Q-Methodology and Psychological Phenotyping to Design Patient-Centered Diabetes Education for Persons With Type 2 Diabetes on Insulin Therapy

Abstract

Purpose The purpose of this study was to identify the psychological phenotypes of persons with type 2 diabetes (T2D) on insulin therapy to better inform personalized diabetes education strategies to improve self-management behaviors. Methods Q-methodology, a research approach combining the quantitative rigor of statistical analysis with qualitative data on perception of diabetes self-management by persons with T2D on insulin therapy, was used. The Summary of Diabetes Self-Care Activity measure and A1C in the past 6 months were used to further describe self-management behaviors of each P-sample, Q-sorter. Of 160 statements, 33 Q-sample statements were selected as Q-set. Then, 37 P-samples (24 men; 13 women) were recruited from a university-affiliated diabetes clinic in South Korea. Data obtained from each P-sample with a Q-set and a Q-sorting table, a forced-choice normal distribution table, were analyzed using varimax rotation. Results Forty-one percent of the variance was explained with 5 factors represented by 27 Q-sorters, explaining variance ranging from 5% to 17% for each factor: Factor A (n = 6): those showing self-management education need but possessing inadequate health literacy; Factor B (n = 4): those valuing lifestyle modification to control diabetes; Factor C (n = 5): those valuing antidiabetic medication to control diabetes; Factor D (n = 6): carpe diem, accepting diabetes as destiny; and Factor E (n = 6): those overestimating their competencies to control diabetes. Ten Q-sorters fell into either confounded or nonsignificant. Conclusions Tailoring messages and educational approaches based on patients’ psychological phenotypes are necessary to promote optimal self-management behaviors.

‘Analogy-Based Comprehensive Diabetes Education’ (ABCDE) Improves Glycemic Control of Diabetic Patients in an Underserved Population: Results of a Retrospective Chart Analysis

“…Many diabetic patients coming from a lower socioeconomic status or those with limited education struggle to understand the health implications of the HbA1c test when they receive this method of explanation, and do not respond to it by improving healthcare compliance. The field of diabetes was already calling for improving health literacy in diabetic patients by developing ‘thinking outside the box’ approaches [ 34 , 35 ], and a recent publication suggests tailoring such messaging based on the psychological phenotyping of patients [ 36 ]. This need was also orchestrated in a study which called for the need for long-lasting education for adult diabetic patients toward improving behavior and achieving self-management of diabetes [ 37 ].…”