The purpose of this study is to gain insight about patient experience of diabetes self-management education in a patient-centered medical home.
Methods
Six focus groups consisting of 37 people with diabetes, diverse in race and ethnicity, were conducted at 3 sites. Participants described their experience in the program and their challenges in diabetes self-management; they also suggested services to meet their diabetes care needs.
Results
The most common theme was ongoing concerns about care and support. There was much discussion about the value of the support provided by health navigators integrated in the diabetes health care team. Frequent concerns expressed by participants centered on personal challenges in engaging in healthy lifestyle behaviors. Ongoing programmatic support of self-management goals was widely valued.
Conclusions
Individuals who received health care in a patient-centered medical home and could participate in diabetes self-management education with integrated support valued both activities. The qualitative results from this study suggest need for more formalized exploration of effective means to meet the ongoing support needs of people with diabetes.
Get full access to this article
View all access options for this article.
References
1.
Standards of medical care in diabetes—2015: summary of revisions. Diabetes Care. 2015;38(suppl S4).
2.
American Association of Diabetes Educators. AADE guidelines for the practice of diabetes self-management education and training (DSME/T). Diabetes Educ. 2009;35:85S-107S.
HaasLMaryniukMBeckJ. National standards for diabetes self-management education and support. Diabetes Care. 2013;36(suppl 1):S100-S108.
5.
NorrisSLLauJSmithSJSchmidCHEngelgauMM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002;25:1159-1171.
6.
NorrisSLEngelgauMMNarayanKM. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001;24:561-587.
7.
MinetLMollerSVachWWagnerLHenriksenJE. Mediating the effect of self-care management intervention in type 2 diabetes: a meta-analysis of 47 randomised controlled trials. Patient Educ Couns. 2010;80:29-41.
8.
EllisSESperoffTDittusRSBrownAPichertJWElasyTA. Diabetes patient education: a meta-analysis and meta-regression. Patient Educ Couns. 2004;52:97-105.
9.
GlazierRHBajcarJKennieNRWillsonK. A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Diabetes Care. 2006;29:1675-1688.
10.
HawthorneKRoblesYCannings-JohnREdwardsAG. Culturally appropriate health education for type 2 diabetes in ethnic minority groups: a systematic and narrative review of randomized controlled trials. Diabet Med. 2010;27:613-623.
11.
ThompsonJRHortonCFloresC. Advancing diabetes self-management in the Mexican American population: a community health worker model in a primary care setting. Diabetes Educ. 2007;33(suppl 6):159S-165S.
12.
BeckhamSBradleySWashburnATaumuaT. Diabetes management: utilizing community health workers in a Hawaiian/Samoan population. J Health Care Poor Underserved. 2008;19:416-427.
13.
BabamotoKSSeyKACamilleriAJKarlanVJCatalasanJMoriskyDE. Improving diabetes care and health measures among Hispanics using community health workers: results from a randomized controlled trial. Health Educ Behav. 2009;36:113-126.
14.
NorrisSLChowdhuryFMVan LeK. Effectiveness of community health workers in the care of persons with diabetes. Diabet Med. 2006;23:544-556.
15.
SepersCEFawcettSBLipmanRD. Measuring the implementation and effects of a coordinated care model featuring diabetes self-management education within four patient-centered medical homes [published online March 23, 2015]. Diabetes Educ. pii:0145721715577638
16.
Standards of medical care in diabetes—2015: foundations of care: education, nutrition, physical activity, smoking cessation, psychosocial care, and immunization. Diabetes Care. 2015;38(suppl S20).
17.
TriefPMSandbergJGDimmockJAForkenPJWeinstockRS. Personal and relationship challenges of adults with type 1 diabetes: a qualitative focus group study. Diabetes Care. 2013;36:2483-2488.
18.
KreugerRACaseyMA. Focus Groups: A Practical Guide for Applied Research. 4th ed.Thousand Oaks, CA: Sage Publications; 2009.
19.
LingTBreretonLConklinANewbouldJRolandM. Barriers and facilitators to integrating care: experiences from the English Integrated Care Pilots. Int J Integr Care. 2012;12:e129.
20.
WallaceAPerkhounkovaYTsengHSchillingerD. Influence of patient characteristics on assessment of diabetes self-management support. Nurs Res. 2013;62:106-114.
21.
JortbergBTMillerBFGabbayRASparlingKDickinsonWP. Patient-centered medical home: how it affects psychosocial outcomes for diabetes. Curr Diab Rep. 2012;12:721-728.
22.
PeyrotMBurnsKKDaviesM. Diabetes Attitudes Wishes and Needs 2 (DAWN2): a multinational, multi-stakeholder study of psychosocial issues in diabetes and person-centred diabetes care. Diabetes Res Clin Pract. 2013;99:174-184.
23.
PietteJResnicowKChoiHHeislerM. A diabetes peer support intervention that improved glycemic control: mediators and moderators of intervention effectiveness. Chronic Illn. 2013;9(4):258-267.
24.
DaleJRWilliamsSMBowyerV. What is the effect of peer support on diabetes outcomes in adults? A systematic review. Diabet Med. 2012;29:1361-1377.
25.
GlasgowRToobertDGilletteC. Psychosocial barriers to self-management and quality of life. Diabetes Spectrum. 2001;14:33-41.
26.
KahnLSVestBMKarlR. Living with diabetes on Buffalo, New York’s culturally diverse West Side. Chronic Illn. 2013;9:43-56.
27.
DaviesMDempsterMMaloneA. Do people with diabetes who need to talk want to talk?Diabet Med. 2006;23:917-919.
28.
DejesusRSVickersKSHowellLAStroebelRJ. Qualities of care managers in chronic disease management: patients and providers’ expectations. Prim Care Diabetes. 2012;6:235-239.
29.
RustveldLOPavlikVNJibaja-WeissMLKlineKNGosseyJTVolkRJ. Adherence to diabetes self-care behaviors in English- and Spanish-speaking Hispanic men. Patient Prefer Adherence. 2009;3:123-130.
30.
BazataDDRobinsonJGFoxKMGrandyS. Affecting behavior change in individuals with diabetes: findings from the Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes (SHIELD). Diabetes Educ. 2008;34:1025-1036.
31.
FunnellMMVallisM. Diabetes HealthSense: development of a resource in support of behavior change. Diabetes Spectrum. 2011;24:144-147.
32.
FisherEBBrownsonCAO’TooleMLAnwuriVV. Ongoing follow-up and support for chronic disease management in the Robert Wood Johnson Foundation Diabetes Initiative. Diabetes Educ. 2007;33(suppl 6):201S-207S.
33.
HallRFJosephDHSchwartz-BarcottD. Overcoming obstacles to behavior change in diabetes self-management. Diabetes Educ. 2003;29:303-311.
34.
GazmararianJAZiemerDCBarnesC. Perception of barriers to self-care management among diabetic patients. Diabetes Educ. 2009;35:778-788.
35.
TangTSGillardMLFunnellMM. Developing a new generation of ongoing: diabetes self-management support interventions: a preliminary report. Diabetes Educ. 2005;31:91-97.
36.
TangTSFunnellMMNoorullaSOhMBrownMB. Sustaining short-term improvements over the long-term: results from a 2-year diabetes self-management support (DSMS) intervention. Diabetes Res Clin Pract. 2012;95:85-92.
