Promoting glycemic control through diabetes self-management: evaluating a patient activation intervention

Williams, Geoffrey; McGregor, Holly A.; Zeldman, Allan; Freedman, Zachary R.; Deci, Edward L.; Elder, D.

doi:10.1016/j.pec.2003.11.008

Cited by 91 publications

(71 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We met weekly to compare coding of the common transcripts, resolve discrepancies and refine coding through consensus. We also rated each transcript on the extent to which the consumer 1) was active in the negotiation about treatment, 2) seemed interested in the management of his/her mental illness, and 3) was involved in controlling his/her mental illness, based on research in diabetes management (11). However, we used a cruder rating scale (0 = not at all; 1 = a little; 2 = somewhat; 3 = a lot) because we did not have the history of prior data for more fine-grained levels of activation.…”

Section: Methodsmentioning

confidence: 99%

The Role of Patient Activation in Psychiatric Visits

Salyers

Matthias²,

Spann³

et al. 2009

Psychiatric Services

View full text Add to dashboard Cite

Objective-This study identified ways that consumers of mental health services are active participants in psychiatric treatment.Methods-Self-reported activity in treatment and observations of audio recorded psychiatric visits were examined. Four providers (3 psychiatrists and one nurse practitioner) and 10 of their consumers with severe mental illness (40 total) were recruited. Consumers completed questionnaires on patient activation, illness self-management and medication attitudes on the day of a psychiatric visit. The visit was audiotaped, transcribed, and thematically analyzed. Providers reported diagnosis, substance abuse, and medication adherence.Results-Self-reported patient activation was positively related to illness self-management and negatively related to substance abuse. Consumers were active in partnership building, seeking and displaying competence, and directing treatment; however, there was little relationship between selfreported activation and observed behaviors.Conclusions-Consumers are active in a variety of ways; but, similar to other populations, the relationship to self-reported desire for involvement is not direct.Living successfully with chronic health conditions requires active collaboration in managing illness --consumer and health care provider working together to identify problem areas, set goals, learn self-management skills, and participate in follow-up (1). An active partnership is critical because the majority of time spent managing chronic illnesses takes place when the consumer is on his/her own in the community rather than in the provider's office. Further, NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript reviews have shown that positive, relationship-centered approaches translate into higher levels of trust, satisfaction, reduced emotional burden, and improved biomedical markers such as blood pressure and blood sugar control (2). Relationships in which patients are activated to take greater control in treatment appear to be particularly important predictors of physical health (3).National policy supports an active role for consumers of mental health services, and research indicates that people with severe mental illnesses such as schizophrenia want to take a role in making decisions about their care (4). Shared decision-making is gaining more attention (5) and interventions are being developed to improve activation and shared decision-making in this population (6). Unfortunately, tools to assess active participation are lacking (5).In the general medical field, the Patient Activation Measure (7) has been successfully used in a variety of chronic health conditions including diabetes, arthritis, and high blood pressure. The scale assesses an individual's knowledge, skill, and confidence for actively managing illness and has been associated with a variety of self-management behaviors including diet, exercise, nutrition, self-monitoring, and reading about medications. Patient activation has also been associated with service utilization, medicatio...

show abstract

Section: Methodsmentioning

confidence: 99%

The Role of Patient Activation in Psychiatric Visits

Salyers

Matthias²,

Spann³

et al. 2009

Psychiatric Services

View full text Add to dashboard Cite

show abstract

“…In the study by Williams et al [39], patients with diabetes were randomly assigned to receive either the education intervention (a 20-min standard videotape on diabetes care) or the activation intervention (a 20-min session with study personnel aimed at identifying and clarifying any questions about their diabetes care that the patients had for their health-care practitioners). Thereafter, participants of both groups would attend their baseline visits with an endocrinologist, a diabetes nurse educator and a dietician.…”

Section: Health-care Providersmentioning

confidence: 99%

The global challenge of type 2 diabetes and the strategies for response in ethnic minority groups

Lirussi

2010

Diabetes Metabolism Res

View full text Add to dashboard Cite

Ethnic minorities living in high-income countries usually exhibit a greater risk of developing diabetes along with higher morbidity and mortality rates. We evaluated the effectiveness of interventions to improve glycaemic control in ethnic minority groups. Results of major controlled trials, systematic reviews and meta-analyses were included in the review. Only 1/47 studies addressing diet and exercise interventions reported details on the ethnicity of the studied population. Self-management education was successful if associated with increased self-efficacy; delivered over a longer period; of high intensity; culturally tailored; and when using community educators. Strategies adopted in community-gathering places, family-based, multifaceted, and those tackling the social context were likely to be more effective. A positive relationship was found between social support and self-management behaviour as well as quality of life, but there is little evidence about the impact of organizational changes within health-care services on diabetes control. More research is needed to strengthen the evidence on effective strategies for response to diabetes in ethnic minorities. Also, there is a need to take into account diabetes beliefs and communication difficulties, as well as potential protective factors. Globally, many health-care systems are inadequately equipped to improve diabetes prevention and disease outcomes in these communities.

show abstract

“…[13][14][15] In addition, specifi c efforts to improve both patient activation and the patient-centeredness of the medical encounter have been shown to result in better glucose control. 2,16 Given that some studies found a participatory decision-making style on the part of the physician is associated with patients who participate more actively in the encounter, and that separate studies found active participation is associated with medication adherence, the purpose of this study was to assess a potential causal pathway among these relationships, including changes in hemoglobin A 1c levels, systolic blood pressure, and LDL cholesterol levels over a 1-year period among a patients with type 2 diabetes in primary care settings. Our hypotheses were as follows:…”

Section: Introductionmentioning

confidence: 99%

Participatory Decision Making, Patient Activation, Medication Adherence, and Intermediate Clinical Outcomes in Type 2 Diabetes: A STARNet Study

Parchman

Zeber

Palmer³

2010

The Annals of Family Medicine

224

168

View full text Add to dashboard Cite

PURPOSE Participatory decision making (PDM) is associated with improved diabetes control. We examine a causal model linking PDM to improved clinical outcomes that included patient activation and medication adherence. METHODSThis observational study was conducted in 5 family physician offi ces. Diabetic patients were recruited by mail and by completing a study interest card at the conclusion of their offi ce visit. Two survey questionnaires, administered 12 months apart, elicited patients' ratings of their physician's PDM style at baseline and their level of activation and medication adherence both at baseline and at follow-up. Measures of glycated hemoglobin (hemoglobin A 1c ), systolic blood pressure, and low-density lipoprotein (LDL) cholesterol were abstracted from the medical record starting 12 months before the baseline survey to 12 months after the follow-up survey. A path analysis using a structural equation model was used to test hypotheses. RESULTSWe mailed questionnaires to 236 participants; 166 (70%) returned the baseline questionnaire, and 141 (80%) returned the follow-up questionnaire. Hemoglobin A 1c levels, systolic blood pressure, and LDL cholesterol values all declined signifi cantly, and patient activation and medication adherence improved. PDM at baseline was associated with patient activation at follow-up. Patient activation at follow-up was associated with medication adherence at follow-up, and medication adherence at follow-up was associated with change in hemoglobin A 1c levels and LDL cholesterol values but not with systolic blood pressure.CONCLUSIONS Participatory decision making during primary care encounters by patients with type 2 diabetes resulted in improvements in hemoglobin A 1c levels and LDL cholesterol values by improving patient activation, which in turn improved medication adherence.

show abstract

Promoting glycemic control through diabetes self-management: evaluating a patient activation intervention

Cited by 91 publications

References 9 publications

The Role of Patient Activation in Psychiatric Visits

The Role of Patient Activation in Psychiatric Visits

The global challenge of type 2 diabetes and the strategies for response in ethnic minority groups

Participatory Decision Making, Patient Activation, Medication Adherence, and Intermediate Clinical Outcomes in Type 2 Diabetes: A STARNet Study

Contact Info

Product

Resources

About