Research from Germany suggests people with newly diagnosed diabetes develop different strategies for managing their condition, and that diabetes self-management education programs need to account for such differences.
Being diagnosed with diabetes is a significant, life-altering event. People with newly diagnosed diabetes (whether type 1, type 2 or gestational) are often advised to make significant changes to lifestyle that require discipline. For example, changing well established eating habits and physical activity routines to improve blood glucose levels or to suit the introduction of new medications. In addition, being diagnosed with diabetes can have tremendous emotional consequences, which can affect an individual’s personal and professional life. Rather than being an automatic process, changing habits and developing new habits can be a slow and challenging process, that involves rethinking one’s life trajectory, expectations for the future and finding the motivation and confidence to live well with a chronic condition.
To understand more about how people develop strategies for managing their condition, Dr Astrid Fink and colleagues interviewed 19 people with newly diagnosed type 2 diabetes and asked them about the impact that the diagnosis had on their lives. People reported that attending diabetes education sessions was difficult because they were time consuming and held at inconvenient times. They indicated that limited access to blood glucose strips was a barrier to learning about their condition, as it restricted their ability to experience how particular foods and physical activity affected their own blood glucose levels. These barriers resulted in a delay in learning about diabetes and to feelings of loss of personal control and confidence in self-management. Although healthcare professionals were perceived as being central to establishing the ‘theory’ of how to manage diabetes, participants reported that the actual implementation of required actions for self-management was the individual’s responsibility. Making changes required the individual to first “accept the challenge” of having diabetes and then develop the motivation to take action.
The researchers found distinct differences in the motivation and management styles among the people they interviewed. For example, some people were motivated by fear, that is, wanting to avoid the negative consequences of diabetes. These people had complete confidence in the authority of their health professionals and followed their recommendations ‘to the letter’, regardless of the limitations that this placed on their lifestyle. Others were motivated to incorporate diabetes into their lives while maintaining a reasonable quality of life. These individuals were more autonomous and interpreted recommendations from health professionals within the context of wanting to not let diabetes ‘take over’ their lives. This group reported feeling less restricted by their diabetes and having a better quality of life.
Consistent with a previous systematic review, this research suggests that diabetes self-management education programs need to be made more accessible, to suit those with busy schedules and minimise barriers to participation. Also, in order to be effective, diabetes self-management education programs need to not only accommodate individual differences in education and cultural beliefs, but also account for psychological factors, such as motivation, autonomy and perceived control.
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Fink A, Fach E, and Schröder S. ‘Learning to shape life’ – a qualitative study on the challenges posed by a diagnosis of diabetes mellitus type 2. International Journal for Equity in Health, 2019; 18(19).Print This Post