Problem Solving in Diabetes Self-management and Control

PURPOSE The purpose of this systematic review is to assess the published literature on problem solving and its associations with diabetes self-management and control, as the state of evidence exists. DATA SOURCES PubMed, PsychINFO, and ERIC electronic databases were searched for the years 1990 to the present and for English-language articles, and reference lists from included studies were reviewed to capture additional studies. STUDY SELECTION Quantitative and qualitative studies that addressed problem solving as a process or strategy for diabetes self-management were included. Fifty-two studies met the criteria for inclusion. DATA EXTRACTION Study design, sample characteristics, measures, and results were reviewed. DATA SYNTHESIS Thirty-six studies were quantitative; 16 were conceptual or qualitative. Studies were classified as addressing the problem-solving definition/framework, assessment, intervention, or health care professional issues. CONCLUSIONS Problem solving is a multidimensional construct encompassing verbal reasoning/rational problem solving, quantitative problem solving, and coping. Aspects of problem solving can be assessed using newly developed diabetes-specific problem-solving measures for children/adolescents and adults. Cross-sectional studies in adults, but not children/adolescents, provide consistent evidence of associations between problem solving and A1C level. Only 25% of problem-solving intervention studies with children/adolescents and 50% of interventions with adults reported improvement in A1C. Most intervention studies reported an improvement in behaviors, most commonly global adherence in children/adolescents and dietary behavior in adults. Methodological limitations (noninclusion of problem-solving measures, inadequate descriptions of problem-solving interventions, homogenous samples) need to be addressed in future research to clarify the effect of problem solving on diabetes outcomes, identify characteristics of effective interventions, and determine the utility across age and racial/ethnic groups.

[1]  Wayne Katon,et al.  The Effectiveness of Depression Care Management on Diabetes-Related Outcomes in Older Patients , 2004, Annals of Internal Medicine.

[2]  M. Kirkevold,et al.  Life Versus Disease in Difficult Diabetes Care: Conflicting Perspectives Disempower Patients and Professionals in Problem Solving , 2005, Qualitative health research.

[3]  W. Halford,et al.  Diet and diabetes (ii): A controlled trial of problem solving to improve dietary self-management in patients with insulin dependent diabetes , 1997 .

[4]  Evette Ludman,et al.  The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression. , 2004, Archives of general psychiatry.

[5]  N. White,et al.  Randomized, controlled trial of behavior therapy for families of adolescents with insulin-dependent diabetes mellitus. , 2000, Journal of pediatric psychology.

[6]  A. Morris,et al.  A randomized control trial of the effect of negotiated telephone support on glycaemic control in young people with Type 1 diabetes , 2002, Diabetic medicine : a journal of the British Diabetic Association.

[7]  P. Lewinsohn,et al.  Improving self-care among older patients with type II diabetes: the "Sixty Something..." Study. , 1992, Patient education and counseling.

[8]  Russell E. Glasgow,et al.  Problem solving and diabetes self-care , 1991, Journal of Behavioral Medicine.

[9]  M. Powers,et al.  Stress and Coping in Hypertensive and Emergency Room Patients , 1981, Nursing research.

[10]  Pierre-Andre La Chance,et al.  Long-term effects and costs of brief behavioural dietary intervention for patients with diabetes delivered from the medical office. , 1997, Patient education and counseling.

[11]  Russell E Glasgow,et al.  Problem Solving and Diabetes Self-Management , 2007, Diabetes Care.

[12]  F. Brancati,et al.  Diabetes Problem-Solving Scale Development in an Adult, African American Sample , 2007, The Diabetes educator.

[13]  T. Bodenheimer,et al.  Patient self-management of chronic disease in primary care. , 2002, JAMA.

[14]  M. Porta,et al.  A 5-year randomized controlled study of learning, problem solving ability, and quality of life modifications in people with type 2 diabetes managed by group care. , 2004, Diabetes care.

[15]  Victoria A. Miller,et al.  Decision-making competence and adherence to treatment in adolescents with diabetes. , 2006, Journal of pediatric psychology.

[16]  R. Elton,et al.  A Project in Diabetes Education for Children , 1990, Diabetic medicine : a journal of the British Diabetic Association.

[17]  L. Howells.  Self-Efficacy and Diabetes: Why Is Emotional ‘Education’ Important and How Can It Be Achieved? , 2002, Hormone Research in Paediatrics.

[18]  R Gagnayre,et al.  Learning difficulties of diabetic patients: a survey of educators. , 1998, Patient education and counseling.

[19]  B. Paterson,et al.  Expert decision making in relation to unanticipated blood glucose levels. , 2000, Research in nursing & health.

[20]  Susan Roth,et al.  Using Solution-Focused Therapy Strategies in Empowerment-Based Education , 1999, The Diabetes educator.

[21]  P P Horan,et al.  Computer-Assisted Self-Control of Diabetes by Adolescents , 1990, The Diabetes educator.

[22]  R. Glasgow,et al.  Behavioral research on diabetes at the Oregon Research Institute , 1995, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[23]  W. Tamborlane,et al.  Coping skills training for youths with diabetes on intensive therapy. , 1999, Applied nursing research : ANR.

[24]  R. Shewchuk,et al.  Profiles in Problem Solving: Psychological Well-Being and Distress Among Persons with Diabetes Mellitus , 2001, Journal of Clinical Psychology in Medical Settings.

[25]  E. Gesten,et al.  Problem Solving and Adjustment in Families of Children With Diabetes , 1994 .

[26]  Malinda Peeples,et al.  Diabetes Self-Management Education Core Outcomes Measures , 2003, The Diabetes educator.

[27]  Victor M. Montori,et al.  Weakness in numbers , 2005 .

[28]  M. Peeples,et al.  The Conceptual Framework of the National Diabetes Education Outcomes System (NDEOS) , 2001, The Diabetes educator.

[29]  P. Sawicki,et al.  A time‐limited, problem‐orientated psychotherapeutic intervention in Type 1 diabetic patients with complications: a randomized controlled trial , 2002, Diabetic medicine : a journal of the British Diabetic Association.

[30]  M. Funnell,et al.  Guidelines for Facilitating a Patient Empowerment Program , 1995, The Diabetes educator.

[31]  R. Glasgow,et al.  Use of the Patient Assessment of Chronic Illness Care (PACIC) with diabetic patients: relationship to patient characteristics, receipt of care, and self-management. , 2005, Diabetes care.

[32]  T. Wysocki.  Impact of blood glucose monitoring on diabetic control: Obstacles and interventions , 1989, Journal of Behavioral Medicine.

[33]  Y. Nakaya,et al.  Stress and coping behavior in patients with diabetes mellitus , 2000, Acta Diabetologica.

[34]  K. Herold,et al.  Increasing Problem Solving in Adolescents With Type 1 Diabetes: The Choices Diabetes Program , 2002, The Diabetes educator.

[35]  F. Pomero,et al.  Group visits improve metabolic control in type 2 diabetes: a 2-year follow-up. , 2001, Diabetes care.

[36]  C. Kinzer,et al.  Impact of anchored instruction on problem-solving strategies of adolescents with diabetes. , 1994, Journal of the American Dietetic Association.

[37]  R. Echemendia,et al.  Association of metabolic control with problem-solving skills. , 2001, Diabetes care.

[38]  C. Kinzer,et al.  Assessing and overcoming situational obstacles to dietary adherence in adolescents with IDDM. , 1996, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[39]  W. Tamborlane,et al.  Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. , 2000, The Journal of pediatrics.

[40]  N. White,et al.  Behavior therapy for families of adolescents with diabetes: maintenance of treatment effects. , 2001, Diabetes care.

[41]  R. Glasgow,et al.  A brief office-based intervention to facilitate diabetes dietary self-management. , 1995, Health education research.

[42]  R Spillar,et al.  Cognitive and behavioral knowledge about insulin-dependent diabetes among children and parents. , 1982, Pediatrics.

[43]  V. Decoster,et al.  An Empowerment Approach for Elders Living With Diabetes: A Pilot Study of a Community-Based Self-Help Group—The Diabetes Club , 2005 .

[44]  C. Kinzer,et al.  Improving the skills of health professionals in engaging patients in diabetes‐related problem solving , 2002, The Journal of continuing education in the health professions.

[45]  R E Glasgow,et al.  Effects of a Brief Office-Based Intervention to Facilitate Diabetes Dietary Self-Management , 1996, Diabetes Care.

[46]  An Experiential Model of Learning Diabetes Self-Management , 1993, Qualitative health research.

[47]  W. Tamborlane,et al.  Short-term Effects of Coping Skills Training as Adjunct to Intensive Therapy in Adolescents , 1998, Diabetes Care.

[48]  F. Brancati,et al.  A Qualitative Study of Problem Solving and Diabetes Control in Type 2 Diabetes Self-Management , 2003, The Diabetes educator.

[49]  J. Aikens,et al.  Development of the Diabetes Problem-Solving Measure for Adolescents , 2001, The Diabetes educator.

[50]  C. Kinzer,et al.  Evaluation of a Multicomponent, Behaviorally Oriented, Problem-Based “Summer School” Program for Adolescents with Diabetes , 1999, Behavior modification.

[51]  Paul C. Burnett,et al.  The Melbourne Decision-Making Questionnaire : an instrument for measuring patterns for coping with decisional conflict , 1997 .

[52]  Neil R. Powe,et al.  Association of Social Problem Solving With Glycemic Control in a Sample of Urban African Americans With Type 2 Diabetes , 2006, Journal of Behavioral Medicine.

[53]  Manuel Barrera,et al.  Assessment of Problem-Solving: A Key to Successful Diabetes Self-Management , 2004, Journal of Behavioral Medicine.

[54]  A. Thomas,et al.  Problem solving and diabetes regimen adherence by children and adolescents with IDDM in social pressure situations: a reflection of normal development. , 1997, Journal of pediatric psychology.

[55]  M. Grey,et al.  Coping skills training and problem solving in diabetes , 2004, Current diabetes reports.

[56]  C. Kinzer,et al.  Problem solving anchored instruction about sick days for adolescents with diabetes. , 1994, Patient education and counseling.

[57]  Felicia Hill-Briggs,et al.  Problem solving in diabetes self-management: A model of chronic illness self-management behavior , 2003, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[58]  F. Brancati,et al.  Associations of Patient Health-Related Problem Solving with Disease Control, Emergency Department Visits, and Hospitalizations in HIV and Diabetes Clinic Samples , 2007, Journal of General Internal Medicine.