “Self-care coping strategies in people with diabetes: a qualitative exploratory study,” there is a need to better understand what factors better promote self-care to prescribe more effective treatment regimens for sufferers.
Purpose and research questions
To better understand the degree to which patients may struggle with self-monitoring, this qualitative, exploratory study was undertaken using a sample of 17 patients from GP practices and diabetes clinics in Ireland. It included patients with type 1 and 2 diabetes. The patients has been prescribed a variety of self-care regimes (both oral and insulin-dependent) and had a wide range of different associated complications. This was designed to gain a full and generalized portrait of self-care in relation to the illness.
The main method of assessment deployed was the use of tape-recorded and transcribed semi-structured interviews which were coded using open and axial procedures. Responses were classified after the fact according to generalized categories which were then validated by an outside authority. The categories which emerged corresponded with “health belief, health value, self-efficacy, and locus of control frameworks” (Collins, Bradley, O’Sullivan, & Perry 2009). This study was designed to act as a guide for future treatment programs and to better understand the management of an increasingly common illness.
The author used both qualitative and quantitative studies to justify the purpose of the research study. Both recent and historical studies were cited as part of the review. For example, the author noted that a large-scale intervention study found that tighter glucose control has been associated with more effective containment of blood sugar reading and better metabolic control. This was enabled with the introduction of home glucose monitoring in the 1980s. As well as improvements in technology, however, better support structures were also helpful. “A recent qualitative study examining self- monitoring of blood glucose in patients with type 2 diabetes suggests the role of the health professional is crucial to patient understanding of their blood glucose fluctuations and whether or not the patient responds to the high blood glucose reading with an appropriate self-care action” (Collins, Bradley, O’Sullivan, & Perry 2009).
While the literature review is comprehensive in its diversity of types of studies, one problem is that the authors do not always specifically cite the names of those who performed the study in the text of the article; this information is available if the citations are consulted on the works cited page but can make for confusing reading. Also, the study results are reported without specific statistics supporting the analysis as in this example. “A meta-analysis of self-management education for adults with type 2 diabetes, reported self-management education improves glycaemic control at immediate follow-up, and increased contact time increases the effect. However, the benefit declines one to three months after the intervention ceases, suggesting that learned behaviours may change over time and continuing education is necessary” (Collins, Bradley, O’Sullivan, & Perry 2009). This information is interesting and useful but it is difficult to evaluate the quality of the study based upon the way the results are presented. The quality of research of the studies composing the meta-analysis and the specific, stated aim of the study are not stated.
One or two specific named studies are referenced such as the fact that Bradley et al. observed “patients reported a higher self-care burden when insulin was added to their regimen” and Williams et al. “found patients who feel their health care provider understands and supports them were more likely to have higher levels of self-confidence resulting in successful behaviour change” but once again, there is a lack of detail in terms of how these studies were conducted which makes it difficult to evaluate the quality of results (Collins, Bradley, O’Sullivan, & Perry 2009). The authors do not evaluate the relative strengths and weaknesses of the studies or even note the years they were performed in the text. Overall, the research indicates the difficulty of managing diabetes with self-care strategies and the necessity of outside support to guide home regimes. It justifies the importance of the central research question but could have been performed in a more thorough and easy-to-evaluate manner.
Conceptual / Theoretical Framework
The study was relatively small (17 individuals) and drawn from a relatively narrow sampling (all came from Ireland and were therefore somewhat homogeneous in terms of ethnic and cultural backgrounds). A grounded theory approach was taken in which interviews were coded and then used to inductively develop a theory about diabetes self-management. After semi-structured interviews were transcribed, recorded, and evaluated by both the researchers and an outside authority, the responses were classified into different categories of health belief, health value, self-efficacy, and locus of control frameworks. Based upon these responses, the researchers developed a conceptual model of different types of personalities in terms of how the patient engages in positive self-management of his or her diabetes.
First, “the proactive manger adopts a healthy lifestyle. Many said that they viewed their diabetes as a condition, not a disease, which they had to manage” (Collins, Bradley, O’Sullivan, & Perry 2009). Proactive managers tended to be disproportionately male and were overall healthier than their counterparts because of the active approach to diabetes management which was undertaken. These patients placed an extremely high personal value upon the benefits of self-care and were willing to accept full responsibility for their diabetes self-management. They were also willing to engage in glycemic control activities such as “testing, recording, assessment of blood glucose records), and adjustment of self-care as required” (Collins, Bradley, O’Sullivan, & Perry 2009). Individuals were willing to engage in meal planning and label-reading, tested their numbers on a regular basis and sought out help at various clinics for assistance and information about new regimes.
In contrast, “the passive follower prefers structure to flexibility, with no variation in medication or meal times” (Collins, Bradley, O’Sullivan, & Perry 2009). These patients, who were more often dependent upon oral medications exclusively, were consistent in following a self-care regime but they were resistant to change and more dependent upon others in managing their care, such as spouses who were given the responsibility of meal planning. Finally, the nonconformist type was actively resistant to treatment and self-screening. “They do not follow many of the activities of their self-care regimen, especially prescribed dietary and activity changes” (Collins, Bradley, O’Sullivan, & Perry 2009). These patients were more often insulin-dependent, found diabetes to be an unsurmountable illness, and suffered more complications as a result.
This typology derived from the grounded research study was intended to provide healthcare providers in the field of diabetes research with greater assistance in terms of how they approached diabetes management with their patients, enabling them to tailor their advice to suit the needs of different mindsets to promote better self-care. It also was intended to act as a springboard for future research studies in the field of diabetes research. “The findings from this study may be relevant to the design of quantitative instruments addressing self-care coping strategies in patients with diabetes and other chronic conditions” (Collins, Bradley, O’Sullivan, & Perry 2009). Gender, age, and current regime (oral vs. insulin-dependent patients) should all be taken into consideration when providing advice and structuring future research.
Collins, M., Bradley, C., O’Sullivan, T. & Perry, I. (2009). Self-care coping strategies in people
with diabetes: a qualitative exploratory study. BMC Endocrine Disorders 9:6 Retrieved from: http://www.biomedcentral.com/1472-6823/9/6
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