Psychosocial care in diabetes
Self management strategies
Social support for diabetes self-management via eHealth interventions
This review discusses the applications of eHealth technologies in providing social support to adult patients with type 2 diabetes.
Summary points
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- eHealth technologies can be defined as health information or services delivered through the Internet or related technologies, and include phone, text, telehealth, web-based and virtual technologies.
- Phone-based support interventions described in the reviewed literature included video conferences with nurses, consultations about lab values and telehealth monitoring of various clinical parameters.
- Web-based support interventions used discussion boards, email, text, online chats, voice communication and web-conferencing to monitor patient data, provide feedback and communicate with peers.
- Many eHealth interventions used a combination of technologies to deliver support.
- The majority of eHealth interventions employed healthcare professionals to provide support (most commonly advanced practice nurses), while others also recruited people with type 2 diabetes.
- While most studies were able to demonstrate short-term improvements in glycemic control and, sometimes, other biomarkers, long-term effectiveness varied; in studies that compared different interventions, generally, their effects on glycemic control were not significantly different.
- Many eHealth interventions, most commonly phone-based interventions, were successful in improving behavioral outcomes, such as medication adherence, glucose monitoring, foot care, exercise, healthy eating, healthy coping and problem solving.
- Psychosocial outcomes, such as diabetes distress, depression and quality of life, were commonly improved with the use of eHealth interventions.
- The frequency and duration of eHealth interventions varied widely; the frequency of contact generally declined over time, as did patient participation.
- Studies describing eHealth interventions often fail to clearly document the impact on social support.
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Vorderstrasse A et al. Curr Diab Rep 2016; 16: 56. doi: 10.1007/s11892-016-0756-0
When does personalized feedback make a difference? A narrative review of recent findings and their implications for promoting better diabetes self-care
This review examined the recent literature on the effectiveness of feedback in eight health-related areas, including those specific to diabetes care, as well as others which were more general, in order to identify how personalized health-related feedback is most effectively designed and delivered.
Summary points
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- Personalized health-related feedback is defined as the provision of personal information that has been derived from some type of assessment procedure to prompt or maintain positive behavioral change.
- Health-related feedback often has beneficial effects on patient behavior and clinical outcomes, but feedback is sometimes no better than no feedback and may occasionally be harmful.
- Although provision of health-related feedback is typically considered a single, uniform type of intervention, it varies dramatically in form, duration, frequency and content from one study to another.
- Authors identified five factors that influence the impact of health-related feedback:
- Clarity;
- Personal meaningfulness;
- Frequency;
- Guidance and support;
- Patient interpretation.
- Clarity of health-related feedback can be improved by providing a good summary of complex data and by making it relatable by providing real-world comparators.
- Personal meaningfulness of health-related feedback can be improved by comparing the recipient’s data to a relevant peer group, demonstrating the connection between health outcomes and targeted behavior, describing the ways feedback can be applied and by providing it promptly.
- Generally, frequent feedback is more effective, however, the frequency of feedback should be appropriate to the message and the characteristics of the behavior/biomarker for which the feedback is given.
- Better outcomes tend to be achieved:
- When the patient is guided to interpret feedback as encouraging rather than discouraging, in the absence of blaming and shaming;
- In an atmosphere of trust and collaboration and when there is collaborative decision-making regarding how best to respond to the presented results.
- In order to make sure that the patient interprets the feedback correctly, the following factors should be considered: affective state, health beliefs, interest or readiness to receive feedback and demographics.
- The authors identify several common limitations in the literature on health-related feedback examined in this review:
- Dearth of studies that evaluate the effect of repeated episodes of feedback over time;
- Common use of a “one-size-fits-all” approach to the delivery of feedback;
- Lack of comprehensiveness and perspective when considering the frequent inconsistent or contradictory findings across studies.
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Polonsky WH, Fisher L. Curr Diab Rep 2015; 15: 50. doi: 10.1007/s11892-015-0620-7
Self-management and self-management support outcomes: A systematic review and mixed research synthesis of stakeholder views
This systematic review discusses published empirical evidence to determine the outcomes of self-management valued by key stakeholder groups (patients, their families, health professionals and those who commission self-management services) in one of three conditions: colorectal cancer, diabetes and stroke.
Summary points
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- A variety of approaches aiming to improve self-management in people with chronic conditions have been trialled, including those led by laypersons or professionals, generic or disease specific, delivered in group or individual setting and most often based on Social Cognition Theory.
- Research tools that measure the impact of self-management interventions most frequently focus upon self-efficacy, health status, mood and quality of life, however, more than 70 different variables used to evaluate self-management programs have been identified.
- A systematic search of Allied and Complimentary Medicine database (AMED), British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline, Psychinfo and Web of science electronic databases was conducted in order to find empirical studies of self-management interventions in adult patients with diabetes, stroke or colorectal cancer published in English between 1995 and June 2014
- In total, 41 studies (individual interviews, n=18, 45%; focus groups, n=10, 25%; quasi-experimental and survey, both n=4, 10%) met the search criteria and were analyzed using the method of mixed research synthesis and NVivo 10 software.
- Gaining applicable knowledge was an important self-management outcome for health professionals involved in the treatment of diabetes, who valued knowledge that was focused around the diabetes disease process and prevention of deterioration.
- Patients with all three conditions valued independence, usually understood as having control over and responsibility for managing the condition.
- From the patients’ perspective, a positive social network is an important factor enabling successful self-management. The perspectives of health professionals and families were not presented in the reviewed literature.
- People with diabetes expressed a strong desire to ‘‘be normal,” which was frequently challenged by the burden of managing blood glucose levels.
- Health professionals involved in diabetes management felt that patient motivation was a key requisite of successful self-management. Across all conditions, patients identified the need to develop skills in managing emotions and stress in order to maintain health and well-being.
- The findings of this review indicate that while there was a general consensus on outcomes, different stakeholders often interpreted the same outcomes in different ways and valued different aspects of the same outcomes.
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Boger E et al. PLoS ONE 2015; 10: e0130990. doi: 10.1371/journal.pone.0130990