Strategies for enhancing information, motivation, and skills for self-management behavior changes: a qualitative study of diabetes care for older adults in Korea

Purpose To describe strategies for enhancing information, motivation, and skills related to changes in diabetes self-management behavior among community-dwelling older adults in Korea. Patients and methods A total of five focus group interviews (three separate focus groups) were conducted with 12 older adults with type 2 diabetes and five diabetes educators. Qualitative content analysis was used. Results “One’s own willingness and ability” emerged as a fundamental belief about the strategies for diabetes self-management. Six major themes under three categories were identified. Under the information category, the recurrent themes were: 1) repeatedly offering detailed knowledge regarding self-management, 2) providing information about current health status, and 3) identifying experiential knowledge of blood glucose control. The recurrent themes in the motivation category were: 1) ensuring a positive attitude regarding self-management, and 2) encouragement or feedback from significant others. Furthermore, in the skills category, we found that the following theme emerged: hands-on skills training with numerical standards. Conclusion This study identified six tailored strategies for enhancing information, motivation, and skills for diabetes self-management behavior changes. These strategies can be used in the development of a culturally sensitive diabetes self-management program for older adults.

[1]  S. Wild,et al.  Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. , 2004, Diabetes care.

[2]  B Downe-Wamboldt,et al.  Content analysis: method, applications, and issues. , 1992, Health care for women international.

[3]  Uk-Prospective-Diabetes-Study-Group Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) , 1998, The Lancet.

[4]  C. Wright,et al.  Self-management approaches for people with chronic conditions: a review. , 2002, Patient education and counseling.

[5]  M. Sevick,et al.  Racial differences in diabetes-related psychosocial factors and glycemic control in patients with type 2 diabetes , 2010, Patient preference and adherence.

[6]  S. Çınar Comparison of psychosocial adjustment in people with diabetes with and without diabetic foot ulceration , 2008 .

[7]  Russell E. Glasgow,et al.  Self-Efficacy, Problem Solving, and Social-Environmental Support Are Associated With Diabetes Self-Management Behaviors , 2010, Diabetes Care.

[8]  E. Fisher,et al.  National Standards for Diabetes Self-Management Education and Support , 2013, Diabetes Care.

[9]  E. Ernst,et al.  Red ginseng for type 2 diabetes mellitus: A systematic review of randomized controlled trials , 2011, Chinese journal of integrative medicine.

[10]  What are the barriers faced by patients using insulin? A qualitative study of Malaysian health care professionals’ views , 2013, Patient preference and adherence.

[11]  P. Haidet,et al.  Integrating diabetes self-management with the health goals of older adults: a qualitative exploration. , 2008, Patient education and counseling.

[12]  Wook Song,et al.  Combined exercise training and self-management education for community-dwelling older adults with diabetes in Korea. , 2012, Journal of gerontological nursing.

[13]  Sharon Lawn,et al.  Chronic physical illness: self-management and behavioural interventions , 2009, International Journal of Integrated Care.

[14]  Polly Ryan,et al.  The Individual and Family Self-Management Theory: background and perspectives on context, process, and outcomes. , 2009, Nursing outlook.

[15]  R. Whittemore,et al.  Metabolic control, self-management and psychosocial adjustment in women with type 2 diabetes. , 2005, Journal of clinical nursing.

[16]  E. Haltiwanger,et al.  A culturally sensitive diabetes peer support for older Mexican-Americans. , 2012, Occupational therapy international.

[17]  J. Nagelkerk,et al.  Perceived barriers and effective strategies to diabetes self-management. , 2006, Journal of advanced nursing.

[18]  E. O'Shea,et al.  Peer support for patients with type 2 diabetes: cluster randomised controlled trial , 2011, BMJ : British Medical Journal.

[19]  Cui-xia Gao,et al.  Factors associated with diet barriers in patients with poorly controlled type 2 diabetes , 2016, Patient preference and adherence.

[20]  Ha T. Nguyen,et al.  Cognitive function is a risk for health literacy in older adults with diabetes. , 2013, Diabetes research and clinical practice.

[21]  Stanton Newman,et al.  Chronic Physical Illness: Self-Management and Behavioural Interventions , 2008 .

[22]  James A Fain,et al.  National Standards for Diabetes Self-Management Education and Support , 2012, The Diabetes educator.

[23]  W A Fisher,et al.  Changing AIDS-risk behavior. , 1992, Psychological bulletin.

[24]  R. Glasgow,et al.  The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. , 2000, Diabetes care.

[25]  N. Leech,et al.  A Qualitative Framework for Collecting and Analyzing Data in Focus Group Research , 2009 .

[26]  D. Anderson,et al.  Lifestyle risk factor modification in midlife women with type 2 diabetes : theoretical modelling of perceived barriers , 2012 .

[27]  C. Schmid,et al.  Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. , 2002, Diabetes care.

[28]  J. Grant,et al.  Relationships Among Self-Efficacy, Social Support, Social Problem Solving, and Self-Management in a Rural Sample Living With Type 2 Diabetes Mellitus , 2012, Research and Theory for Nursing Practice.

[29]  John D. Piette,et al.  National Standards for Diabetes Self-Management Education , 2011, Diabetes Care.

[30]  J. Cade,et al.  Group based training for self-management strategies in people with type 2 diabetes mellitus. , 2005, The Cochrane database of systematic reviews.

[31]  M. Courtney,et al.  Barriers and facilitators to diabetes self-management: perspectives of older community dwellers and health professionals in China. , 2013, International journal of nursing practice.

[32]  Thomas A Arcury,et al.  Differentiating approaches to diabetes self-management of multi-ethnic rural older adults at the extremes of glycemic control. , 2010, The Gerontologist.

[33]  C. Mangione,et al.  Guidelines for improving the care of the older person with diabetes mellitus. , 2003, Journal of the American Geriatrics Society.

[34]  J. Fisher,et al.  The information-motivation-behavioral skills model of HIV preventive behavior. , 2009 .

[35]  Misoon Song,et al.  Barriers to and facilitators of self-management adherence in Korean older adults with type 2 diabetes. , 2010, International journal of older people nursing.

[36]  K Rivet Amico,et al.  An information-motivation-behavioral skills model of adherence to antiretroviral therapy. , 2006, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.