“ I Am Not Alone” : A Photovoice Exploration of Diabetes Self-Management for Older Persons in Rural Ontario,Canada

Abstract

Objective

To explore diabetes self-management for older adults in rural Ontario.

Methods

Fourteen adults, 65 and older, with diabetes, participated in this study using a participatory, art-based approach involving photovoice and semi-structured interviews. Data underwent hermeneutic phenomenology analysis.

Findings

Four themes emerged, elucidating the lived experiences of participants managing diabetes in a rural context.

Discussion

This study underscores the challenges and strategies of diabetes self-management in rural older adults. A holistic approach, encompassing physical, emotional, and mental well-being, is pivotal, augmented by proactive lifestyle choices. Effective coordination in medication management and enhanced communication among health care providers emerged as essential. The unique role of pets illuminates their profound impact on participants’ activity levels and emotional fortitude, suggesting they can be vital assets in diabetes care. Collectively, these findings guide health professionals and policymakers in crafting nuanced, context-sensitive interventions to optimize diabetes management for older adults in rural contexts.

Keywords

Diabetes self-management older adults ontario rural participatory research

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References

Anderson

K. A.

Lord

L. K.

Hill

L. N.

McCune

(2015). Fostering the human-animal bond for older adults: Challenges and opportunities. Activities, Adaptation, & Aging, 39(1), 32–42. https://doi.org/10.1080/01924788.2015.994447

Bendien

Groot

Abma

(2022). Circles of impacts within and beyond participatory action research with older people. Ageing and Society, 42(5), 1014–1034. https://doi.org/10.1017/S0144686X20001336

Brooks

C. M.

Poudrier

(2014). Anti-oppressive visual methodologies: Critical appraisal of cross-cultural research design. Qualitative Sociology Review : QSR, 10(4), 32–51. https://doi.org/10.18778/1733-8077.10.4.02

Byers

Garth

Manley

Chlebowy

(2016). Facilitators and barriers to type 2 diabetes self-management among rural African American adults. Journal of Health Disparities Research and Practice, 9(1), 9. https://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?article=1395&context=jhdrp

Camargo-Plazas

Costa

Duhn

Alvarado

Tregunno

(2020). Uso de métodos participativos en el desarrollo de un programa de educación para el autocuidado de la diabetes en adultos mayores en Canadá. Qualitative Research in Health: Advances and Challenges, 3, 833–845. https://doi.org/10.36367/ntqr.3.2020.833-845

Camargo-Plazas

Robertson

Alvarado

Paré

G. C.

Costa

I. G.

Duhn

(2023). Diabetes self-management education (DSME) for older persons in western countries: A scoping review. PLoS One, 18(8), e0288797–e0288797. https://doi.org/10.1371/journal.pone.0288797

Camargo-Plazas

Robertson

Costa

Paré

G. C.

Alvarado

Duhn

(2022). The big challenge out here is getting stuff: Exploring how the social determinants of health affect diabetes self-management education for seniors. New Trends in Qualitative Research, 11, 1–11. https://doi.org/10.36367/ntqr.11.e555

Capous-Desyllas

Bromfield

N. F.

(2018). Using an arts-informed eclectic approach to photovoice data analysis. International Journal of Qualitative Methods, 17(1), 160940691775218. https://doi.org/10.1177/1609406917752189

Cassimatis

Kavanagh

D. J.

Smith

A. C.

(2014). Perceived needs for supported self-management of type 2 diabetes: A qualitative investigation of the potential for a web-based intervention. Australian Psychologist, 49(2), 75–85. https://doi.org/10.1111/ap.12050

10.

Castleden

Garvin

; First Nation, H.-a.-a. (2008). Modifying photovoice for community-based participatory indigenous research. Social Science & Medicine (1982), 66(6), 1393–1405. https://doi.org/10.1016/j.socscimed.2007.11.030

11.

Choi

Song

Chang

S. J.

Kim

S.-A.

(2014). Strategies for enhancing information, motivation, and skills for self-management behavior changes: A qualitative study of diabetes care for older adults in Korea. Patient Preference and Adherence, 8(default), 219–226. https://doi.org/10.2147/PPA.S58631

12.

Delara

Murray

Jafari

Bahji

Goodarzi

Kirkham

Chowdhury

Seitz

D. P.

(2022). Prevalence and factors associated with polypharmacy: A systematic review and meta-analysis. BMC Geriatrics, 22(1), 601–601. https://doi.org/10.1186/s12877-022-03279-x

13.

Diabetes Canada. (2022). Diabetes in Canada: 2022 Backgrounder. https://www.diabetes.ca/DiabetesCanadaWebsite/media/Advocacy-and-Policy/Backgrounder/2022_Backgrounder_Canada_English_1.pdf .

14.

Dugani

S. B.

Mielke

M. M.

Vella

(2021). Burden and management of type 2 diabetes mellitus in rural United States. Diabetes/Metabolism Research and Reviews, 37(5), e3410. https://doi.org/10.1002/dmrr.3410

15.

Gee

N. R.

Mueller

M. K.

(2019). A systematic review of research on pet ownership and animal interactions among older adults. Anthrozoös, 32(2), 183–207. https://doi.org/10.1080/08927936.2019.1569903

16.

Gee

N. R.

Mueller

M. K.

Curl

A. L.

(2017). Human-animal interaction and older adults: An overview. Frontiers in Psychology, 8, 1416–1416. https://doi.org/10.3389/fpsyg.2017.01416

17.

Gilbert, A. S., Duncan, D. D., Beck, A. M., Eyler, A. A., & Brownson, R. C. (2019). A qualitative study identifying barriers and facilitators of physical activity in rural communities. Journal of Environmental and Public Health, 7298692–7298697. https://doi.org/10.1155/2019/7298692

18.

International Diabetes Federation [IDF]. (2019). IDF diabetes atlas ninth edition. Retrieved March 6 from https://www.diabetesatlas.org/upload/resources/2019/IDF_Atlas_9th_Edition_2019.pdf.

19.

International Diabetes Federation (IDF). (2021). IDF diabetes atlas. https://diabetesatlas.org.

20.

Joo

J. Y.

Lee

(2016). Barriers to and facilitators of diabetes self-management with elderly Korean-American immigrants. International Nursing Review, 63(2), 277–284. https://doi.org/10.1111/inr.12260

21.

Kristianingrum

N. D.

Wiarsih

Nursasi

A. Y.

(2018). Perceived family support among older persons in diabetes mellitus self-management. BMC Geriatrics, 18(Suppl 1), 304–304. https://doi.org/10.1186/s12877-018-0981-2

22.

Kumari

Jain

Kumar

(2022). Effects of polypharmacy in elderly diabetic patients: A review. Curēus (Palo Alto, CA), 14(9), e29068–e29068. https://doi.org/10.7759/cureus.29068

23.

Laine

M. K.

Wasenius

N. S.

Lohi

Simonen

Tiira

Eriksson

J. G.

Salonen

M. K.

(2019). Association between dog ownership and type 2 diabetes in later life: The Helsinki birth cohort study. International Journal of Circumpolar Health, 78(1), 1611328–1611328. https://doi.org/10.1080/22423982.2019.1611328

24.

Drury

Taylor

(2013). Diabetes is nothing': The experience of older Singaporean women living and coping with type 2 diabetes. Contemporary Nurse: A Journal for the Australian Nursing Profession, 45(2), 188–196. https://doi.org/10.5172/conu.2013.45.2.188

25.

T.-J.

Zhou

J.-J.

Luo

H.-Y.

X.-M.

(2022). What are the self-management experiences of the elderly with diabetes? A systematic review of qualitative research. World Journal of Clinical Cases, 10(4), 1226–1241. https://doi.org/10.12998/wjcc.v10.i4.1226

26.

Lommi

Matarese

Alvaro

Piredda

De Marinis

M. G.

(2015). The experiences of self-care in community-dwelling older people: A meta-synthesis. International Journal of Nursing Studies, 52(12), 1854–1867. https://doi.org/10.1016/j.ijnurstu.2015.06.012

27.

Malherbe

Cornell

Shahnaaz

(2015). Taking pictures, telling stories and making connections: A photovoice manual .

28.

Meneilly

G. S.

Knip

Miller

D. B.

Sherifali

Tessier

Zahedi

(2018). Diabetes in older people. Canadian Journal of Diabetes, 42, S283–S295. https://doi.org/10.1016/j.jcjd.2017.10.021

29.

Ohta

Sato

Kitayuguchi

Maeno

Sano

(2021). The association between the self-management of mild symptoms and quality of life of elderly populations in rural communities: A cross-sectional study. International Journal of Environmental Research and Public Health, 18(16), 8857. https://doi.org/10.3390/ijerph18168857

30.

Parsons

Gaudine

Swab

(2021). Experiences of older adults accessing specialized health care services in rural and remote areas: A qualitative systematic review. JBI evidence Synthesis, 19(6), 1328–1343. https://doi.org/10.11124/JBIES-20-00048

31.

Remelli

Ceresini

M. G.

Trevisan

Noale

Volpato

(2022). Prevalence and impact of polypharmacy in older patients with type 2 diabetes. Aging Clinical and Experimental Research, 34(9), 1969–1983. https://doi.org/10.1007/s40520-022-02165-1

32.

Robertson

Paré

G. C.

Costa

Alvarado

Duhn

Plazas

P. C.

(2023). I could have stood a little more education rather than just: ‘hey, you’re diabetic man, make the best out of it’”: Revisioning diabetes self-management education for older adults. Research on Aging, 45(7-8), 563–573. https://doi.org/10.1177/01640275221138968

33.

Ross

Benavides-Vaello

Schumann

Haberman

(2015). Issues that impact type-2 diabetes self-management in rural communities. Journal of the American Association of Nurse Practitioners, 27(11), 653–660. https://doi.org/10.1002/2327-6924.12225

34.

Sherifali

Bai

J. W.

Kenny

Warren

Ali

M. U.

(2015). Diabetes self-management programmes in older adults: A systematic review and meta-analysis. Diabetic Medicine, 32(11), 1404–1414. https://doi.org/10.1111/dme.12780

35.

South East LHIN. (2016). Integrated health service plan 2016-2019. Appendix: B regional capacity analysis and projections (ReCAP). https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiAs8uE8JTvAhX-FlkFHQ81AM8QFjACegQIChAD&url=http%3A%2F%2Fwww.southeastlhin.on.ca%2F∼%2Fmedia%2Fsites%2Fse%2FUploadedFiles%2FIHSP%2FIHSP4%25202016-2019%2FIHSP4%2520ReCAP-Appendix%2520B.pdf%3Fla%3Den&usg=AOvVaw1nCDrDq7rOiQUK0sk3BufG .

36.

Tetui

Zulu

J. M.

Hurtig

A.-K.

Ekirapa-Kiracho

Kiwanuka

S. N.

Coe

A.-B.

(2018). Elements for harnessing participatory action research to strengthen health managers’ capacity: A critical interpretative synthesis. Health Research Policy and Systems, 16(1), 33–33. https://doi.org/10.1186/s12961-018-0306-0

37.

Wang

Burris

M. A.

(1997). Photovoice: Concept, methodology, and use for participatory needs assessment. Health Education & Behavior, 24(3), 369–387. https://doi.org/10.1177/109019819702400309

38.

Werfalli

M. M.

Kalula

S. Z.

Manning

Levitt

N. S.

(2020). Does social support effect knowledge and diabetes self-management practices in older persons with type 2 diabetes attending primary care clinics in Cape Town. South Africa? PLoS One, 15(3), e0230173–e0230173. https://doi.org/10.1371/journal.pone.0230173

39.

World Health Organization [WHO]. (2019). Classification of diabetes mellitus 2019. World Health Organization. Retrieved March 6 from https://apps.who.int/iris/handle/10665/325182.

40.

WHO. (2021). Diabetes. Retrieved November 26 from https://www.who.int/news-room/fact-sheets/detail/diabetes.

41.

Yous

M.-L.

Ganann

Ploeg

Markle-Reid

Northwood

Fisher

Valaitis

Chambers

Montelpare

Légaré

Beleno

Gaudet

Giacometti

Levely

Lindsay

Morrison

Tang

(2023). Older adults’ experiences and perceived impacts of the aging, community and health research unit-community partnership program (ACHRU-CPP) for diabetes self-management in Canada: A qualitative descriptive study. BMJ Open, 13(4), e068694–e068694. https://doi.org/10.1136/bmjopen-2022-068694

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