Forced externalization of control in people with diabetes: a qualitative exploratory study

Gillibrand, Warren P.; Flynn, Maria

doi:10.1046/j.1365-2648.2001.01779.x

Cited by 48 publications

(72 citation statements)

References 57 publications

(69 reference statements)

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“…Overall, results indicate that patients experience a wide range of emotions at diagnosis, including shock, anxiety, denial, anger, fear, and loss of control on the one hand, and relief and affirmation on the other (Dietrich, 1996;Gillibrand & Flynn, 2001 report various emotions found that between one-quarter and one-half experience strong negative emotions at diagnosis (Beeney, Bakry, & Dunn, 1996;Lo & Maclean, 2001).…”

Section: Screen-detected Patientsmentioning

confidence: 93%

“…Results of these studies suggest that patients are not so much concerned about the long-term threats to their health but rather focus on the short-term impact of medical treatment and lifestyle changes on their daily lives, diet in particular (Everett & Kerr, 1998;Gillibrand & Flynn, 2001). Furthermore, for many patients having diabetes was synonymous with having to take injections, a topic which many patients were concerned about regardless of whether it was part of their treatment (Beeney et al, 1996;Everett & Kerr, 1998).…”

Section: Worries and Concerns: Contentmentioning

confidence: 98%

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No worries, no impact? A systematic review of emotional, cognitive, and behavioural responses to the diagnosis of type 2 diabetes

Thoolen

Ridder

Bensing

et al. 2008

RHPR

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Previous research suggests that patients with type 2 diabetes quickly adjust to their diagnosis, but most studies tend to focus on emotional outcomes. This systematic review also examines patients' cognitive and behavioural responses in the first year after diagnosis, based on empirical studies published between 1993 and 2008. A total of 24 studies are presented in order from most to least rigorous design. A further distinction is made between being diagnosed in the context of a screening programme and other forms of diagnoses. This review confirms that the diagnosis of type 2 diabetes has limited longterm emotional impact, if at all, regardless of how patients are detected. Examination of cognitive and behavioural responses indicate that most patients underestimate the seriousness of their diabetes, overestimate their ability to control it and show limited engagement in the management of their disease. The results also indicate considerable variations in adjustment to the illness. These are related to symptom experience, prior knowledge, and information provision and treatment. Overall, this review shows that a lack of emotional distress does not necessarily indicate a successful adjustment but may instead reflect patients' tendency to avoid dealing with and managing their diabetes until the first signs and symptoms appear, potentially undermining the effectiveness of early detection and treatment.

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Section: Screen-detected Patientsmentioning

confidence: 93%

Section: Worries and Concerns: Contentmentioning

confidence: 98%

No worries, no impact? A systematic review of emotional, cognitive, and behavioural responses to the diagnosis of type 2 diabetes

Thoolen

Ridder

Bensing

et al. 2008

RHPR

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“…The literature describing the use of the Multidimensional Health Locus of Control scales with African Americans documents a greater external locus of control among those with diabetes and in the elderly. 22,23,26 Several studies suggest that persons with a high powerful others locus of control might be more adherent to physician or family recommendations for behavior change. 22,26 Most respondents classifi ed themselves as in the maintenance stage of change for regular exercise (46%) or healthy diet behavior (57%).…”

Section: Discussionmentioning

confidence: 99%

“…20 Whereas the health locus of control model has been applied to African American communities in a variety of settings, there are fewer studies of its use in diabetes and cardiovascular disease. [21][22][23][24][25][26] This article provides information about participation in protective health behaviors (physical activity and diet), health locus of control, and stage of readiness to change in an African American community. We discuss how quantitative and qualitative analyses of these data have been used to refi ne existing community-based health promotion interventions in our COPC project.…”

mentioning

confidence: 99%

A Community-Oriented Primary Care Demonstration Project: Refining Interventions for Cardiovascular Disease and Diabetes

Plescia

Groblewski²

2004

The Annals of Family Medicine

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“…Complex treatments involving both lifestyle change and numerous medications can be very demanding, confronting patients with their disease on a daily basis while simultaneously making them more dependent on the health care system (11,12). As a result, many practitioners may be hesitant to treat patients with newly diagnosed diabetes intensively, despite the potential medical benefits.…”

mentioning

confidence: 99%

Psychological Outcomes of Patients With Screen-Detected Type 2 Diabetes

et al. 2006

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OBJECTIVE -The objective of this study was to investigate how time since diagnosis and treatment intensity influence psychological outcomes in patients with screen-detected type 2 diabetes.RESEARCH DESIGN AND METHODS -A 2 ϫ 2 factorial cross-sectional design was used to examine psychological outcomes in 196 patients with screen-detected diabetes diagnosed 3-33 months previously who were receiving usual care or intensive multifactorial pharmacological treatment. Outcomes included anxiety, depression, diabetes-related distress, perceived seriousness and vulnerability, self-efficacy, and self-care. Multivariate analysis was used to examine variations in outcomes based on time since diagnosis (Ͻ1 vs. 2-3 years) and treatment intensity.RESULTS -Most patients reported little distress, low perceived seriousness and vulnerability, high self-efficacy, and low self-care, but outcomes varied considerably across conditions. Time effects were found for perceived vulnerability, which increases significantly with time since diagnosis. Time ϫ treatment interactions were found for anxiety, diabetes-related distress, and self-efficacy; notably, intensively treated patients showed more distress and less self-efficacy in the 1st year, and usual-care patients reported more distress and less self-efficacy 2-3 years after diagnosis.CONCLUSIONS -Screen-detected patients generally do not experience much difficulty with their condition in the first few years, but early and intensive treatment can influence patients' psychological outcomes, leading to relatively more anxiety and less self-efficacy in the 1st year after diagnosis but not necessarily improving self-care. This suggests that intensive treatments confront patients with their diabetes earlier on whereas milder treatments may delay confrontation. This finding should be taken into account in the development and timing of psychological interventions for patients with newly diagnosed diabetes.

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Forced externalization of control in people with diabetes: a qualitative exploratory study

Abstract: The findings also suggested that participants in this study might have felt that the control of their chronic condition had been externalized to the health care professionals responsible for their care.

Cited by 48 publications

References 57 publications

No worries, no impact? A systematic review of emotional, cognitive, and behavioural responses to the diagnosis of type 2 diabetes

No worries, no impact? A systematic review of emotional, cognitive, and behavioural responses to the diagnosis of type 2 diabetes

A Community-Oriented Primary Care Demonstration Project: Refining Interventions for Cardiovascular Disease and Diabetes

Psychological Outcomes of Patients With Screen-Detected Type 2 Diabetes

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