Impact of the Home and Community Environment on Diabetes

Management Presenter-Hayley Kermond Supervisor-Dr Kieran Broome

(http://www.adelaidebariatriccentre.com.au/diabetes-in-australia)

Literature Review

Strong evidence for;

• Physical activity

• Healthy diet

• Stress reduction

• Medications

Difficult to make necessary lifestyle

changes (Booth et al., 2013;Snowling & Hopkins, 2006; Surwit et al., 2002)

Role of Occupational Therapists

Aim of Study

1. Determine how the home and

community environment can act as a

facilitator or barrier to diabetes self-

management.

2. Develop preliminary diabetes-friendly

guidelines from the collected and

analysed data.

Research Design

• Mixed methods design

• 2 part study

• First part Nominal Group Technique (NGT)

• Second part Experienced Sampling Methods

(ESM)

Nominal Group Technique

• Input from all participants

• Diverse opinions

• Several ideas for set topic

• Identifies priorities (Allen, Dyas & Jones, 2004)

Data Sample- NGTWhat in the home helps you to manage your diabetes well? PointsSupport from spouse (family) 9Food/diet changes (for healthy eating) 7Exercising (walking, gardening) 7Remembering to take medications 4Information provided (on food and exercise) 2Pets for company 1What in the home makes it difficult to manage your diabetes?Stress 13Food choices 7Sickness/Illness 6Poor Communication 2Lack of family member support 2

Experience Sampling Methods

• Gains immediate lived experience

• Gains perspective over time

• Reduces need for recall

• Convenient(Barrett & Barrett, 2001)

Data Sample-ESMDay No. Participant 1 Participant 2 Participant 3

1 Had a late lunch, feeling ok though, not stressed.

I have the flu. Everything is difficult!

Having a day out with my spouse makes it hard for food but less stressed

2 Being at shopping centre with all of the cakes and cookies. Hard.

Still flu. No exercise for a few days.

Went to the gym today and healthy eating planned today from a morning of shopping.

SampleInclusion Criteria

Aged 18 and over

Diagnosed with type 1 or type 2 diabetes mellitus

Cognitive capacity to understand requirements of participation in research and provide informed consent.

Sufficient understanding of the English language to understand the requirements of participation in research and provide informed consent.

Owns a mobile phone and lives in area with reliable phone reception (ESM study)

Recruitment• Diabetes support groups

• Community health centres

• Diabetes Queensland

• Medical centres

• Retirement villages

• University of the third age

• Libraries

• Social media

Results- NGTHome Community

Priority Category Points Category Points

1 Family 31 Information 34

2 Control 14 Friends & Others 29

3 Routine 11 Community Understanding 24

4 Walking & Gardening

11 Doctors & Health Professionals

22

5 Friends & Others 8 Food Labelling 11

6 Portion Control 8 Temptations 8

7 Diet Change 7 Footpaths 6

8 Attitude 7 Modern Urban Lifestyle 6

9 Limited Choice 7 Choice 5

10 Having to cook 6 Family 5

Preliminary Results-ESMCommunity Home

Priority Category Count Category Count

1 Routine 44 Routine 44

2 Busy/Time Management

17 Busy/Time Management

17

3 Eating Out 15 Illness or Injury 16

4 Friends 12 Attitude 13

5 Access to Exercise Facilities

11 Family 11

6 Doctors & Health Professionals

10 Blood Glucose Levels 8

7 Travel 9 Sleep 7

8 Work 9 Medications 7

9 Walking 9 Temptations 6

10 Weather 8 Relaxing 5

“Routine always makes managing lifestyle easier.”

“I was busy doing tasks so I forgot to do my exercises and walk.”

“I manage exercise well now that routine is being re-established.”

“The routine of the work day makes managing programs, whether they be diets, exercise or medication programs, easier.”

Preliminary Guidelines

1. Establish routine

2. Strategies for routine changes

3. Education for social networks

4. Education on time management

Discussion

• Guidelines to improve diabetes self-

management.

• Evidence base to implement necessary

environmental changes.

• Evidence base for future research.

Limitations

• Small sample size

• Exclusion of people who don’t

have/use mobile phones

• Voluntary sample

Aims Achieved

Were the aims of the study achieved?

• Barriers and facilitators to diabetes self-

management in the home and

community environment were

identified.

• Preliminary diabetes-friendly guidelines

were developed.

Conclusion

Shift from reactive to proactive role

ReferencesAllen, J., Dyas, J., & Jones, M. (2004). Building consensus in health care: a guide to using the

nominal group technique. British Journal of Community Nursing, 9(3), 110-114. Retrieved from CINAHL

Booth, A.O., Lowis, C., Dean, M., Hunter, S.J., & McKinley, M.C. (2013). Diet and physical activity in the self-management of type 2 diabetes: barriers and facilitators identified by patients and health professionals. Primary Health Care Research & Development, 14, 293-306.

Dunstan, D. W., Zimmet, P. Z., Welborn, T. A., Courten, P. D., Cameron, A. J., Sicree, R. A., Dwyer, T., Colagiuri, S., Jolley, D., Atkins, R., & Shaw, J. E. (2002). The rising prevalence of diabetes and impaired glucose control: The Australian diabetes, obesity and lifestyle study. Diabetes Care, 25(5), 829-834. Retrieved from ProQuest

Herman, W.H. (2013). The economic costs of diabetes: is it time for a new treatment paradigm? Diabetes Care, 36(4), 775-6.

Jones, L., Crabb, S., Turnbull, D., & Oxlad, M. (2013). Barriers and facilitators to effective type two diabetes management in a rural context: a qualitative study with diabetes patients and health professionals. Journal of Health Psychology, in press.

Kuntsche, E., & Labhart, F. (2013). Using personal cell phones for ecological momentary assessment. European Psychologist, 18(1), 3-11.

ReferencesLee, C.M.Y., Colagiuri, R., Magliano, D.J., Cameron, A.J., Shar, J., Zimmet, P., & Colagiuri, S. (2013). The

cost of diabetes in adults in Australia. Diabetes Research & Clinical Practice, 99(3), 385-90.

Novo Nordisk. (2012). Diabetes: the silent pandemic and its impact on Australia. Retrieved from https://www.diabetesaustralia.com.au

Rendle, K.A.S., May, S.G., Uy, V., Tietbohl, C.K., Mangione, C.M., & Frosch, D.L. (2013). Persistent barriers and strategic practices: why (asking about) the everyday matters in diabetes care. The Diabetes Educator, 39(4), 560-7.

Snowling, N. J., & Hopkins, W. G. (2006). Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients. Diabetes Care, 29(11), 2518-2527. doi: 10.2337/dc06-1317

Surwit, R. S., Tilburg, M. A. L. V., Zucker, N., Parekh, P., Feinglos, M. N., Edwards, C. L., Lane, J. D. (2002). Stress management improves long-term glycemic control in type 2 diabetes. Diabetes Care, 25(1), 30-34. doi: 10.2337/diacare.25.1.30

World Health Organization (2007). Global Age-friendly Cities: A Guide. World Health Organization: Geneva.

Worrall, L., Rose, T., Howe, T., McKenna, K., & Hickson, L. (2007). Developing an evidence-base for accessibility for people with aphasia. Aphasiology, 21(1), 124-36.