Date Presented 4/20/2018
In this qualitative study, patients at a safety net primary care facility shared perspectives on occupations related to the daily management of Type 2 diabetes (T2DM). This research contributes to an understanding of the psychosocial impacts of T2DM management and targeted areas for intervention.
Primary Author and Speaker: Tara C. Klinedinst
Additional Authors and Speakers: Karen E. Atler, Laura A. Grimm, Arlene A. Schmid, Matt P. Malcolm
BACKGROUND AND PURPOSE: Type 2 diabetes mellitus (T2DM) is a prevalent metabolic condition that increases risk of microvascular and macrovascular complications including heart disease, stroke, neuropathy, and kidney disease. Diabetes self-management (DSM) is complicated, relying on medication, exercise, diet control, and health monitoring. Because of the severe impact of T2DM on everyday life occupations, there is considerable need for occupational therapy to develop and evaluate interventions that enable self-management of this chronic disease and participation in daily life. Currently, there are no interventions that provide clinically significant, sustained lifestyle change in people with T2DM. More insight into the experience and management of T2DM from the patient perspective can help occupational therapy practitioners provide individualized services to promote DSM and prevent complications and disability. In this study, qualitative methods were used to uncover the individual experience of T2DM and barriers to and facilitators of DSM in everyday life. This study will inform a larger multiphase research project (TODAY Project) aimed at identifying new targets for occupational therapy intervention for people with T2DM.
METHOD: We used a constructivist, phenomenological approach to inquiry. Participants were a small subgroup (n = 10) of participants from the larger cross-sectional study (N = 93) who agreed to be contacted in the future. We used purposive sampling to obtain participants of different ages, genders, and levels of glycemic control. All were adults diagnosed with T2DM who could read English at a sixth-grade level or higher and received primary care at a safety net clinic.
Data were collected during three separate 1-hr focus group meetings of three or four participants each. We used focus group transcripts, researchers’ first impression summaries, and participants’ written notes as data source materials. Research team members analyzed source materials using an iterative open-coding process. Trustworthiness was addressed through triangulation of source materials and peer review.
RESULTS: Four themes related to DSM emerged through analysis of source materials: (1) psychosocial challenges related to DSM, (2) family and social relationships as support or hindrance to DSM, (3) varied individual approaches to DSM, and (4) keys to successfully managing diabetes. Keys to successful diabetes management included sustaining motivation, developing DSM routines, problem solving changes to routines, and overcoming physical and emotional barriers to exercise.
CONCLUSION: Focus groups of people with T2DM revealed four themes surrounding diagnosis and management of the disease that may inform occupational therapy practitioners and other clinicians about the experience of living with T2DM. These data also suggest targets for intervention that go beyond physiological control of T2DM. This exploration of patient perspectives provides evidence for how practitioners can more effectively intervene with people with T2DM to promote active engagement in DSM and decrease disability.
IMPACT STATEMENT: The results of this study provide needed information about the importance of understanding psychosocial factors, family and social relationships, and individual differences in DSM and of addressing motivation, DSM routines, problem-solving strategies, and access to exercise in occupational therapy intervention.
References
American Diabetes Association. (2017). Standards of medical care in diabetes—2017. Diabetes Care, 40(Suppl. 1), S1–S38. https://doi.org/10.2337/cd16-0067
Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for adults with Type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Education and Counseling, 99, 926–943. https://doi.org/10.1016/j.pec.2015.11.003
Toole, L. O., Connolly, D., & Smith, S. (2013). Impact of an occupation-based self-management programme on chronic disease management. Australian Occupational Therapy Journal, 60, 30–38. https://doi.org/10.1111/1440-1630.12008
