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Metabolic improvement after intervention focusing on personal understanding in type 2 diabetes.
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
2005 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 68, no 1, 65-74 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to evaluate, whether an educational intervention, focusing on patients' personal understanding of their illness, was more effective than care given according to national guidelines for diabetes care. METHODS: An intervention group (n = 44), with type 2 diabetes was compared with a control group (n = 60), with HbA1c as the primary outcome. The intervention included ten group sessions addressing themes related to the patients' personal understanding of their illness. The diabetes nurses involved were educated in theories about illness/wellness experiences and participated in group sessions where various caring strategies related to the patients' individual needs and understanding were reflected upon. RESULTS: At 1-year follow-up the intervention group showed lower HbA1c levels (mean difference 0.94%; P < 0.001), lower triglycerides (mean difference 0.52 mmol/l; P = 0.002) and higher high-density lipoprotein (mean difference 0.15 mmol/l; P = 0.029) and treatment satisfaction than did the control group. The differences remained when adjusting for age, gender, body mass index or changed treatment during the intervention period. Within the intervention group, BMI and treatment satisfaction were also improved. CONCLUSION: The intervention, which focused on patients' personal understanding of illness, was found to be effective in terms of metabolic control and treatment satisfaction.

Place, publisher, year, edition, pages
2005. Vol. 68, no 1, 65-74 p.
Keyword [en]
Aged, Cholesterol; HDL/blood, Cholesterol; LDL/blood, Diabetes Mellitus; Type 2/*metabolism/*nursing/therapy, Female, Hemoglobin A; Glycosylated/metabolism, Humans, Male, Middle Aged, Patient Education as Topic/*methods, Patient Satisfaction, Patient-Centered Care/*methods, Primary Health Care/methods, Psychotherapy; Group, Treatment Outcome, Triglycerides/blood
National Category
URN: urn:nbn:se:umu:diva-6742DOI: 10.1016/j.diabres.2004.08.003PubMedID: 15811567OAI: diva2:146412
Available from: 2008-06-27 Created: 2008-06-27 Last updated: 2013-03-05
In thesis
1. Experiences of diabetes care - patients' and nurses' perspectives
Open this publication in new window or tab >>Experiences of diabetes care - patients' and nurses' perspectives
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In order to provide good diabetes care it is important for the health care professionals to share patients’ personal understanding of living with diabetes, which differs from a professional understanding of the illness. Patients’ beliefs about health, illness, control and cure are predictive of the outcome of lifestyle changes and pharmacological treatment. Narratives about illness could be used to elucidate what people believe to be central to their experience of an illness and its management. The overall aim of this thesis was to investigate experiences of diabetes and diabetes care among people with type 2 diabetes and district nurses responsible for diabetes care within primary health care.

Methods: Forty-four patients diagnosed with diabetes during the previous 2 years were interviewed about their personal understanding of illness and experiences of care. They also participated in an intervention study consisting of group sessions during 9 months. The intervention focused on the patients’ understanding of living with diabetes and was directed at the patients and their nurses (n = 5). The outcome variables haemoglobin A1c (HbA1c), lipids, blood pressure (BP) and body mass index (BMI) as well as well-being, treatment satisfaction and diabetes symptoms of the intervention group were compared with those in a control group (n = 60). Another ten patients were interviewed about their views of their lives. Seventeen nurses in diabetes care were interviewed about their views of their work with patients. The narrative, thematic interviews and focus group interviews were analysed using qualitative content analysis.

Findings: Patients’ personal understanding of illness included the categories “image of the disease”; “meaning of the diagnosis”; “integration of the illness”; “space for the illness”; “responsibility for care”; and “future prospects”. Patients’ narratives about their lives included views of knowledge, and capacity, motivation and courage, aspects important for effective self-management. Patients’ views on clinical encounters in diabetes care, interpreted as satisfying or not, included the themes “being in agreement v. in disagreement about the goals”; “being autonomous and equal v. being forced into adaptation and submission”; “feeling worthy as a person v. feeling worthless”; “being attended to and feeling welcome v. being ignored”; and “feeling safe and confident v. feeling unsafe and lacking confidence”. The results of the intervention study with group sessions showed improvements in metabolic balance and treatment satisfaction in the intervention group. At the 1-year follow-up the mean difference between groups in HbA1c was 0.94% (95% confidence interval (CI) 0.58–1.29).

Nurses’ views of their work included the themes “Perspectives on illness and caring are not easily integrated into views of disease and its treatment”; “Nurses view their knowledge as more important than the patients’ knowledge”; Nurses’ conscience is challenged by some of their nursing decisions”; “The individuality of each patient is undermined when patients are regarded as a collective group”; and “Nurses are confirmed in their role of nurses by patients who assume a traditional patient role”.

Conclusion: These results demonstrate that the understanding of illness and care differs between patients and nurses working in diabetes care; furthermore, that an intervention involving patients and their nurses based on patients’ personal understanding of illness is effective with regard to metabolic control and treatment satisfaction. The cost of the intervention is moderate. Also, we believe that it is possible to clinically implement this intervention within the existing resources for primary health care.

Place, publisher, year, edition, pages
Omvårdnad, Umeå Universitet, 2004. 59 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 882
Nursing, diabetes type 2, hemoglobin A1c, Primary health care, clinical encounters, group sessions, intervention, professional perspective, patient perspective, narratives, qualitative content analysis, Omvårdnad
National Category
Research subject
Caring Sciences
urn:nbn:se:umu:diva-258 (URN)91-7305-619-7 (ISBN)
Public defence
2004-05-19, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (English)
Available from: 2004-05-05 Created: 2004-05-05 Last updated: 2010-06-24Bibliographically approved

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Hörnsten, ÅsaLundman, BeritStenlund, HansSandström, Herbert
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