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Evaluating the Validity of the Risk Perception Survey for Developing Diabetes Scale in a Safety-Net Clinic Population of English and Spanish Speakers 在英语和西班牙语人群的临床安全网人群中评估发展中糖尿病风险认知调查量表的有效性
IF 3.9 Q1 Health Professions Pub Date : 2019-11-20 DOI: 10.1177/0145721719889068
C. Rochefort, Austin S. Baldwin, Jasmin A. Tiro, M. Bowen
Purpose The purpose of this study is to examine the factor structure of the Risk Perception Survey for Developing Diabetes (RPS-DD) and test for factorial invariance by language (English, Spanish) and gender (males, females) in a clinically engaged, racially diverse, low-education population. Methods Adult patients seen in a safety-net health system (N = 641) answered an interviewer-administered survey via telephone in their preferred language (English: 42%, Spanish: 58%). Three constructs in the RPS-DD were assessed—personal control (2 items for internal control and 2 for external control), optimistic bias (2 items), and worry (2 items). Single and multigroup confirmatory factor analyses (CFAs) were performed using maximum-likelihood estimation to determine the factor structure and test for invariance. Results Contrary to previous psychometric analyses in white, educated populations, CFAs supported a 4-factor measurement model with internal and external control items loading onto separate factors. The 4-factor structure was equivalent between males and females. However, the structure varied by language, with the worry subscale items loading more strongly for English than Spanish speakers. Conclusions The RPS-DD can be used to investigate group differences across gender and language and to help understand if interventions have differential effects for subgroups at high risk for diabetes. Given the increasing prevalence of diabetes among Spanish speakers, researchers should continue to examine the psychometric properties of the RPS-DD, particularly the worry subscale, to improve its validity and clinical utility.
本研究的目的是在临床参与、种族多样化、教育程度低的人群中检验发展中糖尿病风险感知调查(RPS-DD)的因素结构,并通过语言(英语、西班牙语)和性别(男性、女性)检验因子不变性。方法641名在安全网卫生系统就诊的成年患者通过电话以自己喜欢的语言(英语占42%,西班牙语占58%)回答了一项由访谈者管理的调查。评估了RPS-DD中的三个构念——个人控制(内部控制各2项,外部控制各2项)、乐观偏差(2项)和担忧(2项)。采用最大似然估计进行单组和多组验证性因子分析(CFAs),以确定因子结构并检验不变性。结果与以往对受过教育的白人人群的心理测量分析相反,CFAs支持一个四因素测量模型,其中内部和外部控制项目加载到单独的因素上。4因素结构在男女之间是相等的。然而,结构因语言而异,说英语的人比说西班牙语的人更担心。结论:RPS-DD可用于调查不同性别和语言的群体差异,并有助于了解干预措施是否对糖尿病高危亚群有不同的影响。鉴于西班牙语人群中糖尿病患病率的增加,研究人员应继续检查RPS-DD的心理测量特性,特别是担忧分量表,以提高其有效性和临床应用。
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引用次数: 5
Individuals With Type 2 Diabetes: An Exploratory Study of Their Experience of Family Relationships and Coping With the Illness 2型糖尿病患者家庭关系和疾病应对经验的探索性研究
IF 3.9 Q1 Health Professions Pub Date : 2019-11-15 DOI: 10.1177/0145721719888625
O. Peleg, E. Hadar, Ami Cohen
Purpose The purpose of this qualitative study is to explore familial patterns that may be related to type 2 diabetes (T2DM) and to patients’ ways of coping with the illness. Methods A purposive sample of 32 Israeli Jewish (n = 12) and Arab (n = 20) individuals with T2DM were recruited from a community population and interviewed about their familial experiences and their illness. Interview data were analyzed using Colaizzi’s phenomenological method. Results Many participants, particularly from the Arab society, reported familial patterns that suggest fused relationships and emotional cutoff. They described highly close and positive family relationships, on one hand, but demonstrated unwillingness to share their difficulties with their family members, on the other hand. Precipitating stressful or traumatic events and day-to-day stress appeared as leading perceived causes of the illness. Maintaining an appropriate lifestyle, stress reduction, and family support were the main coping strategies with the illness. Conclusions The findings suggest a possible avenue in which fusion with family members and inability to attenuate emotional distress by sharing difficulties with others may contribute to the development of T2DM. Assessment of such family dynamics and ways of coping with stress could lead to more appropriately nuanced treatment for individuals with T2DM and prediabetes.
目的本定性研究的目的是探讨可能与2型糖尿病(T2DM)和患者应对疾病的方式有关的家族模式。方法从社区人群中招募32名以色列犹太(n=12)和阿拉伯(n=20)T2DM患者,并就他们的家庭经历和疾病进行访谈。访谈数据采用Colaizzi的现象学方法进行分析。结果许多参与者,特别是来自阿拉伯社会的参与者,报告了家庭模式,表明融合的关系和情感切断。他们一方面描述了高度亲密和积极的家庭关系,但另一方面却表现出不愿与家人分享他们的困难。突发的压力或创伤事件以及日常压力似乎是导致疾病的主要原因。维持适当的生活方式、减轻压力和家庭支持是应对疾病的主要策略。结论研究结果表明,与家人融合以及无法通过与他人分享困难来减轻情绪困扰可能有助于T2DM的发展。对这种家庭动态和应对压力的方式进行评估,可以为T2DM和糖尿病前期患者提供更合适的细致入微的治疗。
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引用次数: 6
Barriers to Weight Loss and Physical Activity, and Coach Approaches to Addressing Barriers, in a Real-World Adaptation of the DPP Lifestyle Intervention: A Process Analysis 减肥和体育活动的障碍,以及教练解决障碍的方法,在现实世界中适应DPP生活方式干预:过程分析
IF 3.9 Q1 Health Professions Pub Date : 2019-11-04 DOI: 10.1177/0145721719883615
L. Delahanty, P. Trief, D. Cibula, R. Weinstock
Purpose The purpose of this study is to identify barriers to weight loss and physical activity, as well as approaches used by coaches, in a real-world, community sample of adults with metabolic syndrome (at risk for type 2 diabetes) who participated in a Diabetes Prevention Program (DPP)–adapted weight loss intervention and compare findings to data from the screened and highly selected DPP sample. Methods SHINE (Support, Health Information, Nutrition, and Exercise) was a telephonic DPP adaptation. Primary care staff delivered the DPP curriculum, and lifestyle coaches provided monthly direction to achieve weight loss. For this substudy, barriers to weight loss and physical activity described by participants, as well as approaches coaches used to address them, were gathered. Groupings of barriers (DPP defined) were analyzed in relation to demographic characteristics and compared to data from the DPP sample. Results Top weight loss barriers were problems with self-monitoring, too little physical activity, internal thought/mood cues, vacation/holidays, and social cues. Percentages reporting a barrier were much higher in SHINE. Top physical activity barriers were problems with self-monitoring, access/weather, time management, aches/pains, and vacation/holidays. These did not correspond closely to DPP data. Coaches used problem solving, self-monitoring skills review, increased physical activity, and motivational strategies. SHINE coaches were more likely than DPP coaches to use alternative approaches. Conclusions Barriers to weight loss and physical activity in a community sample of persons at risk for diabetes occurred at much higher rates than in the highly screened DPP sample. Training coaches in a variety of patient-centered approaches may maximize their positive impact.
本研究的目的是确定减肥和体育活动的障碍,以及教练使用的方法,在现实世界中,参与糖尿病预防计划(DPP)适应减肥干预的代谢综合征成人社区样本(有2型糖尿病风险),并将研究结果与筛选和高度选择的DPP样本的数据进行比较。方法SHINE (Support, Health Information, Nutrition, and Exercise)是一种电话DPP改编。初级保健人员提供DPP课程,生活方式教练每月提供减肥指导。在这个子研究中,收集了参与者描述的减肥和体育活动的障碍,以及教练用来解决这些障碍的方法。分析障碍分组(DPP定义)与人口统计学特征的关系,并与DPP样本的数据进行比较。结果:最大的减肥障碍是自我监控问题、身体活动太少、内部思想/情绪线索、假期/假期和社会线索。在SHINE中报告障碍的百分比要高得多。最主要的体育活动障碍是自我监控、出入/天气、时间管理、疼痛/疼痛和假期/假期问题。这些数据与民进党的数据并不吻合。教练使用了解决问题、自我监控技能回顾、增加体育活动和激励策略。SHINE教练比DPP教练更有可能使用替代方法。结论:在糖尿病高危人群的社区样本中,体重减轻和身体活动障碍的发生率远高于经过高度筛选的DPP样本。以各种以患者为中心的方法培训教练员可以最大限度地发挥其积极影响。
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引用次数: 13
The Role and Value of Ongoing and Peer Support in Diabetes Care and Education 持续和同伴支持在糖尿病护理和教育中的作用和价值
IF 3.9 Q1 Health Professions Pub Date : 2019-10-16 DOI: 10.1177/0145721719882007
H. Warshaw, L. Hodgson, Mark Heyman, Tamara K. Oser, Heather R. Walker, Phyllisa Deroze, Joanne Rinker, Michelle L. Litchman
Purpose Increasing attention is being given to the challenges and emotional toll of managing diabetes. This Perspectives in Practice details the specialty’s guiding documents for initial and ongoing support. It also defines various types of social support, including peer support, for optimal diabetes care. Focusing on peer support, this paper provides a review of the body of evidence demonstrating the value of peer support to improve clinical and behavioral outcomes. To achieve positive outcomes, it is optimal for people with diabetes to have access to ongoing support from their health care provider, including diabetes care and education specialists. They should also be made aware of, and given referral to options and opportunities for peer support. This Perspectives in Practice concludes with a call to action for diabetes care and education specialists to deliver to integrate and promote the value of peer support in the care they provide. Conclusion Managing diabetes during the stages and ages of life is chronically challenging and complex. Various types of support offered by health care providers, including diabetes care and education specialists and others in the person’s social support milieu, can positively affect emotional well-being. Health care providers should routinely assess their client’s social supports and refer the person with diabetes and/or their caregivers to evidence-based types of peer support mutually determined to be of most value. Diabetes care and education specialists should increase their awareness of opportunities to integrate the value of and referral to peer support in their counseling and to gain greater insight into the diabetes-lived experience.
目的人们越来越关注糖尿病管理的挑战和情感损失。本实践视角详细介绍了该专业的指导文件,用于初始和持续支持。它还定义了各种类型的社会支持,包括同伴支持,以实现最佳糖尿病护理。本文以同伴支持为重点,回顾了大量证据,证明同伴支持对改善临床和行为结果的价值。为了取得积极的结果,糖尿病患者最好能获得包括糖尿病护理和教育专家在内的医疗保健提供者的持续支持。还应让他们了解同行支持的选择和机会,并将其推荐给他们。《实践展望》最后呼吁糖尿病护理和教育专家采取行动,在他们提供的护理中整合和促进同行支持的价值。结论在生命的各个阶段和年龄段管理糖尿病是一项长期的挑战和复杂的工作。医疗保健提供者提供的各种类型的支持,包括糖尿病护理和教育专家以及个人社会支持环境中的其他人,可以积极影响情绪健康。医疗保健提供者应定期评估其客户的社会支持,并将糖尿病患者和/或其护理人员转介给双方共同认为最有价值的循证类型的同伴支持。糖尿病护理和教育专家应提高他们对机会的认识,将同伴支持的价值和转介纳入他们的咨询中,并对糖尿病的生活体验有更深入的了解。
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引用次数: 15
A Couples-Based Approach for Increasing Physical Activity Among Adults With Type 2 Diabetes: A Pilot Feasibility Randomized Controlled Trial 增加成人2型糖尿病患者身体活动的一种基于夫妻的方法:一项试点可行性随机对照试验
IF 3.9 Q1 Health Professions Pub Date : 2019-10-16 DOI: 10.1177/0145721719881722
Jennalee S. Wooldridge, K. Ranby, S. Roberts, A. Huebschmann
Purpose The purpose of the study was to examine feasibility outcomes and obtain initial efficacy data on an intervention testing collaborative implementation intentions (IIs) for physical activity (PA) among participants with type 2 diabetes. Methods The study used a pilot randomized design and enrolled people with diabetes (PWD) and their partners (N = 40 couples, 80 individuals). PWD reported psychosocial measures, including self-efficacy for PA, diabetes partner investment in diabetes self-management, and PA-related social support. Accelerometers (objective) and the International Physical Activity Questionnaire (self-report) were used to assess PA. Results Participants in both experimental conditions reported being satisfied with the intervention and highly committed to their PA plans. Participants were able to follow instructions and completed the intervention in less than 30 minutes. Participants in the collaborative IIs condition reported a greater increase in PA-related social support (partial 2 = .185, P < .05) and self-reported recreational PA (partial 2 = .210, P < .05) at 6 weeks compared to the other 2 conditions. In this pilot study, there were no significant group differences on other psychosocial outcomes or for objective PA; however, time in light PA trended higher for the collaborative IIs condition compared to the other 2 conditions (partial 2 = .237, P = .056). Conclusions This study provides initial support for collaborative IIs for PA with PWD and their partners. This brief intervention was feasible and highly acceptable, and it may improve relationship dynamics around PA as well as ultimately increase PA.
目的本研究的目的是检查2型糖尿病参与者身体活动(PA)的干预测试合作实施意向(IIs)的可行性结果并获得初步疗效数据。方法本研究采用随机试验设计,纳入糖尿病患者及其伴侣(N=40对夫妇,80人)。PWD报告了心理社会指标,包括PA的自我效能感、糖尿病伴侣对糖尿病自我管理的投资以及PA相关的社会支持。使用加速度计(客观)和国际体育活动问卷(自我报告)来评估PA。结果两种实验条件下的参与者都表示对干预感到满意,并高度致力于他们的PA计划。参与者能够按照指示进行干预,并在不到30分钟的时间内完成干预。与其他2种情况相比,协作IIs条件下的参与者在6周时报告了PA相关社会支持(部分2=.185,P<.05)和自我报告的娱乐性PA(部分2=.210,P<0.05)的更大增加。在这项试点研究中,在其他心理社会结果或客观PA方面没有显著的群体差异;然而,与其他2种情况相比,协作IIs条件下轻度PA的时间趋势更高(部分2=.237,P=.056)。结论本研究为PWD及其伴侣的PA协作IIs提供了初步支持。这种短暂的干预是可行的,也是高度可接受的,它可以改善PA周围的关系动态,并最终增加PA。
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引用次数: 13
Empowering Diabetes Self-Management Through Technology and Nurse Health Coaching 通过技术和护士健康指导增强糖尿病自我管理能力
IF 3.9 Q1 Health Professions Pub Date : 2019-10-14 DOI: 10.1177/0145721719879421
S. Miyamoto, Stuart Henderson, Sarina Fazio, B. Saconi, Elizabeth Thiede, Deborah A. Greenwood, H. Young
Purpose This research explores the impact of mobile health (mHealth) technology and nurse health coaching on views of diabetes self-management (DSM) for persons living with diabetes. Methods Three focus groups (N = 24) were conducted with individuals living with type 2 diabetes who participated in a nurse health coaching and mHealth technology intervention study. Qualitative thematic analysis was used to identify overarching themes in each group. Results Major themes identified following intervention participation included enhanced perspectives about living with diabetes, increased awareness of how health behaviors influence DSM, improved support, and increased ownership of DSM. Conclusions The themes identified suggest that the mHealth technology and health coaching intervention together may have had an empowering effect on participants’ DSM. These results suggest that providing nurse health coaching with mHealth technology may help individuals ameliorate some of the challenges of living with and managing diabetes.
目的本研究探讨移动健康(mHealth)技术和护士健康指导对糖尿病患者糖尿病自我管理(DSM)观点的影响。方法对2型糖尿病患者进行三个焦点小组(N=24),这些患者参加了护士健康指导和mHealth技术干预研究。定性主题分析用于确定每组的总体主题。结果参与干预后确定的主要主题包括增强对糖尿病患者的认识,提高对健康行为如何影响DSM的认识,改善支持,以及增加DSM的所有权。结论所确定的主题表明,mHealth技术和健康指导干预相结合可能对参与者的DSM产生了增强作用。这些结果表明,利用mHealth技术为护士提供健康指导可能有助于个人减轻糖尿病患者生活和管理的一些挑战。
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引用次数: 13
Insights Into Veterans’ Perspectives on a Peer Support Program for Glycemic Management 退伍军人对同伴支持血糖管理项目的看法
IF 3.9 Q1 Health Professions Pub Date : 2019-10-09 DOI: 10.1177/0145721719879417
Briana Lott, T. Dicks, S. Keddem, Valerie S. Ganetsky, J. Shea, Judith A. Long
Purpose The purpose of this study was to explore the mentor-mentee relationship in veterans with type 2 diabetes and gain insight into successful pairings. Methods Qualitative semistructured interviews were conducted as part of a peer mentoring randomized controlled trial to understand participants’ experiences, their relationship with their partner, and how the intervention affected self-care behaviors. Purposive sampling was done to ensure adequate representation of mentees who made large strides in reaching their glycemic targets, those who made marginal improvements toward their glycemic goals, and those who got worse. All interviews were audio-recorded, transcribed, and analyzed for salient themes. Results The intervention was well received, with most participants describing it as valuable. Participants perceived the intervention to have a number of benefits, including accessible support, enhanced self-confidence, increased accountability, better self-efficacy, improved glycemic management, and a fulfilled sense of altruism. Participants did encounter barriers, including logistical, interpersonal, and individual obstacles. The more successful mentees tended to be more effusive in their description of their mentors, endorsed a stronger sense of connection to their mentor, described a more structured interaction with their mentor, and tended to be more complimentary of the intervention. Conclusions Large peer support programs are appealing and well received. These programs can be optimized by selecting naturally inclined mentors, providing additional training to introduce more structure into mentorship interactions, and targeting mentees who are not struggling with overwhelming comorbidities.
目的探讨2型糖尿病退伍军人的师徒关系,了解成功的师徒关系。方法采用质性半结构化访谈作为同伴辅导随机对照试验的一部分,了解参与者的经历、与伴侣的关系以及干预对自我照顾行为的影响。有目的的抽样是为了确保充分代表那些在达到血糖目标方面取得了巨大进步的学员,那些在血糖目标方面取得了微小进步的学员,以及那些变得更糟的学员。所有的采访都被录音,转录,并分析了突出的主题。结果干预效果很好,大多数参与者认为这是有价值的。参与者认为干预有许多好处,包括可获得的支持、增强的自信、增加的责任、更好的自我效能、改善的血糖管理和实现的利他意识。参与者确实遇到了障碍,包括后勤、人际关系和个人障碍。更成功的学员在描述导师时往往更加热情洋溢,对导师的联系感更强,与导师的互动更有条理,对干预的评价也更高。结论:大型同伴支持项目很有吸引力,并且很受欢迎。这些项目可以通过选择自然倾向的导师,提供额外的培训以引入更多的指导互动结构,以及针对那些没有与压倒性的合并症作斗争的学员来优化。
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引用次数: 6
A Coordinated Population Health Approach to Diabetes Education in Primary Care 在初级保健中协调糖尿病教育的人口健康方法
IF 3.9 Q1 Health Professions Pub Date : 2019-10-03 DOI: 10.1177/0145721719879427
Margaret F. Zupa, V. Arena, Patricia A. Johnson, Margaret Thearle, L. Siminerio
Purpose The purpose of this feasibility study was to determine the effectiveness of an insurer-based diabetes educator (DE)–driven intervention that relies on systematic restructuring of primary care (PC) linking DE services through population health, practice redesign, and coordinated care for patients with diabetes mellitus (DM) identified as high risk. Methods Two DEs were introduced as members of PC teams and worked with practice-based care managers (PBCMs) to identify and refer DM patients considered at high risk, A1C >9%, DM-related emergency room visit or hospitalization, or reported barriers to care. Elements shown to ensure quality, including population management, diabetes self-management education and support (DSMES), and coordinated patient-centered team-based PC, were central to intervention. A1C, low-density lipoprotein (LDL), and body mass index (BMI) were collected at baseline and outcomes were followed at 3, 6, 9, and 12 months after intervention. Results For patients who received intervention, A1C decreased on average 1.2% (95% confidence interval [CI], 0.8-1.5) from 9.6% (81 mmol/mol) to 8.4% (68 mmol/mol) over 6 months and by 1.1% (95% CI, 0.7-1.5) from 9.2% (77 mmol/mol) to 8.1% (65 mmol/mol) over 12 months, indicating durable improvement in glycemic control. There was no significant change in BMI, and LDL improvement observed at 9 months was lost by 12-month follow-up. Conclusion Findings support the feasibility of a DE-driven intervention for patients with DM at high risk through a coordinated PC approach that improves glycemic control. The feasibility and clinical outcome of this model warrant consideration of a fresh role for DEs in the complex environment of value-based care.
本可行性研究的目的是确定以保险公司为基础的糖尿病教育者(DE)驱动的干预措施的有效性,该干预措施依赖于通过人口健康、实践重新设计和对确定为高风险的糖尿病(DM)患者的协调护理来连接DE服务的初级保健(PC)的系统重组。方法引入两名de作为PC团队的成员,并与基于实践的护理经理(pbcm)合作,识别和转诊被认为是高风险的糖尿病患者,糖化血红蛋白(A1C)达到9%,与糖尿病相关的急诊室就诊或住院,或报告的护理障碍。确保质量的要素,包括人口管理、糖尿病自我管理教育和支持(DSMES),以及协调以患者为中心的团队PC,是干预的核心。在基线时收集A1C、低密度脂蛋白(LDL)和体重指数(BMI),并在干预后3、6、9和12个月随访结果。结果接受干预的患者,糖化血红蛋白在6个月内从9.6% (81 mmol/mol)降至8.4% (68 mmol/mol),平均下降1.2%(95%置信区间[CI], 0.8-1.5);在12个月内从9.2% (77 mmol/mol)降至8.1% (65 mmol/mol),平均下降1.1% (95% CI, 0.7-1.5),表明血糖控制持续改善。BMI无显著变化,9个月时观察到的低密度脂蛋白改善在12个月的随访中消失。结论:研究结果支持通过协调的PC方法对糖尿病高危患者进行de驱动干预的可行性,该方法可改善血糖控制。该模型的可行性和临床结果保证了在基于价值的护理的复杂环境中为DEs考虑一个新的角色。
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引用次数: 1
Feasibility of Routine Assessment of Exercise Knowledge and Safety in Youth With Type 1 Diabetes. 青少年1型糖尿病患者运动知识与安全常规评估的可行性
IF 3.9 Q1 Health Professions Pub Date : 2019-10-01 Epub Date: 2019-06-27 DOI: 10.1177/0145721719860491
Alissa J Roberts, Connor Mitrovich, Joyce P Yi-Frazier, Craig E Taplin

Purpose: This pilot study assessed the feasibility and satisfaction of an electronic clinical tool to survey management of exercise in youth with type 1 diabetes (T1DM) for use in an outpatient diabetes clinic setting.

Methods: Fifty youth with T1DM were recruited (ages, 10-18 years; mean ± SD, 14.8 ± 2.4) and 11 diabetes providers. Prior to a clinic visit and with an electronic tablet, participants completed the Type 1 Diabetes Report of Exercise Practices Survey, which included 9 primary exercise management guidelines. Responses were flagged if contrary to guidelines, and automated individualized reports with personalized evidence-based recommendations were produced for providers prior to seeing the patient. Postclinic assessment surveys were completed by patients and providers.

Results: Out of the 9 guidelines, a mean of 4 ± 0.9 responses per patient were flagged as potentially unsafe. Ninety-one percent of providers took <10 minutes to review and discuss the report with their patients. Ninety-one percent of providers rated the tool as highly useful in facilitating patient education regarding exercise guidelines at that clinic visit. Fifty-six percent of youth rated the tool highly when asked whether its use altered their planned behavior around exercise. When participants were asked if such a tool should be used routinely in diabetes clinic, 64% of provider responses and 60% of patient responses were highly positive.

Conclusions: This electronic tool identified deficits in exercise management in youth with T1DM and improved education in the clinic visit regarding exercise, and a majority felt it feasible and desirable to include in routine outpatient diabetes care.

目的:本初步研究评估了一种电子临床工具的可行性和满意度,该工具用于调查1型糖尿病(T1DM)青少年运动管理的门诊糖尿病诊所设置。方法:招募50例青年T1DM患者(年龄10-18岁;平均±SD, 14.8±2.4)和11名糖尿病患者。在诊所访问之前,参与者使用电子平板电脑完成了1型糖尿病运动实践调查报告,其中包括9项主要运动管理指南。如果响应与指南相反,则会标记,并且在看到患者之前为提供者生成带有个性化循证建议的自动化个性化报告。临床后评估调查由患者和提供者完成。结果:在9个指南中,平均每位患者有4±0.9个反应被标记为潜在不安全。91%的供应商得出结论:该电子工具确定了青年T1DM患者运动管理的缺陷,并改善了诊所访问中关于运动的教育,并且大多数人认为将其纳入常规门诊糖尿病护理是可行和可取的。
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引用次数: 3
Challenges to Diabetes Self-Management in Emerging Adults With Type 1 Diabetes. 新兴成人1型糖尿病患者自我管理的挑战
IF 3.9 Q1 Health Professions Pub Date : 2019-10-01 Epub Date: 2019-07-13 DOI: 10.1177/0145721719861349
Neesha Ramchandani, Niobe Way, Gail D'Eramo Melkus, Susan Sullivan-Bolyai

Purpose: The purpose of this qualitative descriptive study undergirded by Meleis's Transition Framework was to explore developmental, situational, and organizational challenges experienced by a diverse group of emerging adults (18-29 years old) with type 1 diabetes (T1DM). Their perspectives on creating a developmentally informed diabetes self-management (DSM) program that supports transitional care were also explored.

Methods: A purposive sample of emerging adults with T1DM was recruited from the pediatric and adult diabetes clinics of an urban academic medical center. Those who consented participated in either a single focus group or a single interview. Self-reported demographic and clinical information was also collected.

Results: The sample was comprised of 21 emerging adults, with an average age of 23.6 ± 2.6 years, diabetes duration of 14.7 ± 5.0 years, and 71% female. Four main themes emerged: (1) finding a balance between diabetes and life, (2) the desire to be in control of their diabetes, (3) the hidden burden of diabetes, and (4) the desire to have a connection with their diabetes provider. Use of insulin pumps and continuous glucose monitors and attendance at diabetes camp decreased some of the DSM challenges. Different groups of individuals had different perspectives on living with diabetes and different approaches to DSM.

Conclusions: The emerging adults in this study had a strong desire to be in good glycemic control. However, all participants described having a hard time balancing DSM with other competing life priorities. They also desired personalized patient-provider interactions with their diabetes care provider in clinical follow-up services. Even though the study sample was small, important themes emerged that warrant further exploration.

目的:在Meleis过渡框架的基础上,本定性描述性研究的目的是探讨不同群体的1型糖尿病(T1DM)新成人(18-29岁)所经历的发展、情境和组织挑战。他们的观点,创建一个发展知情的糖尿病自我管理(DSM)计划,支持过渡护理也进行了探讨。方法:从某城市学术医疗中心的儿科和成人糖尿病诊所招募新发T1DM成人患者。那些同意的人参加了一个单独的焦点小组或一次单独的访谈。自我报告的人口统计和临床信息也被收集。结果:21例初生成人,平均年龄23.6±2.6岁,糖尿病病程14.7±5.0年,女性占71%。出现了四个主要主题:(1)在糖尿病和生活之间找到平衡;(2)控制糖尿病的愿望;(3)糖尿病的隐藏负担;(4)与糖尿病提供者建立联系的愿望。使用胰岛素泵和连续血糖监测仪以及参加糖尿病营地减少了一些DSM挑战。不同群体的个体对糖尿病患者的生活有不同的看法,对DSM有不同的方法。结论:在这项研究中,初生成人有良好血糖控制的强烈愿望。然而,所有参与者都描述了在平衡DSM与其他竞争生活优先事项方面的困难。他们还希望在临床随访服务中与糖尿病护理提供者进行个性化的患者-提供者互动。尽管研究样本很小,但重要的主题仍值得进一步探索。
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引用次数: 24
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Diabetes Educator
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