Health care providers’ perspective on using family history in the prevention of type 2 diabetes: a qualitative study including different disciplines

BackgroundFamily history (FH) is considered an important factor to detect individuals at increased risk developing type 2 diabetes (T2D). Moreover, FH information could be used to personalise risk messages, which are assumed to increase risk-reducing behaviours. In this study, we aimed to explore Dutch health care professionals’ attitudes regarding current or future uptake of a more extensive use of FH information and the family system in diabetes prevention.MethodsSemi-structured interviews were conducted with nineteen health care professionals from six general practices and four outpatient diabetes clinics. The use of FH information in opportunistic screening for T2D was explored, as well as the usability of a direct versus patient-mediated targeting strategy to reach persons with a FH of T2D. Three researchers analysed the interview transcripts separately.ResultsDutch health care professionals considered FH an important risk factor in opportunistic screening for T2D. However, none of them used FH to promote risk-reducing behaviours. Directly targeting and educating patients known to have a FH of T2D was desirable for most primary care professionals, but not considered feasible. Findings indicated that FH information was not systematically gathered in primary care settings and electronic medical records were not equipped to retrieve persons with T2D running in their family. The idea of asking patients to pass on risk and preventive information was new to all interviewees, but was considered an acceptable strategy to reach persons with a FH of diabetes. Nevertheless, there were concerns about the accuracy of the messages delivered by the patients to their relatives. Practical barriers with regard to time, expertise, and financial reimbursement were also mentioned.ConclusionsThere is great interest among healthcare professionals in primary as well as secondary care about the use of FH to prevent T2D, but there are significant barriers against such use. The removal of these barriers would depend on evidence showing the cost-effectiveness of FH-based strategies designed to prevent T2D.

[1]  H. McGee,et al.  Reducing health risk in family members of patients with type 2 diabetes: views of first degree relatives , 2009, BMC public health.

[2]  M. Khoury,et al.  Family history and prevalence of diabetes in the US population: 6-year results from the National Health and Nutrition Examination Survey (NHANES, 1999 2004). , 2007, Diabetes.

[3]  Plamen Nikolov,et al.  Economic Costs of Diabetes in the U.S. in 2002 , 2003, Diabetes care.

[4]  Paul Zimmet,et al.  Type 2 Diabetes: An Epidemic Requiring Global Attention and Urgent Action , 2012, Diabetes Care.

[5]  Muin J. Khoury,et al.  Family history in public health practice: a genomic tool for disease prevention and health promotion. , 2010, Annual review of public health.

[6]  Eiko Sato,et al.  Impact of a Booklet about Diabetes Genetic Susceptibility and Its Prevention on Attitudes towards Prevention and Perceived Behavioral Change in Patients with Type 2 Diabetes and Their Offspring , 2010, Advances in preventive medicine.

[7]  G. Elwyn,et al.  BMC Family Practice , 2005 .

[8]  D. Duquette,et al.  Family History, Diabetes, and Other Demographic and Risk Factors Among Participants of the National Health and Nutrition Examination Survey 1999–2002 , 2005, Preventing chronic disease.

[9]  F. Collins,et al.  The family history--more important than ever. , 2004, The New England journal of medicine.

[10]  K. Stronks,et al.  DiAlert: a lifestyle education programme aimed at people with a positive family history of type 2 diabetes and overweight, study protocol of a randomised controlled trial , 2011, BMC public health.

[11]  K. Narayan,et al.  Clinical risk factors, DNA variants, and the development of type 2 diabetes. , 2009, The New England journal of medicine.

[12]  H. Keen,et al.  More good than harm: a randomised controlled trial of the effect of education about familial risk of diabetes on psychological outcomes. , 2000, The British journal of general practice : the journal of the Royal College of General Practitioners.

[13]  K. Stronks,et al.  Changing the odds. What do we learn from prevention studies targeted at people with a positive family history of type 2 diabetes? , 2011, Primary care diabetes.

[14]  M. Khoury,et al.  Influence of Familial Risk on Diabetes Risk–Reducing Behaviors Among U.S. Adults Without Diabetes , 2011, Diabetes Care.

[15]  N. Gungor,et al.  Family history of type 2 diabetes is associated with decreased insulin sensitivity and an impaired balance between insulin sensitivity and insulin secretion in white youth. , 2005, Diabetes care.

[16]  A. Janssens,et al.  Impact of Communicating Familial Risk of Diabetes on Illness Perceptions and Self-Reported Behavioral Outcomes , 2009, Diabetes Care.

[17]  K. Hemminki,et al.  Familial Risks for Type 2 Diabetes in Sweden , 2009, Diabetes Care.

[18]  P. Vermunt,et al.  An active strategy to identify individuals eligible for type 2 diabetes prevention by lifestyle intervention in Dutch primary care: the APHRODITE study. , 2010, Family practice.

[19]  G. Rutten,et al.  [Summary of the practice guideline 'Diabetes mellitus type 2' (second revision) from the Dutch College of General Practitioners]. , 2006, Nederlands tijdschrift voor geneeskunde.

[20]  M. Gwinn,et al.  Use of family history in clinical guidelines for diabetes and colorectal cancer. , 2012, American journal of preventive medicine.

[21]  F. Snoek,et al.  Family communication as strategy in diabetes prevention: an observational study in families with Dutch and Surinamese South-Asian ancestry. , 2012, Patient education and counseling.

[22]  I. Mesters,et al.  The Importance of Written Information Packages in Support of Case-Finding Within Families at Risk for Inherited High Cholesterol , 2006, Journal of Genetic Counseling.

[23]  Susan B. Neuman,et al.  Changing the odds , 2007 .

[24]  D. Whitford,et al.  Cultural variations in attitudes towards family risk of diabetes. , 2010, Diabetes research and clinical practice.

[25]  M. Patton.  Qualitative evaluation and research methods, 2nd ed. , 1990 .

[26]  J. Dekker,et al.  [Summary of the practice guideline 'The Prevention Visit' from the Dutch College of General Practitioners]. , 2011, Nederlandsch tijdschrift voor geneeskunde.

[27]  M. Porteous,et al.  Patients' experiences and views of cascade screening for familial hypercholesterolemia (FH): a qualitative study , 2011, Journal of Community Genetics.

[28]  Mack T Ruffin,et al.  Effect of Preventive Messages Tailored to Family History on Health Behaviors: The Family Healthware Impact Trial , 2011, The Annals of Family Medicine.

[29]  J. Kai,et al.  Informing patients of familial diabetes mellitus risk: How do they respond? A cross-sectional survey , 2008, BMC health services research.

[30]  P. Wilson,et al.  Parental transmission of type 2 diabetes: the Framingham Offspring Study. , 2000, Diabetes.

[31]  V. Basevi.  Standards of Medical Care in Diabetes—2011 , 2011, Diabetes Care.

[32]  M. S. Kirkman,et al.  Comment on: American Diabetes Association. Standards of Medical Care in Diabetes—2011. Diabetes Care 2011;34(Suppl. 1):S11–S61 , 2011 .

[33]  F. Schellevis,et al.  Bridging the gap between public health and primary care in prevention of cardiometabolic diseases; background of and experiences with the Prevention Consultation in The Netherlands , 2012, Family practice.

[34]  A. Zlot,et al.  Influence of Family History of Diabetes on Health Care Provider Practice and Patient Behavior Among Nondiabetic Oregonians , 2008, Preventing chronic disease.

[35]  J. Witteman,et al.  One Risk Assessment Tool for Cardiovascular Disease, Type 2 Diabetes, and Chronic Kidney Disease , 2012, Diabetes Care.

[36]  Hannah McGee,et al.  Will People With Type 2 Diabetes Speak to Family Members About Health Risk? , 2009, Diabetes Care.

[37]  Robert A Hiatt,et al.  National Institutes of Health State-of-the-Science Conference Statement: Family History and Improving Health. , 2009, Annals of internal medicine.

[38]  P. Allhoff,et al.  The Framingham Offspring Study , 1991 .

[39]  M. Patton,et al.  Qualitative evaluation and research methods , 1992 .

[40]  V. Basevi.  Standards of Medical Care in Diabetes—2010 , 2010, Diabetes Care.

[41]  J. Leahy.  Economic Costs of Diabetes in the U.S. in 2007 , 2008 .

[42]  Sue-Jane Wang,et al.  Family history: a comprehensive genetic risk assessment method for the chronic conditions of adulthood. , 1997, American journal of medical genetics.

[43]  Y. Jang,et al.  Standards of Medical Care in Diabetes-2010 by the American Diabetes Association: Prevention and Management of Cardiovascular Disease , 2010 .

[44]  Muin J Khoury,et al.  Family History and Prevalence of Diabetes in the U.S. Population , 2007, Diabetes Care.