Problem Solving in Diabetes Self-management and Control: A Systematic Review of the Literature

Johns Hopkins University, Baltimore, Maryland, United States
The Diabetes Educator (Impact Factor: 1.79). 11/2007; 33(6):1032-50; discussion 1051-2. DOI: 10.1177/0145721707308412
Source: PubMed


The purpose of this systematic review is to assess the published literature on problem solving and its associations with diabetes self-management and control, as the state of evidence exists.
PubMed, PsychINFO, and ERIC electronic databases were searched for the years 1990 to the present and for English-language articles, and reference lists from included studies were reviewed to capture additional studies.
Quantitative and qualitative studies that addressed problem solving as a process or strategy for diabetes self-management were included. Fifty-two studies met the criteria for inclusion.
Study design, sample characteristics, measures, and results were reviewed.
Thirty-six studies were quantitative; 16 were conceptual or qualitative. Studies were classified as addressing the problem-solving definition/framework, assessment, intervention, or health care professional issues.
Problem solving is a multidimensional construct encompassing verbal reasoning/rational problem solving, quantitative problem solving, and coping. Aspects of problem solving can be assessed using newly developed diabetes-specific problem-solving measures for children/adolescents and adults. Cross-sectional studies in adults, but not children/adolescents, provide consistent evidence of associations between problem solving and A1C level. Only 25% of problem-solving intervention studies with children/adolescents and 50% of interventions with adults reported improvement in A1C. Most intervention studies reported an improvement in behaviors, most commonly global adherence in children/adolescents and dietary behavior in adults. Methodological limitations (noninclusion of problem-solving measures, inadequate descriptions of problem-solving interventions, homogenous samples) need to be addressed in future research to clarify the effect of problem solving on diabetes outcomes, identify characteristics of effective interventions, and determine the utility across age and racial/ethnic groups.

Download full-text


Available from: Felicia Hill-Briggs, May 11, 2014
  • Source
    • "Recommendation 26: Therapy should be individualized, and is recommended in children/adolescents for improvement in behaviors and adherence and in adults for dietary behavior[93] (Grade A; EL 1). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although several evidence-based guidelines for managing diabetes are available, few, if any, focus on the psychosocial aspects of this challenging condition. It is increasingly evident that psychosocial treatment is integral to a holistic approach of managing diabetes; it forms the key to realizing appropriate biomedical outcomes. Dearth of attention is as much due to lack of awareness as due to lack of guidelines. This lacuna results in diversity among the standards of clinical practice, which, in India, is also due to the size and complexity of psychosocial care itself. This article aims to highlight evidence- and experience-based Indian guidelines for the psychosocial management of diabetes. A systemic literature was conducted for peer-reviewed studies and publications covering psychosocial aspects in diabetes. Recommendations are classified into three domains: General, psychological and social, and graded by the weight they should have in clinical practice and by the degree of support from the literature. Ninety-four recommendations of varying strength are made to help professionals identify the psychosocial interventions needed to support patients and their families and explore their role in devising support strategies. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management, and help achieve a qualitative improvement in the way physicians manage patients. The guidelines, while maintaining an India-specific character, have global relevance, which is bound to grow as the diabetes pandemic throws up new challenges.
    05/2013; 17(3):376-95. DOI:10.4103/2230-8210.111608
  • Source
    • "As with any treatment or intervention, determination of the most suitable and valid measure of change is key. Given that previous research in this area has highlighted the lack of findings with regard to changes in HbA1c [7], developing reliable and valid measures of success for these interventions is vital. Finally, both these results and past research highlight the importance of peer support; therefore, continued focus in this area is needed. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Management of type 1 diabetes mellitus (T1DM) involves adherence to complex daily behaviors. Some adolescents have difficulty maintaining these regimens within social contexts due to peer pressure and apprehension about being singled out (Wysocki et al., 2003 [1]). Previous research suggests that negative social attributions have a role in adherence difficulties (Hains et al., 2006 [6]). This pilot study examined a cognitive-behavioral intervention geared towards challenging and restructuring negative thinking patterns. Ten adolescents with T1DM and HbA1c readings greater then 7.0% were recruited from a large, Midwestern Children's Hospital. The intervention consisted of a 1-h session followed by three weekly phone calls, which focused on cognitive restructuring and problem-solving training. Measures of diabetes-related stress and concerns surrounding self-care in social situations were completed by the adolescents pre- and post-intervention and at one-month follow-up. A series of repeated measure ANOVAS did not reveal significant differences between pre-intervention and follow-up scores across measures. While there were no significant differences between pre-intervention and follow-up scores, the results highlight some important trends. Specifically, preliminary results suggest that the trends in individual scores indicate that problem-solving may be helpful for improving adherence in social situations.
    11/2009; 4(1):47-55. DOI:10.1016/j.pcd.2009.10.003

Show more