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A model of integration of illness and self-management 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 Nursing.
2011 (English)In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, E-ISSN 1752-9824, Vol. 3, no 1, 41-51 p.Article in journal (Refereed) Published
Abstract [en]

Aim. To describe the process of illness integration and self-management among people with type 2 diabetes.

Background. Integration of illness is a developmental process referring to the emotional and existential aspects of being ill. It is an overarching concept that describes the process that a person undergoes in living with a chronic disease, from prediagnosis to adaptation to illness as a natural part of life. Despite the common use of terms such as illness integration and self-management, there exists little research that investigates how these concepts relate to one another.

Methods. A narrative interview study applying qualitative content analysis was conducted with people diagnosed with type 2 diabetes. The study focused on their personal understandings of illness, and particularly, the relationship of the participants’ illness integration to self-management of the disease. Data were collected in 2002.

Results. In the trajectory from prediagnosis to adaptation, there is a turning point when people seem to integrate the illness emotionally and existentially, and in relation to their self-management practice. The trajectory includes the phases of suspecting illness/being diagnosed, understanding and explaining the illness, and negotiating illness and taking stands about self-management. These phases in turn are influenced by perceptions of the seriousness and threat of the disease; the intensity and nature of the ill person’s emotional response to the disease and its management; goals and expectations for living with the disease and for living in general; and lastly, perceptions of the outcomes and impacts of self-management.

Conclusion. Illness integration and self-management processes develop simultaneously. In some cases, a turning point occurs that causes the person to view self-management as both necessary and feasible.

Relevance to clinical practice. Nurses may influence the illness integration trajectory and assist people with type 2 diabetes to integrate the disease and its management more readily.

Place, publisher, year, edition, pages
Wiley-Blackwell , 2011. Vol. 3, no 1, 41-51 p.
Keyword [en]
chronic illness, nursing research, patients’ experience, qualitative study, self-management, type 2 diabetes
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-41257DOI: 10.1111/j.1752-9824.2010.01078.xOAI: oai:DiVA.org:umu-41257DiVA: diva2:405377
Available from: 2011-03-22 Created: 2011-03-22 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Illness integration, self-management and patient-centred support in type 2 diabetes
Open this publication in new window or tab >>Illness integration, self-management and patient-centred support in type 2 diabetes
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Integration av sjukdom, sjukdomshantering och patientcentrerad support vid typ 2 diabetes
Abstract [en]

Background: Type 2 diabetes is a serious disease that is increasing globally. The focus of diabetes care has been to prevent diabetes related complications and thereby reduce mortality. An older population, the disease progression and decreased ability to perform self-management activities increases the risk for complications. Group education and patient-centred care are recommended to improve self-management through increased patient empowerment. Despite these recommendations, professionals have been reluctant to adopt these methods referring to lack of knowledge, time and tools to deliver patient-centred care in diabetes. Focusing on the patient’s illness integration process has in the literature been suggested to improve self-management and metabolic balance.

Aim: The overall aim of the thesis was to describe the experiences of illness integration, self-management and support in type 2 diabetes and to evaluate the metabolic effects of a nurse-led patient-centred model for self-management support.

Methods: The study setting was primary health care in Västerbotten County, Sweden. In total, 21 diabetes nurses (Study I) and 257 patients (Studies II-IV) participated in the four studies (Study II, n=44; Study III, n= 18; Study IV, n= 195). Data consisted of focus group interviews (Study I), individual semi-structured interviews (Studies II-III) and laboratory measurements (Study IV). Methods for analyses were qualitative content analysis (Studies I-III) and statistics (Study IV).

Results: Study I revealed that diabetes nurses found the ideal diabetes care complex to achieve. Conflicting paradigms, power relations and departmentalisation of work were described. Study II describes a process whereby illness integration and self-management in type 2 diabetes develop simultaneously. When a turning-point occurs, people view self-management as both necessary and feasible. In study III, turning points in self-management are illuminated. Turning-point transitions include existential and emotional aspects that increase inner motivation and power for lifestyle change. Study IV evaluates the effects of a nurse-led intervention in which haemoglobin A1c (HbA1c) was significantly decreased at 12 months’ follow-up. Group intervention and individual intervention were both effective compared to traditional diabetes care.

Conclusions: There is a potential for improvement of type 2 diabetes care. Increased patient-centredness is important to support patients towards illness integration and self-management. Focusing on the patients’ illness experiences, including the existential and emotional aspects of having and managing type 2 diabetes, in counselling can lead to improved self-management and glycaemic control. Patients’ experiences of illness are central to their inner motives for change, and patient-centred self-management support and patient education preferably emanate from this perspective.

Abstract [sv]

Bakgrund: Typ 2 diabetes är en allvarlig sjukdom som ökar globalt. Fokus i diabetesvården har varit att förebygga diabetesrelaterade komplikationer och därmed minska dödligheten. En åldrande befolkning, progression av sjukdomen samt en begränsad förmåga att utföra egenvårdsaktiviteter ökar risken för komplikationer. Grupputbildning och patientcentrerad vård rekommenderas för att förbättra egenvården genom ökad empowerment. Trots dessa rekommendationer har läkare och sjuksköterskor rapporterats vara tveksamma till dessa metoder och hänvisat till bristande kunskap, tidsbrist och avsaknad av verktyg. Att fokusera på patienters sjukdomsintegrationsprocess har i litteraturen föreslagits förbättra såväl egenvård som metabol balans.

Syfte: Avhandlingens övergripande syfte var att beskriva erfarenheter av sjukdomsintegration, sjukdomshantering och support vid typ 2 diabetes samt att utvärdera effekter av en sjuksköterskeledd patientcentrerad modell för egenvårdssupport.

Metod: Studierna genomfördes inom primärvården i Västerbottens läns landsting. Totalt deltog 21 diabetessjuksköterskor (Studie I) och 257 patienter (Studie II-IV), i de fyra studierna (Studie II, n=44; Studie III, n= 18; Studie IV, n= 195). Data bestod av fokusgruppsintervjuer (Studie I), individuella halvstrukturerade intervjuer (Studie II-III) och laboratoriemätningar (Studie IV). Analysmetoderna var kvalitativ innehållsanalys (Studie I-III) och statistik (Studie IV).

Resultat: Studie I visade att en ideal diabetesvård är svår att uppnå enligt diabetessjuksköterskorna. Paradigmkrockar, maktrelationer och splittrade arbetsuppgifter beskrevs. Studie II beskriver en modell där sjukdomsintegration och sjukdomshantering utvecklas samtidigt. När en ”turning point” nåddes såg patienterna sjukdomshanteringen som både nödvändig och möjlig att genomföra. I studie III belystes ”turning points” och som omfattar både existentiella och emotionella aspekter som kan öka inre motivation och egenkraft att utföra livsstilsförändringar. Studie IV utvärderade 12-månaderseffekterna av en sjuksköterskeledd intervention och HbA1c sänktes signifikant. Gruppintervention och individuell intervention visades vara effektiva metoder i jämförelse med traditionell diabetesvård.

Slutsatser: Det finns en förbättringspotential inom diabetesvården och ökad patientcentrering är viktig för att stödja patienter att integrera sjukdom och egenvård i livet. Att i diabetesvården fokusera på patienters sjukdomsupplevelser inklusive de existentiella och emotionella aspekterna av att leva med och hantera en sjukdom kan innebära förbättrad sjukdomshantering och metabol balans. Patienters sjukdomsupplevelser är centrala för deras inre motiv till förändring och patientcentrerad egenvårdssupport och patientutbildning bör utgå från detta perspektiv.

 

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2013. 91 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1560
Keyword
Type 2 diabetes, illness integration, turning points, self-management, patient-centredness, diabetes care, primary health care, intervention, randomised controlled study
National Category
Family Medicine
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-67847 (URN)978-91-7459-576-5 (ISBN)
Public defence
2013-05-03, Aulan, Vårdvetarhuset, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-12 Created: 2013-04-04 Last updated: 2013-04-12Bibliographically approved

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