Facilitating participation in cardiovascular preventive initiatives among people with diabetes: a qualitative study

Abstract

Background Type 2 diabetes (T2D) is associated with a significantly increased risk of cardiovascular disease (CVD). The DIAbetic CArdioVAscular Screening and intervention trial (DIACAVAS) was designed to clarify whether advanced imaging for subclinical atherosclerosis combined with medical treatment is an effective strategy to develop individualised treatment algorithms for Danish men and women with T2D aged 40–60. But in the DIACAVAS pilot study, the uptake was only 41%. Consequently, we explored how people experienced living with T2D to understand how to improve the uptake in initiatives targeting the prevention of CVD. Methods We used semi-structured interviews to obtain information on how the respondents experienced having T2D. For supplementary information, we used structured interviews on e.g. socioeconomic factors. From April to October 2019, 17 participants aged 40–60 years were recruited from general practices and diabetes outpatient clinics in Denmark. Several levels of analysis were involved consistent with inductive content analysis. Results The participants’ experiences of living with T2D fell along two continuums, from an emotional to a cognitive expression and from reactive to proactive disease management. This led to identification of four archetypal characteristics: (I) powerlessness, (II) empowerment, (III) health literacy, and (IV) self-efficacy. These characteristics indicated the importance of using different approaches to facilitate participation in cardiovascular preventive initiatives. Additionally, findings inspired us to develop a model for facilitating participation in future preventive initiatives. Conclusion Encouraging people with T2D to participate in cardiovascular preventive initiatives may necessitate a tailored invitation strategy. We propose a model for an invitational process that takes into consideration invitees’ characteristics, including powerlessness, empowerment, health literacy and self-efficacy. This model may enhance participation in such initiatives. However, participation is a general concern, not only in relation to cardiovascular prevention. Our proposed model may be applicable in preventive services for people with T2D in general.

The interplay between patients with diabetic foot ulcer and healthcare professionals in a cross-sectorial setting addressing treatment and care; A realistic evaluation.

“…The authors elaborate that diabetic patient categized by powerlessness often feel overwhelmed living with the chronical illness. This can lead to predominance of their emotions and a limited ability to undertake diabetes self-care tasks (31).…”

“…Therefore, understanding the patient capacity, experience, and role in in the healthcare can be useful in working towards an increased health literacy for the patient. In addition, it is also suggested that health literacy may facilitate a proactive and health-promoting in diabetic self-care (31).…”

The interplay between patients and healthcare professionals in a cross-sectoral setting in connection with the treatment and care of patients with diabetic foot ulcers: a realistic evaluation

“…The capacity to cope with diabetes has also been discussed in a study by Dahl et al The authors reported that diabetic patients who feel powerless are often overwhelmed by chronic illness. This can lead to a limited ability to undertake diabetes self-care tasks [ 22 ].…”

“…Understanding patients’ capacity, experience, and role in healthcare can be useful for improving health literacy. In addition, health literacy may facilitate proactive and health-promoting diabetes self-care [ 22 ].…”

“…Despite the acknowledged importance of collaboration and interaction between caregivers in primary care settings and patients with DFU, qualitative research on this topic is lacking [ 20 , 21 ]. An understanding of patients’ perceptions of illness and the multiple factors that influence self-care behaviours is imperative for optimising DFU care delivery [ 22 ]. However, the extant literature lacks comprehensive insights into these dynamics and underscores the need for further research to bridge this knowledge gap.…”