Article

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

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

ABSTRACT

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

Download full-text

Full-text

Available from: Felicia Hill-Briggs, May 11, 2014
  • Source
    • "Recommendation 26: Therapy should be individualized, and is recommended in children/adolescents for improvement in behaviors and adherence and in adults for dietary behavior[93] (Grade A; EL 1). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Although several evidence-based guidelines for managing diabetes are available, few, if any, focus on the psychosocial aspects of this challenging condition. It is increasingly evident that psychosocial treatment is integral to a holistic approach of managing diabetes; it forms the key to realizing appropriate biomedical outcomes. Dearth of attention is as much due to lack of awareness as due to lack of guidelines. This lacuna results in diversity among the standards of clinical practice, which, in India, is also due to the size and complexity of psychosocial care itself. This article aims to highlight evidence- and experience-based Indian guidelines for the psychosocial management of diabetes. A systemic literature was conducted for peer-reviewed studies and publications covering psychosocial aspects in diabetes. Recommendations are classified into three domains: General, psychological and social, and graded by the weight they should have in clinical practice and by the degree of support from the literature. Ninety-four recommendations of varying strength are made to help professionals identify the psychosocial interventions needed to support patients and their families and explore their role in devising support strategies. They also aid in developing core skills needed for effective diabetes management. These recommendations provide practical guidelines to fulfill unmet needs in diabetes management, and help achieve a qualitative improvement in the way physicians manage patients. The guidelines, while maintaining an India-specific character, have global relevance, which is bound to grow as the diabetes pandemic throws up new challenges.
    Full-text · Article · May 2013
    • "Of psychosocial interventions in T1DM, coping skills programmes have generated a lot of interest (Hampson et al., 2000; Murphy et al., 2006). Specific coping skills such as problem solving have demonstrated efficacy in improving self-management in T1DM and to a lesser extent glycaemic control (Cook et al., 2002; Hill-Briggs and Gemmell, 2007 ). Several crosssectional studies have also found associations between coping skills and quality of life, adherence to the diabetes treatment regimen and other health outcomes such as glycaemic control in T1DM (Delamater et al., 1987; Graue et al., 2004; Hanson et al., 1989). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Few qualitative studies have examined the views of adolescents with type 1 diabetes mellitus (T1DM) regarding psychosocial programme development and content. We conducted focus groups with 13 adolescents with T1DM to explore stressors and gain feedback on adapting a generic coping skills programme. The following prevalent stressors were identified: parental/adolescent conflict, balancing self-management and daily life, and health concerns. Prevalent views on programme adaptation included enhancing social support and adding diabetes-specific information and skills. Based on these data, the programme was adapted to address stressors and support self-management, thus better meeting the needs of, and appeal to, adolescents with T1DM.
    No preview · Article · Aug 2011 · Journal of Health Psychology
  • Source
    • "As with any treatment or intervention, determination of the most suitable and valid measure of change is key. Given that previous research in this area has highlighted the lack of findings with regard to changes in HbA1c [7], developing reliable and valid measures of success for these interventions is vital. Finally, both these results and past research highlight the importance of peer support; therefore, continued focus in this area is needed. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Management of type 1 diabetes mellitus (T1DM) involves adherence to complex daily behaviors. Some adolescents have difficulty maintaining these regimens within social contexts due to peer pressure and apprehension about being singled out (Wysocki et al., 2003 [1]). Previous research suggests that negative social attributions have a role in adherence difficulties (Hains et al., 2006 [6]). This pilot study examined a cognitive-behavioral intervention geared towards challenging and restructuring negative thinking patterns. Ten adolescents with T1DM and HbA1c readings greater then 7.0% were recruited from a large, Midwestern Children's Hospital. The intervention consisted of a 1-h session followed by three weekly phone calls, which focused on cognitive restructuring and problem-solving training. Measures of diabetes-related stress and concerns surrounding self-care in social situations were completed by the adolescents pre- and post-intervention and at one-month follow-up. A series of repeated measure ANOVAS did not reveal significant differences between pre-intervention and follow-up scores across measures. While there were no significant differences between pre-intervention and follow-up scores, the results highlight some important trends. Specifically, preliminary results suggest that the trends in individual scores indicate that problem-solving may be helpful for improving adherence in social situations.
    Full-text · Article · Nov 2009
Show more