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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2019

Open Access 01-12-2019 | Care | Research

‘Learning to shape life’ – a qualitative study on the challenges posed by a diagnosis of diabetes mellitus type 2

Authors: Astrid Fink, Eva-Maria Fach, Sara Lena Schröder

Published in: International Journal for Equity in Health | Issue 1/2019

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Abstract

Background

Diabetes mellitus type 2 is a central challenge for health policy and healthcare in all advanced countries. For the affected persons, living with a diagnosis of type 2 diabetes is difficult because the disease and its treatment have a considerable effect on daily life. The aim of this study was to investigate the challenges associated with a diagnosis of type 2 diabetes for those affected and the range, depth and complexities of the subjective perspectives of the patients under the conditions of the German healthcare system.

Methods

A cross-sectional qualitative study was conducted using a sample of 19 adult patients with type 2 diabetes mellitus. Patients were recruited successively from two specialized diabetological practices, three general practitioner’s offices, and two hospitals. The patients were interviewed once in person using semi-structured interviews. All interviews were recorded, transcribed, and analysed based on grounded theory.

Results

Persons affected by diabetes mellitus type 2 seem to feel responsible for managing their disease. Two strategies of action could be identified: 1) patients strictly followed the recommendations of the physicians, or 2) they showed that they are knowledgably managing their diabetes mellitus type 2. The action strategy to address the disease seemed to be influenced by patients’ confidence in themselves, the effectiveness of the interventions, or the patients’ locus of control. Minor differences in educational status could be discovered, and patients who were less educated tended to follow the recommendations of the physicians very strictly and seemed to place more emphasis on being compliant, which goes hand in hand with a life with prohibitions and restrictions. In contrast, being perceived as competent patients who make their own rules to manage the disease in daily life appeared to be more important for people with higher education levels.

Conclusion

Patient education and self-management programmes for diabetes mellitus type 2 should take different types of learners into account. Giving less-educated patients specific recommendations for successful diabetes self-management is particularly important.

Trial registration

German clinical trial register (DRKS-ID: DRKS00007847).
Appendix
Available only for authorised users
Literature
1.
Zimmet PZ, Alberti KGMM. Epidemiology of diabetes-status of a pandemic and issues around metabolic surgery. Diabetes Care. 2016;39(6):878–83.PubMedCrossRef
2.
Tamayo T, Brinks R, Hoyer A, Kuß O, Rathmann W. The prevalence and incidence of diabetes in Germany: an analysis of statutory health insurance data on 65 million individuals from the years 2009 and 2010. Dtsch Arztebl Int. 2016;113(11):177–82.PubMedPubMedCentral
3.
International Diabetes Federation. IDF Diabetes Atlas: Eighth edition. 2017:2017.
4.
Jacobs E, Tamayo T, Rathmann W, Epidemiologie d. Diabetes in Deutschland. In: Deutsche Diabetes Gesellschaft und diabetesDE – Deutsche Diabetes-Hilfe, editor. Deutscher Gesundheitsbericht Diabetes 2017: Die Bestandsaufnahme. Mainz: Kirchheim + Co GmbH. 2017:10–21.
5.
Röckl S, Brinks R, Baumert J, Paprott R, Du Y, Heidemann C, et al. All-cause mortality in adults with and without type 2 diabetes: findings from the national health monitoring in Germany. BMJ Open Diabetes Res Care. 2017;5(1):e000451.PubMedPubMedCentralCrossRef
6.
Weitgasser R, Clodi M, Cvach S, Grafinger P, Lechleitner M, Howorka K, et al. Diabetes education in adult diabetic patients. Wien Klin Wochenschr. 2016;128(Suppl 2):S146–50.PubMedCrossRef
7.
Rise MB, Pellerud A, Rygg LO, Steinsbekk A. Making and maintaining lifestyle changes after participating in group based type 2 diabetes self-management educations: a qualitative study. PLoS One. 2013;8(5):e64009.PubMedPubMedCentralCrossRef
8.
Newton P, Asimakopoulou K, Scambler S. A Qualitative exploration of motivation to self-manage and styles of self-management amongst people living with type 2 diabetes. J Diabetes Res. 2015;2015:638205.PubMedPubMedCentralCrossRef
9.
Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Hess Fischl A, et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the academy of nutrition and dietetics. Diabetes Care. 2015;38(7):1372–82.PubMedCrossRef
10.
Levesque C. Therapeutic lifestyle changes for diabetes mellitus. Nurs Clin North Am. 2017;52(4):679–92.PubMedCrossRef
11.
Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns. 2002;48(2):177–87.PubMedCrossRef
12.
Fransen MP, Beune EJAJ, Baim-Lance AM, Bruessing RC, Essink-Bot M-L. Diabetes self-management support for patients with low health literacy: perceptions of patients and providers. J Diabetes. 2015;7(3):418–25.PubMedCrossRef
13.
Gomersall T, Madill A, Summers LKM. A metasynthesis of the self-management of type 2 diabetes. Qual Health Res. 2011;21(6):853–71.PubMedCrossRef
14.
Funnell MM, Anderson RM. Influencing self-management: from compliance to collaboration. In: Feinglos MN, Bethel MA, editors. Type 2 diabetes mellitus: an evidence-based approach to practical management. Totowa NJ: Humana press a part of springer science+business media LLC; 2008. p. 455–66.CrossRef
15.
16.
17.
18.
Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, et al. Diabetes self-management education and support in type 2 diabetes. Diabetes Educ. 2017;43(1):40–53.PubMedCrossRef
19.
American Diabetes Association. Standards of medical Care in Diabetes—2015 abridged for primary care providers. Clin Diabetes. 2015;33(2):97–111.PubMedCentralCrossRef
20.
Deakin T, McShane CE, Cade JE, Williams RDRR. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005;2:CD003417.
21.
Duke SAS, Colagiuri S, Colagiuri R. Individual patient education for people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2009;1:CD005268.
22.
Ellis SE, Speroff T, Dittus RS, Brown A, Pichert JW, Elasy TA. Diabetes patient education: a meta-analysis and meta-regression. Patient Educ Couns. 2004;52(1):97–105.PubMedCrossRef
23.
Hermanns N, Kulzer B, Maier B, Mahr M, Haak T. The effect of an education programme (MEDIAS 2 ICT) involving intensive insulin treatment for people with type 2 diabetes. Patient Educ Couns. 2012;86(2):226–32.PubMedCrossRef
24.
Minet L, Moller S, Vach W, Wagner L, Henriksen JE. 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(1):29–41.PubMedCrossRef
25.
Pillay J, Armstrong MJ, Butalia S, Donovan LE, Sigal RJ, Vandermeer B, et al. Behavioral programs for type 2 diabetes mellitus: a systematic review and network meta-analysis. Ann Intern Med. 2015;163(11):848–60.PubMedCrossRef
26.
Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99(6):926–43.PubMedCrossRef
27.
Odgers-Jewell K, Ball LE, Kelly JT, Isenring EA, Reidlinger DP, Thomas R. Effectiveness of group-based self-management education for individuals with type 2 diabetes: a systematic review with meta-analyses and meta-regression. Diabet Med. 2017;34(8):1027–39.PubMedCrossRef
28.
Vas A, Devi ES, Vidyasagar S, Acharya R, Rau NR, George A, et al. Effectiveness of self-management programmes in diabetes management: a systematic review. Int J Nurs Pract. 2017;23(5).
29.
Onwudiwe NC, Mullins CD, Winston RA, Shaya FT, Pradel FG, Laird A, et al. Barriers to self-management of diabetes: a qualitative study among low-income minority diabetics. Ethn Dis. 2011;21(1):27–32.PubMed
30.
Vissenberg C, Stronks K, Nijpels G, Uitewaal PJM, Middelkoop BJC, Kohinor MJE, et al. Impact of a social network-based intervention promoting diabetes self-management in socioeconomically deprived patients: a qualitative evaluation of the intervention strategies. BMJ Open. 2016;6(4):e010254.PubMedPubMedCentralCrossRef
31.
Horigan G, Davies M, Findlay-White F, Chaney D, Coates V. Reasons why patients referred to diabetes education programmes choose not to attend: a systematic review. Diabet Med. 2017;34(1):14–26.PubMedCrossRef
32.
Mielck A, Reitmeir P, Rathmann W. Knowledge about diabetes and participation in diabetes training courses: the need for improving health care for diabetes patients with low SES. Exp Clin Endocrinol Diabetes. 2006;114(5):240–8.PubMedCrossRef
33.
Grintsova O, Maier W, Mielck A. Inequalities in health care among patients with type 2 diabetes by individual socio-economic status (SES) and regional deprivation: a systematic literature review. Int J Equity Health. 2014;13:43.PubMedPubMedCentralCrossRef
34.
Ricci-Cabello I, Ruiz-Pérez I, Olry de Labry-Lima A, Márquez-Calderón S. Do social inequalities exist in terms of the prevention, diagnosis, treatment, control and monitoring of diabetes? A systematic review. Health Soc Care Community. 2010;18(6):572–87.PubMedCrossRef
35.
Forssas E, Manderbacka K, Arffman M, Keskimaki I. Socio-economic predictors of mortality among diabetic people. Eur J Pub Health. 2012;22(3):305–10.CrossRef
36.
Geyer S. Social inequalities in the occurrence of chronic diseases. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz. 2016;59(2):181–7.CrossRef
37.
Gerlach S, Kulzer B. Soziale Ungleichheit und Diabetes. In: Deutsche Diabetes Gesellschaft und diabetesDE – Deutsche Diabetes-Hilfe, editor. Deutscher Gesundheitsbericht Diabetes 2017: Die Bestandsaufnahme. Mainz: Kirchheim + Co GmbH. 2017:216–25.
38.
Glaser BG, Strauss AL, Paul AT. Grounded theory: Strategien qualitativer Forschung. 3., unveränd. Aufl. Bern: Huber; 2010. (Programmbereich Gesundheit)
39.
Rathmann W, Scheidt-Nave C, Roden M, Herder C. Type 2 diabetes: prevalence and relevance of genetic and acquired factors for its prediction. Dtsch Arztebl Int. 2013;110(19):331–7.PubMedPubMedCentral
40.
Przyborski A, Wohlrab-Sahr M. Qualitative Sozialforschung: Ein Arbeitsbuch. 4., erw. Aufl. München: Oldenbourg; 2014.
41.
Maier W, Holle R, Hunger M, Peters A, Meisinger C, Greiser KH, et al. The impact of regional deprivation and individual socio-economic status on the prevalence of type 2 diabetes in Germany. A pooled analysis of five population-based studies. Diabet Med. 2013;30(3):e78–86.PubMedCrossRef
42.
Müller G, Kluttig A, Greiser KH, Moebus S, Slomiany U, Schipf S, et al. Regional and neighborhood disparities in the odds of type 2 diabetes: results from 5 population-based studies in Germany (DIAB-CORE consortium). Am J Epidemiol. 2013;178(2):221–30.PubMedCrossRef
43.
Mielck A. Soziale Ungleichheit und Gesundheit: Einführung in die aktuelle Diskussion. 1st ed. Bern: Huber; 2005.
44.
Kivimaki M, Virtanen M, Kawachi I, Nyberg ST, Alfredsson L, Batty GD, et al. Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222 120 individuals. Lancet Diabetes Endocrinol. 2015;3(1):27–34.PubMedPubMedCentralCrossRef
45.
Walker J, Colhoun H, Livingstone S, McCrimmon R, Petrie J, Sattar N, et al. Type 2 diabetes, socioeconomic status and life expectancy in Scotland (2012-2014): a population-based observational study. Diabetologia. 2018;61(1):108–16.PubMedCrossRef
46.
Galea S, Tracy M. Participation rates in epidemiologic studies. Ann Epidemiol. 2007;17(9):643–53.PubMedCrossRef
47.
Arbeitsgruppe ‘Epidemiologische Methoden’ in der DAE der GMDS und der DGSMP. Messung und Quantifizierung soziographischer Merkmale in epidemiologischen Studien. Berlin; 1997.
48.
Strauss AL, Corbin JM. Basics of qualitative research: grounded theory procedures and techniques. 1. Print. Newbury Park, calif: Sage; 1990.
49.
Pekrun R. The impact of emotions on learning and achievement: towards a theory of cognitive/motivational mediators. Appl Psychol. 1992;41(4):359–76.CrossRef
50.
Tyng CM, Amin HU, Saad MNM, Malik AS. The influences of emotion on learning and memory. Front Psychol. 2017;8.
51.
van Cappellen P, Rice EL, Catalino LI, Fredrickson BL. Positive affective processes underlie positive health behaviour change. Psychol Health. 2018;33(1):77–97.PubMedCrossRef
52.
Collier A, Ghosh S, Hair M, Waugh N. Impact of socioeconomic status and gender on glycaemic control, cardiovascular risk factors and diabetes complications in type 1 and 2 diabetes: a population based analysis from a Scottish region. Diabetes Metab. 2015;41(2):145–51.PubMedCrossRef
53.
Dalsgaard E-M, Skriver MV, Sandbaek A, Vestergaard M. Socioeconomic position, type 2 diabetes and long-term risk of death. PLoS One. 2015;10(5):e0124829.PubMedPubMedCentralCrossRef
54.
Gonzalez JS, Tanenbaum ML, Commissariat PV. Psychosocial factors in medication adherence and diabetes self-management: implications for research and practice. Am Psychol. 2016;71(7):539–51.PubMedPubMedCentralCrossRef
55.
Graffigna G, Barello S, Libreri C, Bosio CA. How to engage type-2 diabetic patients in their own health management: implications for clinical practice. BMC Public Health. 2014;14:648.PubMedPubMedCentralCrossRef
56.
Laranjo L, Neves AL, Costa A, Ribeiro RT, Couto L, Sa AB. Facilitators, barriers and expectations in the self-management of type 2 diabetes--a qualitative study from Portugal. Eur J Gen Pract. 2015;21(2):103–10.PubMedCrossRef
57.
58.
Nam S, Chesla C, Stotts NA, Kroon L, Janson SL. Barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract. 2011;93(1):1–9.PubMedCrossRef
59.
Schafer I, Kuver C, Wiese B, Pawels M, van den Bussche H, Kaduszkiewicz H. Identifying groups of nonparticipants in type 2 diabetes mellitus education. Am J Manag Care. 2013;19(6):499–506.PubMed
60.
Kneck A, Fagerberg I, Eriksson LE, Lundman B. Living with diabetes - development of learning patterns over a 3-year period. Int J Qual Stud Health Well-being. 2014;9:24375.PubMedCrossRef
61.
Klein J, Hofreuter-Gätgens K, Ovd K. Socioeconomic status and the utilization of health Services in Germany: a systematic review. In: Janssen C, Swart E, Tv L, editors. Health care utilization in Germany: theory, methodology, and results. New York, NY: Springer New York; 2014. p. 117–43.CrossRef
Metadata
Title
‘Learning to shape life’ – a qualitative study on the challenges posed by a diagnosis of diabetes mellitus type 2
Authors
Astrid Fink
Eva-Maria Fach
Sara Lena Schröder
Publication date
01-12-2019
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2019
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-019-0924-3

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