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Religion and self-management of Thai Buddhist and Muslim women with type 2 diabets
Abstract
To report of a qualitative study of how religion affects the self-management of Thai Buddhist and Muslim women with type 2 diabetes.
The importance of diabetes self-management is well recognised. However, research on such self-management in Thailand is scarce, in particular on the influence of religion on the self-management of Thai Buddhist and Muslim women with type 2 diabetes.
A descriptive qualitative study was conducted.
Purposive convenience sampling was used, and 48 women, 19 Buddhist and 29 Muslim, aged from 28-80 years, participated. Data were collected in 2008-09 and analysed by use of manifest and latent content analysis.
Four themes of the influence of religion on the self-management among Thai women with type 2 diabetes emerged: religion - a way of coping with diabetes, spiritual practice - a help for disease control, spiritual practice - an effort to struggle with everyday life, and support from family - a cultural practice.
The Buddhist and Muslim women had self-management capabilities that were often related to their religions. However, many of them had poor control of their blood sugar levels and needed assistance.
Reference to religion and spiritual practice can be an effective means of helping diabetes patients better manage their disease and change their lifestyles. Furthermore, family and economic and social environments should be taken into account both in care and in interventions aimed at helping patients cope and empowering them to control their disease.
... The public religious practices could be attending public religious ceremonies or public worship in Mosque, Church or Temple (15)(16)(17). In the diabetes care context, by following religious practice in daily lives, it promotes diabetes people to perform diabetes care management such as taking medication, maintaining healthy diet, engaging physical activity, abstaining smoking, performing self-blood glucose monitor and foot care (5,13,14,(17)(18)(19)(20). ...
... In the diabetes care context, diabetes people seek help from their religion to give them hope and strength to cope their disease problem (18,22). They believed that God always helps them and never gives more than they could face which lead to reduce their worries and strengthen them to adhere on diabetes care management such as taking medication, adjusting diet habit, practicing physical activity, and performing self-blood glucose monitor (18,20,22). ...
... Religiousness has a significantly associated with better glycemic control (9). In addition, the religiousness was reported to be the source of motivation, hope, strength, and coping that may lead to better psychological well-being (11,18,20,22). Furthermore, the religiousness could promote better type 2 diabetes care management ...
The concept of religiousness role on the type 2 diabetes care management has not clearly explained. Terminology of "religiousness" and "spirituality" are sometimes confused and broadly explained. We applied Walker and Avant's concept analysis model to explore the meaning of religiousness on diabetes management among type 2 diabetes patients through selecting a concept, determining the analysis purpose, identifying a model case, investigating attributes, antecedents, and consequences, as well as defining empirical referents. The findings identified attributes of religiousness role in diabetes care management context including religious belief, religious practice, religious support, and religious coping. Antecedents included age, gender, education, race or ethnicity, religions, income, employment. Glycemic control and psychological well-being were documented as consequences. Health care provider might consider the antecedent as or inhibitor factors to impede the expected outcome. Further research might need to take religiousness role into account to type 2 diabetes care management intervention
... This is supported by previous studies among people with type 2 diabetes in Thailand which have identified many factors that impact upon daily living such as culture, belief, religion and education level. 14,[22][23][24] Diet also impacts upon managing type 2 diabetes and preventing complications. In Thailand, most people eat food with rice or glutinous rice that is high in carbohydrates. ...
... limited energy and mobility, cultural impact, spiritual impact, and self-care management. [22][23][24]38 However, there were themes identified which are unique to the Thai population. All participants described how their old habits were hard to change. ...
... Participants' beliefs appeared to impact on their disease and wound healing. 24 This study found that treatment from a holy shaman was associated with chronic wound healing and/ or severe infection. It is noted that the healthcare provider should be aware of a person's spiritual/ cultural beliefs so that they can assist the individual in getting appropriate treatments in conjuction with their beliefs. ...
Diabetic foot ulcers are a main cause of morbidity related to type 2 diabetes. Living with a diabetic foot ulcer has a significant impact on health-related quality of life and has a negative impact on daily living among people with the condition. The aim of this study was to explore the experiences of Thai adults living with diabetic foot ulcers using a descriptive qualitative design. Participants were recruited from the outpatient diabetes and foot clinic at a tertiary teaching hospital in Northern Thailand from January to April 2017. In-depth interviews were conducted with 13 participants using a semi-structured interview guide.
Thematic analysis was used to identify the participants’ experiences and two themes were identified: 1) living with a diabetic foot ulcer and 2) managing a diabetic foot ulcer. The findings enhance the knowledge of healthcare professionals and the public to understand the experience of having diabetic foot ulcers and contribute to understanding how to manage a diabetic foot ulcer based on the participant’s experiences in the Thai context. Nurses must provide knowledge and self-care skills as part of routine care to improve health-related quality of life for people with diabetic foot ulcers.
... Thai culture has strong kinship and family ties with family members providing physical, mental and economic support to people with diabetes. In particular, family support has been found to influence the ability of the individual to selfmanage their diabetes [28]. The assistance provided included helping the individual by preparing healthy food, prompting medication and exercise activities, and facilitating access to health professionals [28]. ...
... In particular, family support has been found to influence the ability of the individual to selfmanage their diabetes [28]. The assistance provided included helping the individual by preparing healthy food, prompting medication and exercise activities, and facilitating access to health professionals [28]. ...
... Family support is another resource assisting individuals with T2DM to improve their self-care activities [14,15] and these findings support the additional benefit achieved by including the family in the education program. Family support is essential in the Thai society 'where the family has an important role in the provision of physical, mental and socio-economic support to people living with diabetes' (p.556) [28]. Despite religious differences, Asian countries are culturally similar in terms of the primary responsibility for the ill-health of members traditionally remaining with other family members living in the home [41]. ...
Aims: We evaluated a theoretically-derived family-oriented intervention aimed to improve self-efficacy, self-management, glycemic control and quality of life in individuals living with Type 2 diabetes in Thailand.
Methods: In a single-blinded randomized controlled trial, 140 volunteer individuals with Type 2 diabetes, recruited from a diabetes clinic in rural Thailand, were randomly allocated to intervention and control arms. Those in the intervention arm received routine care plus a family-oriented program that included education classes, group discussions, a home visit, and a telephone follow-up while the control arm only received routine care. Improvement in outcomes over time (baseline, Week 3, and Week 13 following intervention) was evaluated using Generalized Estimating Equations multivariable analyses.
Results: Except for age, no between-group significant differences were observed in all other baseline characteristics. Diabetes self-efficacy, self-management, and quality of life improved in the intervention arm but no improvement was observed in the controls. In the risk-adjusted multivariable models, compared to the controls, the intervention arm had significantly better self-efficacy, self-management, outcome expectations, and diabetes knowledge (p<0.001, in each). Participation in the intervention increased the diabetes self-management score by 14.3 points (β=14.3, (95% CI 10.7-17.9), p<0.001). Self-management was better in leaner patients and in females. No between-group differences were seen in quality of life or glycemic control, however, in the risk-adjusted multivariable models, higher self-management scores were associated with significantly decreased HbA1c levels (p<0.001) and improved patient quality of life (p<0.05) (irrespective of group membership).
Conclusions: Our family-oriented program improved patients’ self-efficacy and self-management, which in turn could decrease HbA1c levels.
... However, a Thai study has found that women define themselves as being "normal" when they can work and perform daily activities of their usual lives even if they have diabetes (Naemiratch & Manderson, 2008). Another study of Thai Buddhist and Muslim women with T2D mentions religion as a significant factor that promotes psychosocial well-being when living with the disease (Lundberg & Thrakul, 2013), and one of the Buddhist teachings indicates illness as a common element in the cycle of human life (Phromtha, 1999). Additionally, research has reported that Thai people with diabetes believe in the consequence of actions, called karma, either in a past or a present life (Lundberg & Thrakul, 2012, and diabetes is acknowledged as a karma illness (Sowattanangoon, Kotchabhakdi, & Petrie, 2009). ...
... The oft-mentioned lack of empirical studies that consider the lives of Asian people with diabetes (Li, Drury, & Taylor, 2013;Lundberg & Thrakul, 2013;Naemiratch & Manderson, 2008;Sowattanangoon et al., 2009;Yamakawa & Makimoto, 2008) and the high prevalence and morbidity of T2D as one of the top five chronic diseases in Thailand (Bureau of Epidemiology, Ministry of Public Health, 2013) encourage the understanding of how people perceive their lives with this disease. Moreover, the higher diabetes prevalence among Thai women makes it important to focus a study on their perceptions (Bureau of Epidemiology, Ministry of Public Health, 2013). ...
... Moreover, the higher diabetes prevalence among Thai women makes it important to focus a study on their perceptions (Bureau of Epidemiology, Ministry of Public Health, 2013). While some research has considered women's lives with diabetes in general (Li et al., 2013;Lundberg & Thrakul, 2013), almost none has focused on the perceptions of women with diabetes of low socioeconomic status. A narrow perspective on the various individual experiences may add to better understandings of how people in this population perceive their life situations with diabetes. ...
The purpose of this study was to examine the life experiences of nineteen Thai women of low socioeconomic status who were living with type 2 diabetes. A qualitative research design was conducted, and the women were identified by the snowball technique. Data was collected through semi-structured interviews, and processes of induction and abstraction were used for data analysis. The theme “keeping equilibrium of one’s mind” involved two sub-themes: experiencing an unpredictable future and being empowered by emerged beliefs. The first sub-theme encompassed worries concerning health and fears of being a burden to one’s family. The second sub-theme comprised the experiences of continuing life without being conquered by the disease and believing in the natural law described in Buddhist teachings. These findings revealed that participants could maintain a balance among their concerns through empowerment by inner and outer sources of beliefs, particularly in Buddhist teachings. Despite the vulnerable situations caused by diabetes and low socioeconomic status, the women remained calm, with a consciousness to continue their lives with the disease. The Buddhist views on life, specifically natural law, assisted them to consider life with diabetes as simply a natural course. Buddhism served as a spiritual refuge and helped the women to cope with their psychological burden from diabetes. These findings may reflect the need for health care professionals to provide more holistic care that would assist patients to live with their disease. Buddhist beliefs can be used as a tool to assist Thai patients to empower themselves successfully.
... 7 Handling T2D not only depends on the disease itself but also is influenced by social surroundings. [12][13][14][15] Many contemporary studies have attempted to explore the effect that factors in the social environment have on the daily lives of people with T2D. These influences include religion, [12][13][14] family relationships and support, 14,15 hierarchy in the healthcare system, 16 the role of the women in the family 17 and economic status. ...
... [12][13][14][15] Many contemporary studies have attempted to explore the effect that factors in the social environment have on the daily lives of people with T2D. These influences include religion, [12][13][14] family relationships and support, 14,15 hierarchy in the healthcare system, 16 the role of the women in the family 17 and economic status. 12,18 Furthermore, research reporting the effects of the social environment on the daily life of people with T2D has highlighted the need for further investigations of these influences in different populations. ...
... However, little empirical evidence regarding handling life with T2D and the social influences on doing so has been collected in Thailand. 12,13,16,19 Most of these prior studies were conducted with both women and men of all socioeconomic statuses. 12,16,19 Until now, studies exploring women's experiences and focusing on individuals of low socioeconomic status have been rare, especially in Thailand. ...
Objective:
The objective of this study was to explore how Thai women of low socioeconomic status handle their type 2 diabetes.
Methods:
A qualitative interpretative method was used to study 19 women with type 2 diabetes in a suburban community in Thailand. Data were collected via semi-structured interviews and were analysed using inductive and constructive processes.
Results:
Participants’ lives underwent many changes between their initial diagnoses and later stages when they became adept at handling diabetes. Two themes emerged, which involved (1) the transition to handling diabetes and (2) the influences of the social environment. The first theme encompassed confronting the disease, reaching a turning point in the process of adaptation and developing expertise in handling diabetes. The second theme involved threats of loss of status and empowerment by families. These findings showed that becoming adept at handling diabetes required significant changes in women’s behaviours and required taking advantage of influences from the social environment.
Conclusion:
The process of developing expertise in handling diabetes was influenced by both inner and outer factors that required adjustment to learn to live with diabetes. Furthermore, the reductions found in women’s social statuses when they become patients in the healthcare system might pose a barrier to women of low socioeconomic status becoming adept at handling diabetes. However, the experiences of empowerment received from the women’s families acted as a powerful strategy to strengthen their handling of the disease. To develop accessible and sensitive health care for this population, it is important to pay attention to these findings.
... A study in Qom City, Iran, found significant positive correlations between religious practices and diabetes self-management, including regularly testing blood sugars, performing foot care, sticking to a specific diet, and not smoking (Heidari et al. 2017). Studies with Thai Muslim women, Thai Buddhist women, and Malaysians outlined similar findings (Lundberg and Thrakul 2013;Saidi, Milnes and Griffiths 2018). Other studies similarly show significant relationships between T2DM patients' spirituality or religiosity, reduced emotional and mental problems, and increased QoL scores (Yazla et al. 2017). ...
... Our findings about health-enhancing spiritual practices can assist in improving both T2DM clinical management and self-management; this is in agreement with similar findings from countries such as Iran, Indonesia, Malaysia, Thailand, Sudan, Nigeria, Sweden, the United Kingdom, Australia, Canada, and the United States (Ahmed 2003;Arifin et al. 2020;Brown et al. 2013;Heidari et al. 2017;Jacklin et al. 2017;Lundberg and Thrakul 2013;Marshall and Archibald 2015;Permana 2018;Rubin, Walen and Ellis 1990;Saidi, Milnes and Griffiths 2018;Unantenne et al. 2013). Fasting, observing Lent and other rituals, prayer, meditation, and referring to sacred texts are some of the spiritual practices present in Belize that may represent an underutilised resource and source of wellness for people living with T2DM, chronicity, and the exacerbations of poverty. ...
With increasing prevalence in Belize, Central America, Type 2 diabetes mellitus (T2DM) is a serious chronic illness and leading cause of preventable death. Spiritual and religious practices, such as regular prayer, scripture reading, or communal worship, have been shown to improve patient emotional adjustments to diagnosis, psychological endurance with chronic illness, and improved mental health (including reduced depression and anxiety), glycemic control, and quality of life (QoL). The purpose of this Grounded Theory study was to better understand how spiritual practices of people living with T2DM affects disease management and mental wellness in Belize. Semi-structured interviews with diabetes patients (n=11), discussions with key informants (n=20), participatory observation, and regular field notes occurred between February and March of 2020. Findings indicate that many Belizeans with T2DM engage in diverse spiritual and religious practices (e.g., fasting, observing Lent, prayer, referring to sacred texts, meditation) to support and build psychological determination and commitment to healthy lifestyle choices for T2DM self-management and provide relief for both inner psychological tensions and external stressors which could otherwise exacerbate the condition. This research proposes suggestions for health care providers (HCPs) in Belize in order to optimize diabetes care through collaboration with patients’ spiritual frameworks and faith-based organizations. Similarly, T2DM prevention and education can likely be better facilitated by interdisciplinary efforts that take into consideration faith-based and spiritual perspectives.
... A study in Qom City, Iran, found significant positive correlations between religious practices and diabetes self-management, including regularly testing blood sugars, performing foot care, sticking to a specific diet, and not smoking (Heidari et al. 2017). Studies with Thai Muslim women, Thai Buddhist women, and Malaysians outlined similar findings (Lundberg and Thrakul 2013;Saidi, Milnes and Griffiths 2018). Other studies similarly show significant relationships between T2DM patients' spirituality or religiosity, reduced emotional and mental problems, and increased QoL scores (Yazla et al. 2017). ...
... Our findings about health-enhancing spiritual practices can assist in improving both T2DM clinical management and self-management; this is in agreement with similar findings from countries such as Iran, Indonesia, Malaysia, Thailand, Sudan, Nigeria, Sweden, the United Kingdom, Australia, Canada, and the United States (Ahmed 2003;Arifin et al. 2020;Brown et al. 2013;Heidari et al. 2017;Jacklin et al. 2017;Lundberg and Thrakul 2013;Marshall and Archibald 2015;Permana 2018;Rubin, Walen and Ellis 1990;Saidi, Milnes and Griffiths 2018;Unantenne et al. 2013). Fasting, observing Lent and other rituals, prayer, meditation, and referring to sacred texts are some of the spiritual practices present in Belize that may represent an underutilised resource and source of wellness for people living with T2DM, chronicity, and the exacerbations of poverty. ...
This book explores how people draw upon spiritual, religious, or faith-based practices to support their mental wellness amidst forms of chronicity. From diverse global contexts and spiritual perspectives, this volume critically examines several chronic conditions, such as psychosis, diabetes, depression, oppressive forces of colonization and social marginalization, attacks of spirit possession, or other forms of persistent mental duress.
As an inter- and transdisciplinary collection, the chapters include innovative ethnographic observations and over 300 in-depth interviews with care providers and individuals living in chronicity, analyzed primarily from the phenomenological and hermeneutic meaning- making traditions. Overall, this book depicts a modern global era in which spiritualty and religion maintain an important role in many peoples’ lives, underscoring a need for increased awareness, intersectoral collaboration, and practical training for varied care providers.
This book will be of interest to scholars of religion and health, the sociology and psychology of religion, medical and psychological anthropology, religious studies, and global health studies, as well as applied health and mental health professionals in psychology, social work, cultural psychiatry, and medicine.
... A study in Qom City, Iran, observed significant positive correlations between religious practices and diabetes self-management, including regularly testing blood sugars, performing foot care, sticking to a specific diet, and not smoking. Studies with Thai Muslim women, Thai Buddhist women, and Malaysians outlined similar findings (Heidari et al., 2017;Lundberg & Thrakul, 2013;Saidi et al., 2018). Other studies similarly showed significant relationships between T2DM patients' spirituality (or religiosity), reduced emotional and mental problems, and increased quality of life (QoL) scores (Yazla et al., 2018). ...
... My findings suggested that optimizing spiritual practices that are health-enhancing would assist in improving both T2DM clinical management and self-management; this is in agreement with similar findings from countries such as Iran, Indonesia, Malaysia, Thailand, Sudan, Nigeria, Sweden, United Kingdom, Australia, Canada, and the United States (A. M. Ahmed, 2003;Arifin et al., 2020;Brown et al., 2013;Heidari et al., 2017;Jacklin et al., 2017;Lundberg & Thrakul, 2013;Marshall & Archibald, 2015;Permana, 2018;Rubin et al., 1990;Saidi et al., 2018;Unantenne et al., 2013 from the outreach of these communities (Darvyri et al., 2018;Permana, 2018). My interviews showed that the individual's at-home spiritual practices are important elements of T2DM selfmanagement, and key informants reported that these were even more crucial in the times of covid-19, thus they merit more inquiry in and of themselves. ...
Type 2 diabetes mellitus (T2DM) is the leading cause of death in Belize, and its prevalence is rapidly increasing. The purpose of this study is to understand the everyday realities of people living with T2DM in Belize (e.g., barriers to care, strengths, health practices), how these affect diabetes self-management (DSM), and implications for health care. Data generation methods include interviews with T2DM patients, discussions with key informants, field notes, and participatory observation which took place in February and March of 2020. Principal findings were categorized into three main themes. The first is that patients experience numerous difficulties, including a tiered health care system privileging those with more resources, communication barriers with health care providers, and major gaps in prevention, education, and social supports. Secondly, many Belizeans with T2DM engage in spiritual practices that provide for mental strength, stress relief, lifestyle guidance, overcoming addictions, overcoming denial, and building determination toward health promoting, life-affirming attitudes and actions. Further, geographies can empower DSM. Home is a domain where personal power is most focused. A community domain that is conducive to active living is crucial. People use a plethora of local plant medicines instead of, alongside of, or to complement pharmaceuticals for DSM without disclosure to HCPs. Plant medicine usage and cultural-spiritual healing is pervasive in this population; therefore, health care can optimize T2DM outcomes through open dialogue and collaboration with patients, herbal doctors, traditional Indigenous medicine practitioners, community leaders, and faith leaders. Integrating these understandings will be key for moving forward to improve DSM education and support, as well as culturally safe care.
... Spiritual belief does not always mean passive acceptance to fate, but was often a way of finding support in facing stressful life events. Studies involving communities with different spiritual beliefs have shown that individuals with a strong religious belief appeared to have more positive coping responses, as seen by not being frustrated over difficulties as a result of having diabetes (Lundberg & Thrakul, 2013;Rowe & Allen, 2004). Diabetes is a chronic disease that needs persistent effort to manage. ...
... Furthermore, diabetes-related distress has been found to affect clinical outcomes, and quality of life (Fisher, Glasgow, & Strycker, 2010;Karlsen, Oftedal, & Bru, 2012;Wagner & Tennen, 2007). Therefore, people perceived their religion as a means of coping and a support in the struggle with diabetes (Lundberg & Thrakul, 2013). ...
Background: Understanding perceptions and experiences of people with diabetes is important before establishing effective interventions. Previous research indicates that socio-cultural characteristics influence people’s views about diabetes.
Objective: This study aimed at understanding diabetes from the perspective of people with diabetes in the Indonesian cultural context.
Methods: Six focus group discussions involving 45 people with diabetes were conducted in East Nusa Tenggara and West Sumatera. The discussions were recorded, transcribed verbatim in their original language, translated into English, and analysed for common themes.
Results: This study showed that participants tried to understand diabetes based on their personal experiences. They also saw the disease in a broader context of cultural identity and changes in their cultural environment. In coping with the disease, three strategies were identified: seeing it as beyond their control, normalising their condition, and resignation to God. People who used the first and second methods of coping tended to have a more negative response to diabetes treatment. People with strong religious beliefs coped more positively with diabetes.
Conclusions: People with diabetes conceptualised the disease into their own narratives. These lay concepts influenced their strategies of coping and their behaviours in managing the disease. Understanding people’s lay perceptions and experiences are important to develop personalised strategies of diabetes management that may influence people’s responses to their disease and treatment.
... Studies in western countries have found differences in diabetes perceptions and self-management in relation to race and ethnicity [24] and have found a relationship between socioeconomic inequality and glycemic control [25,26]. Until now, the research conducted in Thailand with people with type 2 diabetes has mostly focused on the issue of self-management without comparing different socioeconomic conditions [27][28][29]. Thus, knowledge concerning the effects of socioeconomic status is limited. In order to increase this knowledge, it is important to investigate the influences of socioeconomic status on people's life with diabetes, particularly concerning income and education. ...
... Additionally, the way that Buddhist beliefs influence people's thinking and behavior and are involved in their perceptions and self-management has earlier been shown among Thai people with diabetes [28,29] Understanding the fact that life goes on as the law of nature may lead the participants to view their life with diabetes and a low socioeconomic status as the way it is, and to realize that they cannot go against the law of nature. Furthermore, the Buddhist law of karma, which explains the occurrences in this life resulting from intended action in the past or in one's current life [50], may influence the participants to accept their diabetes in this current life as an unavoidable situation. ...
... Thailand is a Buddhist country, and religion has a substantial impact on all aspects of the society: the healthcare system and the regulations, cultural norms as well as individual health beliefs. The burden of HPV in Thailand is high, and the HPV vaccine is available at a cost but not included in the national vaccination program [41][42][43]. Parents must give consent to have their children be vaccinated, and their beliefs are of great importance for successful implementation. Thus, the aim of this study was to examine parents' knowledge, beliefs, and acceptance of HPV and the HPV vaccine for their young daughter/s, in relation to their sociodemographics, health behavior, and religious beliefs in the Thai setting. ...
... We found that religion was positively related to both susceptibility and benefit (i.e., respondents who reported that religion was important had higher susceptibility and benefit than those who reported that religion was less important). It is probable that those parents who reported religion as being of importance have a strong belief in "Karma" i.e., the misfortune, good or bad things that happened in life are the result from the previous life, which they cannot control so that the risk of cancer can be real and the vaccine will help to resolve it [42,43]. The importance of religion in relation to the beliefs about the HPV vaccine varies, according to previous studies [10,20,34,35,38,39]. ...
Thailand has one of the world’s highest prevalence of cervical cancer, mainly caused by the human papillomavirus (HPV). HPV infections can successfully be prevented by vaccination, which is available at a cost but not yet implemented in the national vaccination program. Parents play a critical role in deciding whether to vaccinate their child against HPV. Thus, the aim was to examine the association between parents’ knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. A cross-sectional design was used among three schools in Thailand: Nakorn Phatom province (suburban) and Bangkok (urban). Parents of 9–12-year-old daughters completed the questionnaires, guided by the Health Belief Model. In total, 359 parents completed the questionnaires; of those, 301 were included in the final analyses. The ordinary least squares (OLS) regression analysis showed that background knowledge of HPV and the HPV vaccine was positively related to knowledge of HPV and cervical cancer. For beliefs, knowledge was positively associated with susceptibility (i.e., parents’ perceived risk of an HPV infection/ related disease), severity, and benefit. However, knowledge was not significantly related to barriers. For acceptance, higher susceptibility and benefit were related to higher acceptance, and greater knowledge was associated with higher acceptance. Thus, we found associations between parents’ knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. Parents, who reported religion as important, as opposed to those who did not, were more favorable toward the HPV vaccination. Four out of ten mothers had never undergone a cervical cancer screening, but most had accepted previous childhood vaccinations for their daughters. The overall acceptance of the vaccine was high, and we believe our results are promising for future implementation of the HPV vaccination in the national childhood vaccination program in Thailand.
... The results of this study were consistent with the findings of studies of patients with MS or related diseases in other countries. A qualitative study by Lundberg et al. [35] showed that most Thai Buddhist and Muslim women with type 2 diabetes reported that it was very difficult to change their lifestyles and perform health self-management according to the advice of medical staff, and their overall level of health self-management behaviour was generally poor; a large-scale survey of 19,843 black, white, and Hispanic diabetic patients in the 50 states of the United States by Oster et al. showed that all racial/ethnic groups had low levels of health selfmanagement behaviours and that there were racial and ethnic differences [36]. Here, the explanation may relate to the unique lifestyle and religious beliefs of the studied ethnic groups. ...
Background
Metabolic syndrome (MS) is common among Muslim patients living in China, most of whom are Kazakh adults. Continuous and effective health self-management plays a critical role in preventing negative health outcomes for individuals with MS. However, Muslim minority patients with MS face many difficulties in actively participating in health self-management, and the factors supporting their successful self-management of MS remain unclear.
Objective
This study aimed to identify the factors predicting health self-management behaviour among Kazakh MS patients and provide empirical evidence for establishing recommendation guidelines or intervention programmes for health self-management among Muslim minorities.
Methods
A cross-sectional study was conducted in Xinjiang Province, China, with the use of convenience sampling to explore the current health self-management behaviour of 454 Kazakh MS patients and its influencing factors. Univariate analysis and logistic regression were used to analyse the data.
Results
The total health self-management behaviour score of Kazakh MS patients was 85.84±11.75, and the weaknesses in self-management behaviour were mainly reflected in three dimensions: disease self-monitoring, emotion management and communication with physicians. The significant positive predictors of health self-management behaviour were sex, education, family monthly income per capita, weight, knowledge of MS, and self-efficacy, while the significant negative predictors were blood pressure, the number of MS components, chronic disease comorbidities, and social support (objective support and utilization of support).
Conclusion
The health self-management behaviour of Kazakh MS patients is poor. Health care providers should aim to develop culturally specific and feasible health management intervention programmes based on the weaknesses and major modifiable influencing factors in Muslim minority MS patient health self-management, thus improving the health outcomes and quality of life of patients.
... Moreover, pain and immobilization will significantly impact the patient's quality of life. Any impact that arises makes patients with diabetic ulcers tend to depend on family or closest friends in performing daily activities[19,20].with social support such as family and neighborhood should have a better strategy and problem-solving abilities. ...
Introduction: Patients with diabetic ulcers tend to experience problems in implementing spirituality practices. Patients with diabetic ulcers also experience weaknesses and impaired mobilization that have an impact on family dependence and decreased self-efficacy. The purpose of this study was to determine the relationship between spirituality level and family support with spiritual self-care behavior in diabetic ulcer patients.
Methods: A descriptive correlation design with a cross-sectional approach. In a total of 92 patients with diabetic ulcers in Sidoarjo General District Hospital in June-July 2019 recruited. Independent variables were the level of spirituality and family support. The dependent variable was spiritual self-care behavior. Data obtained through the Daily Spiritual Experience Scale (DSES) questionnaire, family support questionnaire, and Spiritual Self Care Practice (SSCPS) questionnaire. Data were analyzed using the Chi-square test of categorical variables with a p-value ≤ 0.05 and logistic regression for multivariate analysis.
Results: The study showed there was a significant relationship between spirituality level (p = 0,000) and family support (p = 0,001) with spiritual self-care behavior in diabetic ulcer patients. The result of regression analysis showed the respondents with a high level of spirituality would increase 0.138 times of the spiritual self-care behavior probability.
Conclusion: The level of spirituality and family support can promote individual coping to be more positive which may accelerate the process of receiving and healing wounds.
... Also, private and all forms of public religious practices among these patients were most strongly associated with self-care activities. Lundberg and Thrakul (2013) in their qualitative study found that religious and spiritual practices can be an effective means of helping Buddhist and Muslim women with type 2 diabetes to better manage their disease and change their lifestyles. Relationships with the divine are major sources of hope and strength in diabetes self-management (Gupta and Anandarajah 2014). ...
This study aimed to examine the relationship between religious practices and
self-care of patients with type 2 diabetes. A descriptive cross-sectional survey was conducted
on 154 diabetic patients who were referred to two general teaching hospitals in
Qom City (Iran). Data were collected using demographic questionnaire, private and public
religious practices, and summary of diabetes self-care activities questionnaires. Data were
analyzed using descriptive statistics and statistical tests including independent t test, and
Pearson correlation coefficient. Significant positive correlations were observed between
religious practices and self-care activities in diabetic patients (p\0.05). Significant
positive correlations were also found between some religious practices and self-care activities subscales (p\0.05). Healthcare providers should be aware of the role that
religion plays in the lives of diabetic patients and be able to take religious factors into
account when developing care plans. Doing so will enhance a more patient-centered
approach and thereby support patients in their role as self-care decision-makers.
Keywords Religious practice � Religiosity � Self-care � Diabetic patients.
... While most Western people are shown to hold a strong belief in the biomedical model and to focus on self-responsibility [42], research conducted with Eastern people has found that they place a high value on a holistic view of health and illness, connecting with family closeness and religious beliefs [43] and social norms and values [44]. Corresponding to previous studies of Thai women with diabetes, the close attentiveness, encouragement, and understanding among the members in Eastern families [45] and their Buddhist beliefs [46] may have empowered our participants to improve their mental strength and have enabled them to accept their fate and to remain calm. This may also have increased their ability to cope with and manage their daily routines to suit their lives, in accordance with earlier Eastern research [47,48]. ...
Background:
Increased knowledge concerning the differences in the illness perception and self-management among sexes is needed for planning proper support programs for patients with diabetes. The aim of this study was to investigate the illness perception and self-management among Thai women and Thai men with type 2 diabetes and to investigate the psychometric properties of the translated instruments used.
Methods:
In a suburban province of Thailand, 220 women and men with type 2 diabetes participated in a cross-sectional descriptive study. The participants were selected using a multistage sampling method. Data were collected through structured interviews and were analyzed using group comparisons, and psychometric properties were tested.
Results:
Women and men with type 2 diabetes demonstrated very similar experiences regarding their illness perception and no differences in self-management. Women perceived more negative consequences of the disease and more fluctuation in the symptoms than men, whereas men felt more confident about the treatment effectiveness than women. Furthermore, the translated instruments used in this study showed acceptable validity and reliability.
Conclusions:
The Thai sociocultural context may influence people's perceptions and affect the self-care activities of Thai individuals, both women and men, with type 2 diabetes, causing differences from those found in the Western environment. Intervention programs that aim to improve the effectiveness of the self-management of Thai people with diabetes might consider a holistic and sex-related approach as well as incorporating Buddhist beliefs.
... Also, private and all forms of public religious practices among these patients were most strongly associated with self-care activities. Lundberg and Thrakul (2013) in their qualitative study found that religious and spiritual practices can be an effective means of helping Buddhist and Muslim women with type 2 diabetes to better manage their disease and change their lifestyles. Relationships with the divine are major sources of hope and strength in diabetes self-management (Gupta and Anandarajah 2014). ...
This study aimed to examine the relationship between religious practices and self-care of patients with type 2 diabetes. A descriptive cross-sectional survey was conducted on 154 diabetic patients who were referred to two general teaching hospitals in Qom City (Iran). Data were collected using demographic questionnaire, private and public religious practices, and summary of diabetes self-care activities questionnaires. Data were analyzed using descriptive statistics and statistical tests including independent t test, and Pearson correlation coefficient. Significant positive correlations were observed between religious practices and self-care activities in diabetic patients (p < 0.05). Significant positive correlations were also found between some religious practices and self-care activities subscales (p < 0.05). Healthcare providers should be aware of the role that religion plays in the lives of diabetic patients and be able to take religious factors into account when developing care plans. Doing so will enhance a more patient-centered approach and thereby support patients in their role as self-care decision-makers.
... Research in Muslim and Buddhist women also showed that religion aided coping, spiritual practices aided diet and exercise, and support from family helped. However, some would ignore medical advice in favour of spiritual practice, such as fasting during Ramadan for Muslim women (Lundberg and Thrakul, 2013). Additionally, illness is viewed as atonement for sin in Islam and a result of behaviour in a previous life in Buddhism. ...
Citation: Duke N, Wigley W (2016) Literature review: The self-management of diet, exercise and medicine adherence of people with type 2 diabetes is influenced by their spiritual beliefs. Journal of Diabetes Nursing 20: 184–90 Article points 1. The spirituality and religious beliefs of people with type 2 diabetes have profound effects on their self-management of the condition. 2. Positive effects of spirituality include improved coping and incentives towards healthful behaviours; however, negative effects include fatalism and the use of complementary medicine and/or practices instead of prescribed medicines. 3. Clinicians should be prepared to discuss a patient's spiritual beliefs without trying to change them, in order to give the best targeted, individualised care. Authors Natasha Duke is an Advanced Nurse Practitioner in Hampshire and studying towards a Doctorate of Clinical Practice at the University of Southampton. Wendy Wigley is Principal Teaching Fellow, University of Southampton, and academic supervisor of Natasha Duke. This article is a literature review on how the spirituality of people with type 2 diabetes can significantly impact their approach to their diabetes treatment plans. The results show that, although spirituality can give people strength to cope with a chronic condition, it may result in poor diabetes care if they abandon self-management because they believe it is fate or the will of a deity for them to have diabetes. Key themes include how spirituality/religion influences the self-management behaviours of diet and exercise; how the use of complementary and alternative medicines and practices affect diet and medicine adherence; how ethnicity and gender impact self-management; and how coping styles affect self-management, including how a " future-orientated focus " may aid self-care. Finally, a model is outlined that can be used in the clinic for spiritual assessment of people with diabetes.
... One of the potential answers is that the spiritual belief might give results to positive behaviors related to foot care. Previous study confirmed that spiritual belief associated with positive coping among T2DM patients [27] and has a role in controlling glycemic status [28]. ...
Indonesia is one of the top ten diabetes mellittus (DM) countries. However as the main complication of DM, there was lack of studies related to diabetic foot ulcer (DFU). Thus, the aim of this study was to survey the prevalence of DFU risk factors and DFU among type 2 diabetes mellitus (T2DM) patients. An epidemiological study was conducted at an outpatient endocrine clinic in a regional hospital, eastern Indonesia. All T2DM participants attending research setting that were ≥ 18 years were included. Demographic and foot care behavior were assessed using minimum data sheet (MDS). Meanwhile, presence of risk factors was evaluated by using 5.07/10 g Semmes-Weinsten Monofilament (SWM) for neuropathy and presence of angiopathy was evaluated with Ankle Brachial Index (ABI) by using a hand held Doppler (Bidop ES-100V3, Hadeco-Kawasaki, Ja-pan) both dorsal and posterior tibialis foot. At the end of study, 249 T2DM participants were enrolled. The prevalence of DFU risk factors was 55.4% (95% CI: 53.7%-57.0%), and prevalence of DFU was 12% (95% CI: 10.3%-13.6%). Based on a logistic regression, predictors for DFU risk factors included age (OR: 1.04; 95% CI: 1.005-1.074) and daily foot inspection (OR: 0.36; 95% CI: 0.186-0.703). Meanwhile, the predictors for presence of DFU were insulin (OR: 9.37; 95% CI: 2.240-39.182), shoes (OR: 0.05; 95% CI: 0.007-0.294), spiritual belief that DM was a disease (OR: 0.04; 95% CI: 0.004-0.326) and belief that DM was a temptation from God (OR: 0.13; 95% CI: 0.027-0.598). In conclusion, we recommend to educate high risk patients to understand positive foot care behavior as essentially preventive strategies to prevent presence risk and DFU.
... Health education for patients and their family members should help the patients to manage their activities against diabetes concern. Health care service providers should be able to promote the patients' self-awareness to change their behavior by taking their cultural and religious beliefs into account as a part of educational strategies (15) . ...
Background: Fasting in Ramadan has adverse effects on health of Muslims with diabetes. Key strategies to prepare the patients are to provide appropriate health education to the patients prior to Ramadan and to adjust anti-diabetic medicines during Ramadan.
Objective: To study outcomes of the specific health care services that providing health education in parallel with counseling by Islamic leader.
Material and Method: The Thai Muslims with type 2 diabetes mellitus were divided into two groups. There were 62 patients in experimental group that was provided with specific health care service for Thai Muslims with diabetes in which health education prior to Ramadan and adjustment of anti-diabetic medicine applied. The other was control group with 28 patients that was provided only with original health care service. The results were monitored after Ramadan by interviews, weight and waist measurements, blood pressure measurement and blood tests.
Results: Both mean systolic and diastolic blood pressure were well controlled in both groups and slightly decreased after Ramadan. The mean diastolic blood pressure of the experimental group decreased after Ramadan (p-value = 0.041). From behavior point of view, it was found that the patients in the experimental group had consumed less sweetened food (p-value = 0.002). There was no incidence of severe hypoglycemia in either experimental or control group. The number and portion of patients with hypoglycemic symptoms in experimental group were lower than those in controlled group (p-value = 0.013).
Conclusion: Specific health care service by providing health education prior to Ramadan and adjustment of anti-diabetic
medicine application resulted in a positive effect as the patients tended to consume less sweetened food to keep blood sugar level in control. Fasting could affect the patients’ health in a positive way as it helps to control blood pressure, while in parallel, adjustment of anti-diabetic medicine application helps to prevent hypoglycemia. This health care service, which can be achieved in collaboration with a health care team and Islamic leaders, is useful and suitable for Thai Muslims with diabetes mellitus type 2.
... These themes are consistent with previous studies (Lundberg and Thrakul , 2013;Tuicomepee et al., 2012) indicating that Thai women place importance on meritmaking, which is a key concept in Buddhism. The merit that accumulates as a result of good deeds, acts or thoughts will carry over throughout one's life or in subsequent incarnations. ...
Cancer is one of the leading causes of death in Thailand as well as other countries. Evidences from studies in Asia show that alcohol consumption has been linked to an increased risk for various types of cancer. In the qualitative participatory action research presented here, the possibilities of a volunteer women's movement to reduce harmful alcohol consumption by facilitating the creation of emancipatory knowledge in the Thai-Isaan community was explored. During in-depth interviews with 10 female volunteer participants, the following themes emerged: merit making, developing a sense of personal empowerment, and the experience of participating in an action plan that utilized various strategies. The project activities empowered participants to create and share knowledge which was then applied toward action for change. Adoption of this type of program by local health care providers to reduce health problems and risks related to alcohol misuse in similar contexts and cultures is recommended.
... Religion often refers to "an organized system of beliefs, practices, rituals, and symbols designed to facilitate closeness to the sacred or transcendent and to foster an understanding of one's relationship and responsibility to others," while spirituality is defined as "the personal quest for understanding answers to ultimate questions about life, meaning, and relationship to the sacred or transcendent," (Lundberg & Thrakul, 2013, p. 1908. Religion and spirituality are often used as distinct but overlapping concepts in many studies (Dancy II, 2010;Lundberg & Tharkul, 2013). ...
Background
The prevalence of heart failure (HF) is increasing in many low-income and middle-income countries, but the limited availability of data on patient profiles and clinical outcomes, particularly at a community level, challenges health service planning.
Methods
The Thai HF Snapshot Study was a multi-site, observational study conducted in Thailand between June 2017 to June 2019. It aimed to document demographic, clinical and sociodemographic characteristics, and to compare clinical outcomes by the level of the hospital.
Results
A total of 512 participants were recruited across Thailand: mean age was 64.9±15.3 years and 286 were female (55.9%). The most frequently identified admitting diagnosis was ischaemic heart disease (45.1%). Most patients (70.3%) were classified as New York Heart Association class II at discharge. Patients in university hospitals were frailer (3.2 vs 2.9; p=0.015), had more depressive symptoms (8.1 vs 5.7; p<0.001), and had lower functional status (66.2 vs 73.3; p<0.001) than those in tertiary care.
Conclusion
Although HF patients admitted to university hospitals had access to advanced technology and health care specialists, clinical outcomes likely affected patient acuity. Interventions are urgently needed to ensure improved HF management considering the social determinants of health in Thailand.
Background: Chronic conditions such as diabetes (DM) and cardiovascular disease are associated with disability and poor quality of life. Asians are 30% more likely than non-Hispanic Whites to develop type 2 DM. The important roles of wearable technological applications or devices in maintaining individuals’ motivation to attain their physical activity (PA) goal have been reported. However, evidence of the feasibility and impact of the mobile technology on the PA in Thailand is limited. This study aims to examine the feasibility and the impact of the immediate
performance feedback feature of the wearable device on PA.
Methods: This pilot study recruited persons aged 18 or older with diabetes from two diabetes clinics in Chiang Mai, Thailand. Participants were randomly assigned into three groups: the aware group (AW: can see the step count on the device screen), the unaware group (UW: the device screen was completely covered), and the control group (usual care). Participants in the AW and UW groups were asked to wear the device for 2 full days while the usual care group did not wear the device. All participants completed a questionnaire package at their first study visit. Data analysis of univariate and multivariate general linear models were conducted using SAS version 9.4 (SAS Institute Inc., Cary, NC). All significance levels were set at 5%.
Results: One hundred and fourteen participants age ranged from 39 to 75 years old were included in this analysis. The majority were female (n = 86, 69%) and married (n = 103, 82%). No adverse events were reported among device users. Within 2 days, there were less than 10% missing data and more than 70% of participants liked the devices mainly because they could see the step count. More than 63% of participants who wore the device had an average of steps greater than 10,000 per day. Although the number of steps and sleep hours were not significantly different between the AW and UW groups, 68% of the AW participants found that the device help them with their exercise.
Discussion: The results demonstrate the feasibility of the use of the wearable device among people living with chronic conditions. Participants found that the step count screen provided immediate physical performance feedback that was helpful with their exercise. The behavioral changes, however, could not be examined due to the short duration of the usage. Future studies that require longer device usage in larger sample sizes are needed.
This study aimed to identify factors influencing self-management in patients with Parkinson's disease (PD) based on social cognitive theory. A cross-sectional design was used; data were collected at three tertiary medical centers in Korea from a convenience sample of 356 PD patients. Higher self-management scores were associated with higher education level, having a religion, and higher family income. Self-management score was positively correlated with activities of daily living, self-efficacy, and social support, and negatively correlated with non-motor symptoms. Hierarchical regression analysis revealed that demographic factors and non-motor symptoms explained 26.2% of the variance in self-management in PD. The explanatory power increased by 7.5% when self-efficacy was added, and by 6.7% when social support was added. Assessment of self-management in patients with PD should consider self-efficacy and social support, along with demographic factors and non-motor symptoms. Self-management programs that reflect these factors may be useful for improving self-management in PD patients.
Study aims were to explore how religion and spirituality impacted attitudes about self-management practices among African Americans with homelessness histories and to understand resilience in diabetes care practices. Qualitative semistructured face-to-face interviews were conducted with 42 African Americans older than 18 years. All audio-taped interviews lasted between 1–1.5 hr, transcribed verbatim, and analyzed using ATLAS.ti (version 7.0). Five resilience themes emerged. While participants recognized diabetes as an illness requiring professional treatment, the context of balancing treatment with religion and spiritual practices mattered. The study findings highlight the importance of spirituality, religious beliefs, and coping strategies in diabetes self-care activities.
The aim of the present study was to explore self‐care management of Thai Buddhists and Muslims with type 2 diabetes and inadequate blood glucose levels, after they had been subjected to a 6‐month diabetes empowerment education program. Twenty‐seven participants (male and female) were selected through purposive convenience sampling for an explorative qualitative study. Semistructured focus group interviews with four open‐ended questions were used to study the participants’ self‐care behavior at the beginning and the end of the program, and the data obtained were subjected to content analysis. At the end, one third of the participants had been able to reduce their blood glucose to acceptable levels. Most of the others had achieved reduced but irregular blood glucose levels; however, some did not achieve any reduction. Diet was the most difficult problem, and economic difficulties, incorrect knowledge, and misleading beliefs were barriers. In conclusion, an empowerment education program can substantially improve the outcome of self‐care management for many people with type 2 diabetes. In the planning of such programs, barriers should be taken into account.
Objetivo:
Identificar las diferencias en el automanejo de la DMT2 bajo un enfoque de género.
Metodología:
Se realizó una Revisión Integrativa en diferentes bases de datos de las cuales 24 artículos cumplieron con los criterios de inclusión para esta investigación, 13 artículos cuantitativos y 11 cualitativos, la mayoría de los estudios fueron realizados en Estados Unidos y Canadá.
Resultados:
De acuerdo a los hallazgos, las mujeres cumplen mejor con la alimentación y la toma de medicamentos, presentan menor apoyo social, mayores problemas psicológicos, y la religión, oración, la fe y la espiritualidad son un mecanismo positivo para el manejo de su enfermedad. Mientras que los hombres, cumplen mejor con la actividad física, presentan menor conocimiento, mayor consumo de alcohol y tabaco, y reciben mayor apoyo social. Sin embargo, el trabajo y la ausencia de síntomas graves son una barrera para el automanejo.
Conclusiones
Existen diferencias entre hombres y mujeres en relación al automanejo, mismas que permiten al personal de enfermería orientar intervenciones bajo un enfoque de género, basado en las necesidades particulares que presentan los hombres y mujeres. Por una parte, las mujeres requieren mejorar el ejercicio y mayor apoyo social, psicológico y espiritual. Los hombres muestran dificultades para cumplir con la alimentación y la toma de medicamentos.
Introduction
Health system responses to the emergence of non-communicable diseases (NCDs) in many Southeast Asian nations, Cambodia included, have been insufficient. Little is known about how people suffering from such conditions behave in constrained contexts. We examined the experience of patients with NCDs as they seek care for their conditions and manage them.
Methods
In-depth interviews with 28 purposively selected patients with hypertension and/or diabetes using an interview guide to capture the trajectory followed by interviewees from the development and recognition of symptoms to adherence to treatment. A general outline of major topics to be discussed was used instead of a predetermined list of specific questions.
Results
All interviewees had experienced symptoms for a substantial period of time, sometimes many years, before being diagnosed. Initial treatment focused on symptoms instead of underlying conditions, often at considerable financial cost. Following diagnosis, many struggled to take medicines daily for their condition and adhering to the required behaviour changes. Many resorted to complementary medicine. Lack of financial resources was a common reason to discontinue treatment. Many reported loss of income and assets such as livestock and productive land and increasingly relied on others.
Conclusion
In order to assist people with NCDs in Cambodia, there is a need for a multipronged approach focusing on communities and healthcare providers. Information campaigns could focus on the timely recognition by communities of symptoms indicative of the conditions, together with instigating demand for routine screening at qualified health providers. Peer support is considerable, and locally adjusted approaches based on this principle should be considered.
Background:
Although, there is an increased recognition of the importance of blood glucose control and diabetes education, low levels of adherence to medications, as well as, dietary and exercise relationships between motivation and long-term outcomes of type II DM are lacking. The major aims of this study are to a) Describe the motivational styles of Jordanian patients with type II diabetes mellitus, regarding self-care management, taking medications and self-monitoring of blood glucose, as well as, following therapeutic diet instructions and exercising regularly, and b) Examine their significance in predicting glycemic control.
Methods:
A package including the treatment self-regulation questionnaire concerning diabetes, was administered to a convenience sample of 110 patients with type II diabetes. The latest HbA1cs results were extracted from the patients' medical records.
Results:
Almost fifty-eight (52.7%) patients reported an intrinsic motivation as regards taking medications and practicing a regular self-monitoring of blood glucose, whereas, half of the participants (50%) were intrinsically motivated, as regards following therapeutic diet instructions and regular exercise. Patients who were intrinsically motivated were 8.25 (95% CI = 1.43 - 47.85) times more likely to have glycemic control than those with extrinsic motivation, whereas, those who reported intrinsic motivation, as regards following therapeutic diet instructions and exercising regularly were 10.50 (95% CI = 2.55-49.21) times more likely to report glycemic control than those with extrinsic motivation.
Conclusion:
Interventional strategies should focus on promoting intrinsic motivation in order to enhance glycemic control. This article is protected by copyright. All rights reserved.
This study aimed to determine whether the self-management skills of patients with epilepsy are associated with certain demographic, clinical, and psychosocial variables.MethodsA direct survey of 182 patients, including the Epilepsy Self-Management Scale, was conducted.ResultsOn univariate analysis, higher age, the occurrence of convulsions, and the use of religion as a coping mechanism were associated with higher self-management scores. On multiple linear regression, only age and the presence of convulsions remained independently significant. Older individuals employed more medication management skills. Those who experienced convulsions utilized more information management, seizure management, and lifestyle management skills. However, using binary logistic regression, we found that these subscales were not independently significant.The presence of superior self-management skills did not necessarily translate into decreased seizure frequency.Conclusion
Individuals with epilepsy who are older and experience convulsions generally have better self-management skills. This indicates that antecedents influence the development of self-management skills.
Abstract
Background
Diabetes mellitus (DM) is increasing globally, with the greatest increase in Africa and Asia. In Zimbabwe a threefold increase was shown in the 1990s. Health-related behaviour is important in maintaining health and is determined by individual beliefs about health and illness but has seen little study. The purpose of the study was to explore beliefs about health and illness that might affect self-care practice and health care seeking behaviour in persons diagnosed with DM, living in Zimbabwe.
Methods
Exploratory study. Consecutive sample from a diabetes clinic at a central hospital. Semi-structured interviews were held with 21 persons aged 19-65 years. Data were analysed using qualitative content analysis.
Results
Health was described as freedom from disease and well-being, and individual factors such as compliance with advice received and drugs were considered important to promote health. A mixture of causes of DM, predominantly individual factors such as heredity, overweight and wrong diet in combination with supernatural factors such as fate, punishment from God and witchcraft were mentioned. Most respondents did not recognize the symptoms of DM when falling ill but related the problems to other diseases, e.g. HIV, malaria etc. Limited knowledge about DM and the body was indicated. Poor economy was mentioned as harmful to health and a consequence of DM because the need to buy expensive drugs, food and attend check-ups. Self-care was used to a limited extent but if used, a combination of individual measures, household remedies or herbs and religious acts such as prayers and holy water were frequently used, and in some cases health care professionals were consulted.
Conclusions
Limited knowledge about DM, based on beliefs about health and illness including biomedical and traditional explanations related to the influence of supernatural forces, e.g. fate, God etc., were found, which affected patients' self-care and care-seeking behaviour. Strained economy was stated to be a factor of the utmost importance affecting the management of DM and thus health. To develop cost-effective and optimal diabetes care in a country with limited resources, not only educational efforts based on individual beliefs are needed but also considering systemic and structural conditions in order to promote health and to prevent costly consequences of DM.
A meta-analysis of data from 42 independent samples examining the association of a measure of religious involvement and all-cause mortality is reported. Religious involvement was significantly associated with lower mortality (odds ratio = 1.29; 95% confidence interval: 1.20–1.39), indicating that people high in religious involvement were more likely to be alive at follow-up than people lower in religious involvement. Although the strength of the religious involvement–mortality association varied as a function of several moderator variables, the association of religious involvement and mortality was robust and on the order of magnitude that has come to be expected for psychosocial factors. Conclusions did not appear to be due to publication bias. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To explore the experience of diabetes in British Bangladeshis, since successful management of diabetes requires attention not just to observable behaviour but to the underlying attitudes and belief systems which drive that behaviour.
Qualitative study of subjects' experience of diabetes using narratives, semi-structured interviews, focus groups, and pile sorting exercises. A new qualitative method, the structured vignette, was developed for validating researchers' understanding of primary level culture.
40 British Bangladeshi patients with diabetes, and 10 non-Bangladeshi controls, recruited from primary care.
Several constructs were detected in relation to body image, cause and nature of diabetes, food classification, and knowledge of complications. In some areas, the similarities between Bangladeshi and non-Bangladeshi subjects were as striking as their differences. There was little evidence of a fatalistic or deterministic attitude to prognosis, and most informants seemed highly motivated to alter their diet and comply with treatment. Structural and material barriers to behaviour change were at least as important as "cultural" ones.
Bangladeshi culture is neither seamless nor static, but some widely held beliefs and behaviours have been identified. Some of these have a potentially beneficial effect on health and should be used as the starting point for culturally sensitive diabetes education.
1. Anthropometric variables, resting heart rate and respiratory gas exchange were measured in twelve male and nine female Asiatic adult Moslems during the month of Ramadan, the week before and the month after Ramadan.
2. Energy intakes were estimated from dietary recall during fasting and non-fasting conditions.
3. Both male and female subjects experienced a decrease in body mass with the reduction in energy intake during fasting. Males experienced a greater reduction than females in resting heart rate; females lost more body weight and subcutaneous fat than males.
4. Urine output and fluid intake were measured in twelve male subjects for 1 d during each week of fasting and 1 d during the pre-fasting control period. Among the subjects examined, the Ramadan regimen did not result in changes in the pattern of fluid exchange.
To determine the prevalence of depression in adult diabetic populations through a comprehensive literature review and to critically evaluate the methods and findings of such studies from an epidemiological perspective.
A systematic review of the scientific literature revealed a total of 20 studies, 14 of which had been conducted since 1988. Nine of the studies were controlled investigations, whereas the remaining 11 studies did not contain comparison groups. The studies included both treatment and community samples.
The range of the prevalence of current depression obtained from structured diagnostic interviews in diabetic samples was 8.5-27.3% (mean = 14.0%) in controlled studies and 11.0-19.9% (mean = 15.4%) in uncontrolled studies. These rates are at least three times the prevalence of major depressive disorder found in the general adult population of the U.S. Investigations using depression symptom scales corroborated these findings, as the range of clinically significant depression symptomatology in diabetic samples was 21.8-60.0% (mean = 32.4%) in controlled studies and 10.0-28.0% (mean = 19.6%) in uncontrolled studies.
An increased prevalence of depression in diabetes relative to the general population is highly suggested by the literature, but biases and methodological problems commonly encountered in prevalence studies may interfere with the strength of this conclusion. An increased prevalence of depression in diabetes relative to other somatic illnesses remains unproven. The pervasive impact of depression on quality of life and its potential negative effect on diabetes management warrant recognition and treatment of the affective disorder in diabetic individuals.
The effects of religious belief and activity on remission of depression were examined in medically ill hospitalized older patients.
Consecutive patients aged 60 years or over who had been admitted to medical inpatient services at a university medical center were screened for depressive symptoms. Of 111 patients scoring 16 or higher on the Center for Epidemiologic Studies Depression Scale, 94 were diagnosed with depressive disorder (DSM-III major depression or subsyndromal depression) by a psychiatrist using a structured psychiatric interview. After hospital discharge, depressed patients were followed up by telephone at 12-week intervals four times. At each follow-up contact, criterion symptoms were reassessed, and changes in each symptom over the interval since last contact were determined. The median follow-up time for 87 depressed patients was 47 weeks. Religious variables were examined as predictors of time to remission by means of a multivariate Cox model, with controls for demographic, physical health, psychosocial, and treatment factors.
During the follow-up period, 47 patients (54.0%) had remissions; the median time to remission was 30 weeks. Intrinsic religiosity was significantly and independently related to time to remission, but church attendance and private religious activities were not. Depressed patients with higher intrinsic religiosity scores had more rapid remissions than patients with lower scores.
In this study, greater intrinsic religiosity independently predicted shorter time to remission. To the authors' knowledge, this is the first report in which religiosity has been examined as a predictor of outcome of depressive disorder.
To estimate the prevalence of diabetes and the number of people with diabetes who are > or =20 years of age in all countries of the world for three points in time, i.e., the years 1995, 2000, and 2025, and to calculate additional parameters, such as sex ratio, urban-rural ratio, and the age structure of the diabetic population.
Age-specific diabetes prevalence estimates were applied to United Nations population estimates and projections for the number of adults aged > or =20 years in all countries of the world. For developing countries, urban and rural populations were considered separately
Prevalence of diabetes in adults worldwide was estimated to be 4.0% in 1995 and to rise to 5.4% by the year 2025. It is higher in developed than in developing countries. The number of adults with diabetes in the world will rise from 135 million in 1995 to 300 million in the year 2025. The major part of this numerical increase will occur in developing countries. There will be a 42% increase, from 51 to 72 million, in the developed countries and a 170% increase, from 84 to 228 million, in the developing countries. Thus, by the year 2025, >75% of people with diabetes will reside in developing countries, as compared with 62% in 1995. The countries with the largest number of people with diabetes are, and will be in the year 2025, India, China, and the U.S. In developing countries, the majority of people with diabetes are in the age range of 45-64 years. In the developed countries, the majority of people with diabetes are aged > or =65 years. This pattern will be accentuated by the year 2025. There are more women than men with diabetes, especially in developed countries. In the future, diabetes will be increasingly concentrated in urban areas.
This report supports earlier predictions of the epidemic nature of diabetes in the world during the first quarter of the 21st century. It also provides a provisional picture of the characteristics of the epidemic. Worldwide surveillance of diabetes is a necessary first step toward its prevention and control, which is now recognized as an urgent priority.
We applied the self-determination theory of human motivation to examine whether patient perceptions of autonomy supportiveness (i.e., patient centeredness) from their diabetes care providers related to improved glucose control over a 12-month period.
We conducted a prospective cohort study of patients with diabetes from a diabetes treatment center at a university-affiliated community hospital. Participants were 128 patients between 18 and 80 years of age who took medication for diabetes, had no other major medical illnesses, and were responsible for monitoring their glucose and taking their medications. The main outcome measure was a change in HbA1c values over the 12 months of the study
Patient perception of autonomy support from a health care provider related to a change in HbA1c values at 12 months (P < 0.05). Further analyses showed that perceived autonomy support from the staff related to significant increases in patient autonomous motivation at 12 months (P < 0.05); that increases in autonomous motivation related to significant increases in perceived competence (P < 0.05); and that increases in a patient's perceived competence related to significant reductions in their HbA1c values over 12 months (P < 0.001).
The findings support the prediction of the self-determination theory that patients with diabetes whose health care providers are autonomy supportive will become more motivated to regulate their glucose levels, feel more able to regulate their glucose, and show improvements in their HbA1c values.
A meta-analysis of data from 42 independent samples examining the association of a measure of religious involvement and all-cause mortality is reported. Religious involvement was significantly associated with lower mortality (odds ratio = 1.29; 95% confidence interval: 1.20-1.39), indicating that people high in religious involvement were more likely to be alive at follow-up than people lower in religious involvement. Although the strength of the religious involvement-mortality association varied as a function of several moderator variables, the association of religious involvement and mortality was robust and on the order of magnitude that has come to be expected for psychosocial factors. Conclusions did not appear to be due to publication bias.
Depression is common among patients with diabetes, but its relationship to glycemic control has not been systematically reviewed. Our objective was to determine whether depression is associated with poor glycemic control.
Medline and PsycINFO databases and published reference lists were used to identify studies that measured the association of depression with glycemic control. Meta-analytic procedures were used to convert the findings to a common metric, calculate effect sizes (ESs), and statistically analyze the collective data.
A total of 24 studies satisfied the inclusion and exclusion criteria for the meta-analysis. Depression was significantly associated with hyperglycemia (Z = 5.4, P < 0.0001). The standardized ES was in the small-to-moderate range (0.17) and was consistent, as the 95% CI was narrow (0.13-0.21). The ES was similar in studies of either type 1 or type 2 diabetes (ES 0.19 vs. 0.16) and larger when standardized interviews and diagnostic criteria rather than self-report questionnaires were used to assess depression (ES 0.28 vs. 0.15).
Depression is associated with hyperglycemia in patients with type 1 or type 2 diabetes. Additional studies are needed to establish the directional nature of this relationship and to determine the effects of depression treatment on glycemic control and the long-term course of diabetes.
Many African-American women are affected by diabetes and its complications, and culturally appropriate lifestyle interventions that lead to improvements in glycemic control are urgently needed. The aim of this qualitative study was to identify culturally relevant psychosocial issues and social context variables influencing lifestyle behaviors--specifically diet and physical activity--of southern African-American women with diabetes.
We conducted 10 focus group interviews with 70 southern African-American women with type 2 diabetes. Group interviews were audiotaped and transcripts were coded using qualitative data analysis software. A panel of reviewers analyzed the coded responses for emerging themes and trends.
The dominant and most consistent themes that emerged from these focus groups were 1) spirituality as an important factor in general health, disease adjustment, and coping; 2) general life stress and multi-caregiving responsibilities interfering with daily disease management; and 3) the impact of diabetes manifested in feelings of dietary deprivation, physical and emotional "tiredness," "worry," and fear of diabetes complications.
Our findings suggest that influences on diabetes self-management behaviors of African-American women may be best understood from a sociocultural and family context. Interventions to improve self-management for this population should recognize the influences of spirituality, general life stress, multi-caregiving responsibilities, and the psychological impact of diabetes. These findings suggest that family-centered and church-based approaches to diabetes care interventions are appropriate.
Caring from Islamic perspectives is not well versed in Eurocentric nursing literature. There is widespread misunderstanding of the concept and practice of Islam within the context of health care and nursing practice. The areas of contention, in the context of health care systems, are whether the western paradigm to nursing care and management are applicable to Muslims and non-Muslims in both Islamic and non-Islamic countries. What is lacking in some of the conceptual frameworks and models of care is not only the fundamental spiritual dimension of care, but also the significance of spiritual development of the individual towards healing. The focus of this paper is to provide an awareness of Islamic health practices, health behaviours, code of ethics and the framework of Islamic perspectives of caring and spirituality. A brief overview of the Muslim world, the historical development in caring and health and the pillars of the Islamic faith provide the context of the paper. The development of a model of care based on the Islamic perspective is suggested.
The aim of this study was to determine in Thai adults aged >or=35 years the prevalence and management of diabetes and the associations of diabetes with cardiovascular risk factors.
The International Collaborative Study of Cardiovascular Disease in Asia was a complex sample survey. Data from a structured questionnaire, brief physical examination, and blood sample were collected from 5,105 individuals aged >or=35 years (response rate 68%). Population estimates were calculated by applying sampling weights derived from the 2000 Thai census.
The estimated national prevalence of diabetes in Thai adults was 9.6% (2.4 million people), which included 4.8% previously diagnosed and 4.8% newly diagnosed. The prevalence of impaired fasting glucose was 5.4% (1.4 million people). Diagnosed diabetes, undiagnosed diabetes, and impaired fasting glucose were associated with greater age, BMI, waist-to-hip ratio, systolic blood pressure, total cholesterol, and serum creatinine levels. The majority of individuals with diagnosed diabetes had received dietary or other behavioral advice, and 82% were taking oral hypoglycemic therapy. Blood pressure-lowering therapy was provided to 67% of diagnosed diabetic patients with concomitant hypertension.
Diabetes is common in Thailand, but one-half of all cases are undiagnosed. Because diagnosed diabetes is likely to be treated with proven, low-cost, preventive therapies such as glucose lowering and blood pressure lowering, initiatives that increased diagnosis rates would be expected to produce substantial health benefits in Thailand.
The goal of this study was to estimate the prevalence of diabetes and the number of people of all ages with diabetes for years 2000 and 2030.
Data on diabetes prevalence by age and sex from a limited number of countries were extrapolated to all 191 World Health Organization member states and applied to United Nations' population estimates for 2000 and 2030. Urban and rural populations were considered separately for developing countries.
The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people >65 years of age.
These findings indicate that the "diabetes epidemic" will continue even if levels of obesity remain constant. Given the increasing prevalence of obesity, it is likely that these figures provide an underestimate of future diabetes prevalence.
During Ramadan, the ninth month of the Islamic lunar calendar, adult Muslims are required to refrain from taking any food, beverages, or oral drugs, as well as from sexual intercourse, between dawn and sunset. Ramadan can occur in any of the four seasons, and the hours spent fasting vary accordingly from 11 hours to 18 hours a day. Rhythms of life and habits during this fasting period differ from one country to another. In Morocco, two to three meals daily are eaten within a short overnight span during this month. The first meal might be taken immediately after sunset (Iftar) and the second one around three hours later (dinner); the last meal might be taken shortly before dawn (Sohour). Intake of drug doses is therefore not easy, and its adjustment to the life rhythm of Ramadan is often not rational.
Aslam et al surveyed 81 patients to determine the alterations they made to their drug regimens during the fasting period of Ramadan.1 They found that 42% of the patients adhered to their usual treatment, and 58% changed their intake pattern. Among the second group, 35 patients stopped their treatments, eight changed the administration schedule, and four took all the daily doses in one intake. Another survey of 325 outpatients in a Kuwaiti hospital found that most of them changed their drug regimens during Ramadan.2 Sixty four per cent of the patients changed their therapeutic scheme during the month; 18% took their daily medicines in a single intake, either before the first meal (sunset) or straight after the last one (before dawn). The authors warned about the high risk of drug interactions in such cases. In fact, a 57 year old woman with heart failure experienced side effects of digitalis after being treated with both a thiazide diuretic and …
Difference in explanatory models (EMs) between the person and the healthcare professional has been suggested as one reason for non-adherence to a recommended treatment regimen. The aim of this study was to explore the EMs of diabetes by a group of Asian and Caucasian participants. A total of 25 Asians and 24 Caucasians were recruited from a local diabetic clinic and subsequently interviewed about their personal EMs of diabetes. Responses to the tape-recorded semistructured interview questions about the perceived cause, time and mode of symptom onset, pathophysiology, course of illness and treatment were analysed and categories of response established and compared across the two groups. Although the results indicated some similarities of EMs of diabetes between the groups, certain differences were identified. It is suggested that nurses who include EMs in their care planning are more likely to enhance adherence among people with diabetes.
Experimental fasting has been shown to alter the sleep-wakefulness pattern in various species. As fasting during Ramadan is distinct from experimental fasting, the physiological and behavioural changes occurring during Ramadan fasting may differ from those occurring during experimental fasting. There has been increased interest in recent years in sleep changes and daytime sleepiness during Ramadan. Moreover, many of those who fast during Ramadan associate this fasting with increased daytime sleepiness and decreased performance. This raises the question of whether Ramadan fasting affects sleep. In this review, we discuss the findings of research conducted to assess changes in sleep pattern, chronobiology, circadian rhythms, daytime sleepiness and function and sleep architecture during the month of Ramadan. Where applicable, these findings are compared with those obtained during experimental fasting.
This book, the first of its kind, reviews and discusses the full range of research on religion and a variety of mental and physical health outcomes. Based on this research, the authors build theoretical models illustrating the various behavioural, psychological, and physiological pathways by which religion might affect health. They also review research that has explored the impact of religious affiliation, belief, and practice one use of health services and compliance with medical treatment. Finally, they discuss the implications of these findings, examine a number of possible clinical applications, and make recommendations for future research in this area
The purpose of this study is to highlight culturally unique experiences and responses to type 2 diabetes among Chinese immigrant families. Patient and spouse narratives from 16 different families were elicited in a series of group interviews on this topic. Using interpretive phenomenology, 5 primary cultural considerations in diabetes management emerged from the narratives: (1) conceptualization of diabetes, illness and health, (2) significance and meaning of food, (3) perceptions of Chinese and Western medicines, (4) exercise and physical activity, and (5) effects of the disease on family dynamics. The relation of these cultural considerations to an interdependent view of the self, collectivistic social orientation, Chinese cultural beliefs and norms, and acculturation processes are discussed. Clinical recommendations for culturally appropriate disease management strategies are outlined.
The authors examined the ways in which 40 women with chronic illnesses (rheumatoid arthritis, osteoporosis, multiple sclerosis, systemic lupus erythematosus, or a combination of these disorders) used religious beliefs as a means of coping with their illnesses. The Ss, all between the ages of 28 and 79 yrs, were interviewed about the role religious beliefs played in their experiences and the ways in which they made meaning in their lives or coped with their illnesses. The majority of the women reported that religious beliefs were important in living with a chronic illness. In addition, more women who were identified as coping well with their illness reported strong religious beliefs, whereas the majority of women identified as poor copers reported that religion was unimportant or that they had no religious beliefs. Implications of these findings for counselors are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
lundberg pc & thrakul s (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 52–60 Diabetes type 2 self-management among Thai Muslim women
Aim. To explore and describe Thai Muslim women’s self-management of diabetes type 2.
Background. The importance of diabetes self-management is well recognised. However, research on diabetes self-management in Thailand is limited, and no such research related to Muslim patients with diabetes type 2 has been found.
Methods. An explorative qualitative study using ethnography was conducted. The ethnographic method was based on qualitative interview and participant observation carried out in 2008. Orem’s self-care deficit nursing theory provided the theoretical framework. Purposive convenience sampling was used, and twenty-nine women aged 40–80 years participated.
Results. Four themes of self-management among Thai Muslim women with diabetes type 2 emerged, viz., daily life practices (dietary management, exercise, use of medicine, see doctor to follow-up, self-monitoring of blood sugar and use of herbal remedies), impact of the illness (feeling psychological burden of diabetes and struggling to control the disease), everyday life as before (maintaining religious practices and learning to live with the disease) and family support.
Conclusion. The Thai Muslim women suffered from a partial self-care deficit. The results underline the importance of taking religious traditions into account in the care, offering health education that helps patients cope with their disease, involving family members who can reinforce information given to patients, and increasing self-management power and capability of patients.
Relevance to clinical practice. When caring for Thai Muslim women with diabetes type 2, health care professionals should stimulate their patients to adopt a powerful strategy for modifying their daily life behaviour, and they should be aware of the existence of certain problematic behaviour of their patients. It is also important that they understand the roles of cultural background, religious tradition and family as parts of the basis for educational strategies aimed at helping patients successfully integrate disease management into their lives.
Forced externalization of control in people with diabetes: a qualitative exploratory study
Aim. The purpose of this study was to explore and describe the patients’ perceptions of the Diabetic Disease State and its complications using an ethnographic method.
Background. Diabetes mellitus is an extensively researched and studied disease, however, relatively little attention has been given to the lived experience of chronic illness.
Methods. A purposive sample of 18 people with diabetes was derived from a diabetes register database. Data were collected by semistructured interviews, which were tape-recorded and transcribed. The transcripts were analysed together with the researchers’ observational notes, using open coding procedures to identify main categories. Discussion of the results is made in the theoretical context of the locus of control (LOC) framework.
Findings. Three main categories emerged from the data: information-knowledge of illness; the psychological burden of diabetes; rationalizing. A further subcategory, reality avoidance, was identified. The findings showed that these people with diabetes experience and describe complex psychological effects and coping mechanisms in having a chronic illness.
Conclusions. 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.
This paper is a report of a study of how Thai Buddhist people with type 2 diabetes practice self-management.
The importance of diabetes self-management is recognized in the literature. However, research on self-care management in Thailand, in particular concerning Buddhist people with type 2 diabetes, is scarce.
A descriptive qualitative study was conducted. Purposive convenience sampling was used, and thirty men and women with diabetes, aged 28-79 years, participated. Data were collected from June to August 2009 and analysed by use of manifest and latent content analysis.
Five themes of self-management among Thai Buddhist people with type 2 diabetes were identified: cultural influence on disease control, Buddhism and Thai culture, struggle for disease control, family support and economy a high priority.
Even though the Buddhist people with diabetes had certain self-management capabilities, many had poor control of their blood sugar levels and needed assistance. Reference to Buddhist moderation can be an effective means of helping the people with diabetes better manage their disease and change their lifestyles. In addition to cultural and religious traditions, family, economy and social environment should be taken into account both in the care and in interventions aimed at helping people with diabetes cope and empowering them to control their disease.
The aim of this study was to explore how Thai nurses in intensive care units of a university hospital in Bangkok provided spiritual care to their patients.
The function of nursing is to promote health, prevent illness, restore health and alleviate suffering. An holistic approach to this promotion includes spirituality.
An explorative qualitative study was used.
Thirty Thai nurses, selected through purposive sampling with the snowball technique, participated voluntarily. Semi-structured interviews with open-ended questions were carried out, taped-recorded, transcribed verbatim and subjected to content analysis.
Five themes related to the provision of spiritual care emerged: giving mental support, facilitating religious rituals and cultural beliefs, communicating with patients and patients' families, assessing the spiritual needs of patients and showing respect and facilitating family participation in care. Several ways of improving the spiritual care were suggested by the nurses.
Spirituality was an important part of the care for the nurses when meeting the needs of their patients and the patients' families. Therefore, nursing education should enhance nurses' understanding and awareness of spiritual issues and prepare them to respond to human spiritual needs.
Nurses should consider spirituality as an important component of holistic care. During their professional career, they should expand their knowledge and understanding of spirituality and develop tools for assessment of spiritual needs.
The present study examined the factors related to self-care behaviour in type 2 diabetic patients aged > or =65 years. In addition, this study tested the effect of the important explanatory factors on self-care behaviour.
Along with the development of an ageing society, diabetes occurs frequently among older people. Diabetes requires continual medical treatment, with patients responsible for self-care. Although the relationships among social support, depression and self-care have been widely studied, little is know about older diabetic patients, especially in Taiwan.
A correlational design was adopted. In total, 165 patients recruited using convenience sampling were diabetic outpatients at three hospitals in southern Taiwan from January-March 2005.
The participants were interviewed using the Personal Resource Questionnaire 2000 (PRQ 2000), Diabetes Self-Care Scale and Taiwan Geriatric Depression Scale (TGDS). Data were analysed using descriptive statistics and multiple regression analysis.
Self-care behaviour scores were significantly influenced by different gender, education level, economic status and religious beliefs of older diabetic patients. Depression and self-care behaviour were negatively correlated. Social support, education and duration of diabetes significantly affected self-care behaviour, accounting for 35.6% of total variance. CONCLUSIONS. Social support plays a vital factor in contributing to the facilitation of self-care behaviour. These analytical findings demonstrate the importance of social support, education and duration of diabetes in determining self-care behaviour for diabetic older diabetic patients and serve as references for future studies of self-care behaviour in type 2 older diabetic patients.
Implication for nurses highlights the significance of providing patients with social support that will enable them to have good support systems during their disease treatment to enhance self-care abilities and improve quality of life.
Buddhist Ethics: A Very Short Introduction illustrates how Buddhism might approach a range of fascinating dilemmas confronting the modern world, ethical moral issues ranging from abortion and suicide to cloning. The latter half of the twentieth century witnessed a growing interest in Buddhism, and it continues to capture the imagination of many in the West who see it as either an alternative or a supplement to their own religious beliefs. Why is it that ethics has not received as much attention in traditional Buddhist thought as it has in the West? Why are there so few publications on the subject?
Throughout the history of humanity it has been said that the individual ego, is a very limited form of identity. Spirituality is shaped by larger social circumstances and by the beliefs and values present in the wider culture. In Asia, as compared to other regions, people fall back on spiritualism. Mental health professionals, laymen and patients have great interest in spirituality and religious activities but still it is one of the most neglected fields of life. Spirituality and religion often are used interchangeably and it has also been described as an individual search for meaning. In psychiatry, religion and spirituality play a vital role in an individual's personal and social life. They are part of a very powerful medium to help in the healing process. Spiritual people know the meaning and goal of their life, have strong belief and firm faith in God or themselves, they can easily cope with stress and have the ability to adjust in every situation. They have satisfaction and contentment. They are less anxious and depressed and if they feel so, they try to overcome it through religious activities or rituals. Patients who depend heavily on their religious faith are significantly less depressed than those who don't. Spiritual practices foster an awareness that serves to identify and promote values such as creativity, patience, perseverance, honesty, kindness, compassion, wisdom, equanimity, hope and joy, all of which support good healthcare practice. Spirituality and religion form a bridge of contact between human, a composite of body and soul, and the Creator. Realizing this need, mental health professionals working in this field need to understand the spiritual values of patients and incorporate them in assessment and treatment.
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The effects of fasting on the drug regimens of 81 Asian Moslem patients during the religious month of Ramadan have been examined.
Twenty-two male and 15 female patients were found to change their drug dosage pattern while fasting: 35 missed doses; 8 took their tablets at different times and 4 patients took all their medication as one single daily dose after breaking fast in the evening.
The consequences of these changes are discussed and ways in which the problems which arise may be overcome are examined.
The literature on self-management in diabetes consists predominantly of investigations on compliance, behavioral modification techniques, assessment of health beliefs, and cognitive theories. Little systematic research has explored the actual experience of applying and adapting to a diabetes regimen. This qualitative study reports a diabetes self-management model (DSMM) based on interview data from 18 adults with Type I diabetes. As described and confirmed by the study participants, the DSMM is composed of sequential phases and stages that evolve over time and is influenced by four major factors: personal considerations, monitoring activities, specific cognitive skills for diabetes problem solving, and definition of control. This study provides a model that affirms the experience and effort of learning self-management and recognizes the importance of individualized regimens developed from personal experiences and perceptions of what "works for me."
To determine levels of depression and anxiety symptoms among adults with diabetes and identify factors associated with increased risk.
This study administered self-report symptom inventories to patients at the beginning (n = 634) and end (n = 578) of an outpatient diabetes education program. Subjects (n = 246) contacted by mail 6 months later completed the same instruments.
Rates of disturbance for depression (41.3%; 95% CI: 37.4-45.2%) and anxiety (49.2%; 95% CI: 45.3-53.1%) were higher than those typical in the general population (10-20%). Probability of disturbance ranged from 5-7% for those with the lowest risk profile to 82-92% for those with the highest risk profile. Diabetes-related complications were the only disease factor associated with significantly increased risk of disturbance. Women and those with less education were at much higher risk. Only 13% of those followed for 6 months were disturbed at all three time-points.
Diabetes is associated with increased risk of psychological disturbance, especially for those with more diabetes-related complications. Sociodemographic factors account for much of the risk differential among people with diabetes.
Muslim immigrant families living in the United States may well come to be attentiaon of mental health professionals. This article examines the applicability of the Anglo-American models of family therapy to Muslim immigrant families. The most significant difference in value systems between the Muslim and Anglo-American cultures is Muslim families' preference for greater connectedness, a less flexible and more hierarchial family structure, and an implicit communication style.
Systemic thinking, which deals with the pattern of relationships, is valid for all families regardless of cultural difference. However, the preferred directions of change for Muslim families need to be integrated into the assessment and goals for family therapy.
As the number of Arabs living in the United States increases, so does the number of children of Arab descent seeking medical attention. However, despite the sizable and ever increasing number of American Arabs, their health beliefs and practices remain relatively unexplored. When cultural differences exist with regard to beliefs about health and illness, health practices, and health-seeking behavior, the process of health-related interaction becomes difficult and often detrimental to health outcomes. Among Arab immigrants, their children tend to be the least visible population. This article describes the beliefs and practices, both cultural and health-related, of Arab families, with an emphasis on child care and rearing. Nursing considerations, which take these cultural factors into account, are discussed that will accommodate the needs of Arab children receiving professional Western medical treatment.
The purpose of this study was to discover and describe the meanings and expressions of cultural care of a group of Thai immigrants in Sweden. Participants included 15 key informants and 24 general informants living in and around the town of Uppsala. The conceptual framework was provided by Leininger's theory of cultural care diversity and universality. Use was made of the ethnonursing method and the Sunrise Model in the search for multiple and related dimensions that influenced the generic and professional care practices of the Thai immigrants. Four major themes were formulated. Thus, care (a) means family and kinship relationships as expressed in daily life, (b) is expressed in traditional gender roles, (c) means religious beliefs as expressed in the Buddhist worship, and (d) means support of traditional health care practices. These themes support the cultural care theory and also confirm the Sunrise Model.
The purpose of this paper is to provide an overview of self-management approaches for people with chronic conditions. The literature reviewed was assessed in terms of the nature of the self-management approach and the effectiveness. Findings are discussed under the headings of: chronic conditions targeted, country where intervention was based, type of approach (e.g. format, content, tutor, setting), outcomes and effectiveness. The last of these focused on reports of randomised controlled studies.
To evaluate the effectiveness of the Shanghai Chronic Disease Self-Management Program (CDSMP).
A randomized controlled trial with six-month follow-up compared patients who received treatment with those who did not receive treatment (waiting-list controls) in five urban communities in Shanghai, China. Participants in the treatment group received education from a lay-led CDSMP course and one copy of a help book immediately; those in the control group received the same education and book six months later.
In total, 954 volunteer patients with a medical record that confirmed a diagnosis of hypertension, heart disease, chronic lung disease, arthritis, stroke, or diabetes who lived in communities were assigned randomly to treatment (n = 526) and control (n = 428) groups. Overall, 430 (81.7%) and 349 (81.5%) patients in the treatment and control groups completed the six-month study. Patients who received treatment had significant improvements in weekly minutes of aerobic exercise, practice of cognitive symptom management, self-efficacy to manage own symptoms, and self-efficacy to manage own disease in general compared with controls. They also had significant improvements in eight indices of health status and, on average, fewer hospitalizations.
When implemented in Shanghai, the CDSMP was acceptable culturally to Chinese patients. The programme improved participants' health behaviour, self-efficacy, and health status and reduced the number of hospitalizations six months after the course. The locally based delivery model was integrated into the routine of community government organizations and community health services. Chinese lay leaders taught the CDSMP courses as successfully as professionals.
This research attempted to explore the current experience and attitude towards control of diabetes among Kashmiri men with diabetes in Leeds. The data was collected by the author by conducting interviews among a total of 106 men.
The results of this survey indicate that a large number of men with diabetes were failing to control and manage their condition. The overall attitude was to enjoy life and “leave the rest to Allah.” Data indicated the large influence of cultural values dominating the behaviour of the sample population. The data showed that although a large majority of the men had been told by health professionals that they were overweight, a majority of them did not believe themselves to be so. This belief seems to have been influenced by cultural norms in which the overweight figures tend to project prosperity and well-being in the community. Similarly, first cousin marriages are common in this community. Such cultural practices may lay foundations for future hereditary complications.
The study concluded that there is a need to change attitudes towards food and exercise, and controlling sugar level and blood pressure to avoid diabetic complications. For this, both the men as well as the women must be targeted separately in the form of open days, meetings and discussions to promote healthy food consumption, physical activity and healthy living.
The purpose of this study was to review the existing empirical evidence about factors that contribute to effective diabetes self-management as indicated by healthy outcomes in persons with the disease, with a specific focus on self-efficacy, to determine the link between learned self-efficacy and effective diabetes self-management in adults.
A systematic review was conducted of the extant literature from 1985-2001 that described factors related to effective self-management of diabetes. The review included theoretical and empirical articles. The search engines included CINAHL, MEDLINE, PUBMED, and COCHRANE.
Empirical evidence supports the following factors to improve the education outcomes for adults with diabetes: involve people with diabetes in their own care, guide them in actively learning about the disease, explore their feelings about having the disease, and teach them the skills necessary to adjust their behavior to control their own health outcomes. Thus, the goal for educating people with diabetes is to improve their individual self-efficacy and, accordingly, their self-management ability.
Education sessions need to involve fewer lectures and more practical, interactive exercises that focus on developing specific skills. Follow-up contact is a valuable method for helping people make a healthy adjustment to living with diabetes.
Hispanics are twice as likely as non-Hispanic Whites to have diabetes and are also at higher risk for diabetes-related complications and poorer outcomes. The prevalence of diabetes is inversely related to educational status. Low literacy is common, especially among older Hispanics. Little literature exists on formative research to create diabetes education materials for this audience. Two focus groups assessed views and preferences for diabetes education of low-literate, low-income, non-English-speaking urban Caribbean and Central American Hispanics with diabetes, as well as utility of materials developed specifically for this population, as part of the preliminary work for a pilot study of a diabetes intervention. Implications for practitioners and researchers are discussed.
A significant and accelerating worldwide increase in the incidence of diabetes, coupled with growing population mobility, will lead to an urgent need for all nurses to develop a greater understanding of the role of different cultural and religious beliefs in diabetes control and care. In this article, the author presents a brief overview of the five major religions practised in the UK and the associated beliefs, customs and lifestyle factors that may affect the person with diabetes and his/her compliance with current advice and education with the aim of promoting culturally competent health care.
Type 2 diabetes is becoming more prevalent in Taiwan. Growing evidence suggests a patient-centred approach is more effective in facilitating self-management than a professional-centred one. The aim of this qualitative study was to investigate Chinese diabetic patients' perceptions about their illness and treatment strategies to facilitate patient-centred, culture-sensitive clinical skills.
We used in-depth interviews to collect perspectives from 22 participants recruited from a rural Taiwan community. All interviews were audio-taped and the transcripts were analysed by editing and immersion/crystallization. Emerging themes were compared with current medical knowledge to determine their clinical significance.
Generally, Chinese diabetic patients had variable perceptions about different treatment strategies. All agreed that dietary restriction and exercise were beneficial. The former, mainly understood as reducing carbohydrate intake, was thought to be most important; exercise, to the point of sweating, was seen as a way to eliminate pharmaceutical toxins. Taking medicine was regarded with ambivalent attitudes due to concerns about adverse effects (especially renal injury).
Patients regarded all treatment strategies as integrative and intertwined in daily life. There are three misconceptions which we found should be clarified during medical consultations: (i) focusing on sugar-control only; (ii) benefit of sweating to eliminate toxins; (iii) fear of renal toxicity of hypoglycaemic agents. The renaming of diabetes, to such as 'metabolic syndrome', may bring new, acceptable insight to Chinese diabetic patients.
This paper reports the perceived barriers to and effective strategies for self-management of adults with type 2 diabetes in a rural setting.
Worldwide, diabetes is a major public health concern and financial burden. Research shows that, for people with diabetes, adhering to programs of self-care is often problematic. Despite the potential for improved metabolic control and quality of life, little is published on the barriers and effective strategies that people with diabetes successfully use to incorporate plans of care into their lifestyles.
Twenty-four adults diagnosed with type 2 diabetes were recruited from a rural primary care practice to participate in one of three audiotaped focus groups. Content analysis was conducted on the focus group transcripts and validity was strengthened through independent rankings of barriers and strategies by an expert panel and by the nurse researchers. The data were collected 2002.
The most frequently reported barriers were lack of knowledge of a specific diet plan, lack of understanding of the plan of care and helplessness and frustration from lack of glycaemic control and continued disease progression despite adherence. Effective strategies identified were developing a collaborative relationship with a provider, maintaining a positive attitude that prompts proactive learning and having a support person who provides encouragement and promotes accountability.
These data highlight the importance of barrier and strategy identification in developing and implementing realistic self-management plans and the significance of collaborative alliances between patients and practitioners. Awareness of barriers, identification of strategies to overcome obstacles and the opportunity to problem solve with practitioners assists patients in managing a chronic illness that requires numerous daily decisions.
Diabetes is managed via a regimen of control. Physicians advise adults living with type 2 diabetes to control blood sugar levels by controlling diet, maintaining regular exercise, and complying with medication. The extent to which individuals are able to adhere to such recommendations varies. In this article, we explore lay perceptions of diabetes and its control, drawing on data from an ethnographic study conducted in Bangkok, Thailand. Between August 2001 and February 2003 the first author spent time with twelve man and women living with type 2 diabetes, their spouses, children and health providers. An additional 21 people were interviewed to extend the data and test for generalisibility. It was found that individual explanations of control, and adherence or resistance to medical advice, are interpreted and adapted in ways consistent with Buddhist philosophy and Thai norms that govern everyday life. Notions of moderation and cultural values of being and behaving, and ideals of interaction, provide a philosophical basis and practical guidelines for control.
During the month of Ramadan, Muslims fast every day from dawn to sunset. In the healthy subject, this fasting does not have any harmful consequences on health. However, it can induce several complications for patients with diabetes. The aim of this review twofold: first, it seeks to give some clues about methodological aspect of research during Ramadan and to show the impact of various diabetes monitoring and treatment, including biochemical and clinical parameters, diet and caloric intake, drug intake when fasting. Second, it intends to determine whether or not Ramadan fasting induces complications in patients with types 1 and 2 diabetes and ultimately to elaborate some advice as to the management of fasting patients. Several studies have shown that Ramadan fasting did not alter biochemical parameters in patients with type 2 diabetes. However, other studies have shown that there is either an increase or a decrease in biochemical parameters during Ramadan. Ramadan fasting would be acceptable for patients with well-balanced type 2 diabetes who are conscious of their disease and compliant with their diet and drug intake. If patients with type 1 diabetes wish to fast, it is necessary to advise them to undertake control of their glycaemia several times a day. Patients with type 1 diabetes who will fast during Ramadan may be better managed with fast absorption insulin.