Role of social support in culturally sensitive diabetes self-management education among an ethnic minority population in Denmark.

AIMS: CUSTOM is a culturally sensitive diabetes self-management education and support programme tailored to Urdu, Turkish and Arabic-speaking people in Denmark. The aim of this study was twofold: first, to examine the functional social support perceived by CUSTOM participants before and after the intervention; and, second, to explore how participants' structural social support affected the physical and mental health benefits of the intervention. METHODS: The participants were people with type 2 diabetes whose primary language was Urdu, Arabic or Turkish (n = 73). Outcomes included A1C, body fat percentage, diabetes distress, well-being and functional social support. Changes were observed between baseline and six months after participation in a single-group pre-test/post-test design. The Cochran-Armitage trend test was used to assess pre-post differences in functional social support. The role of structural social support was assessed using moderation regression analysis. RESULTS: Participants reported higher availability of functional social support after the programme (p < 0.05), although the change in loneliness was not significant. In addition, cohabitating with adult children increased the average body fat percentage reduction achieved following the programme, while living with a partner lowered the average body fat percentage reduction achieved. The intervention was particularly successful in improving diabetes distress among those with weak structural social support. CONCLUSIONS: Culturally sensitive diabetes self-management education and support can improve social support among people with an ethnic minority background. The structure of social relations may influence the benefit of culturally sensitive diabetes self-management education and support. Future programmes should include family members and other social relations more actively, drawing attention to both positive and negative aspects of social relations.

Recommendations for ethnic equity in health: A Delphi study from Denmark.

AIMS: A key issue in public health is how to approach ethnic inequities. Despite an increased focus on the health of people from ethnic minorities in the last 15 years, significant ethnic health inequities still exist in Denmark. These arise during pregnancy and are exacerbated by higher rates of exposure to health risks during the life course. This study aimed to formulate recommendations on both structural and organisational levels to reduce ethnic health inequities. METHODS: Nine decision-makers - representing municipalities, regions, the private sector and voluntary organisations in Denmark - participated in the formulation of recommendations inspired by the Delphi method. The consensus process was conducted in three rounds during spring 2020, resulting in eight overall recommendations, including suggestions for action. RESULTS: The recommendations address both structural and organisational levels. They aim to strengthen: 1) health policies and strategies related to the needs of people from ethnic minorities, including health literacy, linguistic, cultural and social differences; 2) health-promoting local initiatives developed in co-creation with people from ethnic minorities; 3) health promotion and prevention from a life course perspective with a focus on early intervention; 4) cross-sectoral and interdisciplinary collaborations that facilitate transitions and coordination; 5) competencies of professionals in terms of cultural knowledge, awareness, reflexivity and skills; 6) access to healthcare services by increasing information and resources; 7) interpreting assistance for, and linguistic accessibility to, healthcare services; 8) documentation and intervention research. CONCLUSIONS: To reduce ethnic health inequities, it is crucial that Danish welfare institutions, including their strategies, approaches and skills of employees, are adapted to serve an increasingly heterogeneous population.

Improving Health and Diabetes Self-Management in Immigrants with Type 2 Diabetes Through a Co-Created Diabetes Self-Management Education and Support Intervention.

To examine the impact of a co-created culturally sensitive diabetes self-management education and support (DSMES) intervention on the physical and mental health of immigrants with type 2 diabetes (T2D). Pre- and post-test among people with T2D whose primary language was Urdu, Arabic or Turkish (n = 97). Participants were offered a six-week intervention based on a person-centred approach using research-based dialogue tools to facilitate learning and reflection, which was developed in co-creation with immigrants and healthcare professionals. Data were collected at baseline, post-intervention and after 6 months and analysed using paired t-tests, Wilcoxon signed-rank tests, chi-square tests and regression models when appropriate. Several clinical outcomes were improved post-intervention, including HbA1c (P < 0.001), body fat percentage (P = 0.002), self-rated general health (P = 0.05), well-being (P = 0.004) and several self-management behaviours, e.g., physical activity (P < 0.001). Most outcomes remained improved after 6 months, but the effect on HbA1c was no longer statistically significant. Some outcomes were improved only at 6 months, including waist circumference (P < 0.001) and diabetes-related emotional distress (P < 0.001). Fatigue did not change. Attendance at more programme sessions was associated with better outcomes. The DSMES intervention developed in a co-creation process was highly effective in improving the health of immigrants with T2D.

Acquisition, application, and distribution of health literacy from culturally sensitive type 2 diabetes education among Arabic-Speaking migrants in Denmark: A longitudinal qualitative analysis.

BACKGROUND: Effective self-management of type 2 diabetes requires adequate health literacy (HL) and a supportive network. Diabetes self-management education and support programmes play a crucial role in improving these factors. However, limited research exists on how such programmes can support health literacy among migrants and facilitate the dissemination of knowledge within their social networks. AIM: This study aimed to investigate the perspectives of Arabic-speaking informants with a migrant background in relation to how their type 2 diabetes-related health literacy was acquired, applied and distributed within social networks through participation in a culturally sensitive diabetes self-management education and support (DSMES) programme. METHODS: Semi-structured interviews were conducted with 12 informants during the programme and three to 7 months later, from September 2019 to May 2020. Abductive analysis was applied using HL and distributed health literacy (DHL) theory as frameworks. RESULTS: The analysis generated three themes: (1) sources of health information and the development of health literacy; (2) changes towards active self-management; and (3) distributed health literacy. Prior to programme participation, informants faced challenges in navigating conflicting information from family, friends and social media. After participating in the programme, they reported improvements in HL, particularly in knowledge acquisition. Many became more actively engaged in decision-making and exhibited improved health behaviours, such as dietary choices. Nonetheless, some informants continued to struggle with choosing appropriate prevention and treatment strategies. Notably, certain informants acted as HL mediators, sharing their newly acquired knowledge within their social networks in Denmark and abroad. CONCLUSION: Culturally sensitive diabetes self-management education programmes have the potential to enhance HL among migrants, leading to the distribution of relevant diabetes knowledge within their social networks. Future studies should explore how members of migrants' social networks perceive their supportive role in type 2 diabetes management. Programmes can benefit from emphasising critical HL and exploring how participant-informants effectively communicate diabetes-related knowledge within their networks to address misinformation and conflicting information.

Is time-restricted eating a robust eating regimen during periods of disruptions in daily life? A qualitative study of perspectives of people with overweight during COVID-19.

BACKGROUND: Time-restricted eating (TRE) has been suggested as a feasible dietary strategy in individuals with overweight. Disruptions in daily life e.g., severe illness can affect engagement in lifestyle interventions to obtain healthier body weight. This study examined if and how the engagement with TRE among people with overweight was affected by the Danish COVID-19 lockdowns as an example of disruptions in daily life. METHODS: Fifteen participants with overweight enrolled in a TRE intervention, i.e. restricting all eating and drinking except water to the same daily ten-hour window, were interviewed about their experiences and engagement with TRE during COVID-19 lockdowns. Interviews were semi-structured and conducted by phone or face-to-face with safe social distancing. Data analysis was grounded in a reflexive thematic analysis approach. RESULTS: Daily life rhythms were disrupted by lockdowns by preventing participants from performing ordinary daily activities such as going to work, socialising, eating out or exercising. For some, this challenged their TRE engagement, while most were able to undertake the TRE eating window but reported increased snacking and consumption of take-away food within their eating window. For all, exercise habits became unhealthier. The negative impact on TRE engagement primarily occurred during daytime, as social distancing made it easier to engage with TRE during evenings. CONCLUSIONS: This study showed that even people highly motivated to obtain healthier lifestyles practices struggled to maintain engagement with healthy behaviours, whereas sticking to the TRE window was manageable during COVID-19. TRE as a weight loss strategy was challenged which calls for more attention to supporting people in daily life to obtain healthier practices, also in case of periods of other disruptions such as divorce, serious illness etc.

What happens after a weight loss intervention? A qualitative study of drivers and challenges of maintaining time-restricted eating among people with overweight at high risk of type 2 diabetes.

Time-restricted eating (TRE)1 has been conceptualised as a strategy for achieving weight loss and improving metabolic health, but limited knowledge exists about how people can maintain TRE in daily life. This study examined how TRE was maintainable in daily life after a three-month intervention (the RESET study) in which participants were encouraged to consume all food and beverages except water within a 10-h daily window. Specifically, we examined TRE maintenance patterns across participants, including drivers and challenges for maintenance success. A qualitative longitudinal study was conducted, and twenty participants with overweight at high risk of type 2 diabetes were interviewed using a semi-structured interview guide at the end of the intervention and after a three-month follow-up period. Data were analysed longitudinally in two steps inspired by a pattern-oriented longitudinal analysis approach. Seven participants maintained a strict 10-h window, ten maintained an adjusted TRE regimen (e.g., taking days off), and three did not attempt maintenance. Maintenance drivers included consistent daily rhythms and regular meal patterns, subjective experiences (e.g., feeling healthier), making flexible adjustments to the TRE regimen, family support and avoiding feelings of guilt. Maintenance challenges included social evening events, inconsistent daily rhythms and eating patterns, preoccupation with losing weight, lack of family support and self-blame. TRE was manageable for most participants; however, personalised support for adjusting TRE to daily life is needed to ensure long-term maintenance. Future studies should explore the effectiveness of a personalised TRE concept to determine the usefulness of TRE in real-life settings.

Caught between good intentions and rigid structures: A qualitative description of professionals' experiences with health promotion in mental health services.

BACKGROUND AND AIM: Compared with the general population, people with mental illness are at higher risk of developing type 2 diabetes due to poor diet, medication and inactive lifestyle. People with mental illness and members of the general population are equally interested in health behaviour change, but those with mental illness experience communication barriers with professionals. The study aimed to explore philosophies that social care and healthcare professionals apply to health promotion activities targeting people with mental illness and challenges they face in applying these philosophies across multiple settings. METHODS: Qualitative interviews were conducted with 18 social and healthcare professionals in a range of settings in 2016-2019. Descriptive qualitative analysis was applied to interview data. RESULTS: Interviewees faced many structural challenges in the organisation of their work, which did not coincide with their philosophy or intentions in relation to health promotion. Three philosophical categories were identified: (a) health promotion approach, (b) elements of care and (c) social relations. Many interviewees intended to apply philosophies of broadly defined health, dialogue-based health education, and incremental approaches to health behaviour change. They wanted to provide holistic and flexible care and they valued peer-to-peer activities, family and friend involvement in care and a trusting relationship between the professional and the person with mental illness. However, rigid structures determining the organisation of health promotion challenged professionals' ability to follow their philosophical intentions. CONCLUSION: Interviewees aspired to a collaborative, empowering and person-centred approach, but practical and structural factors made this difficult to achieve in practice. Major changes are required at the organisational level, implemented with the active involvement of professionals and people with mental illness.

Watching, keeping and squeezing time to lose weight: Implications of time-restricted eating in daily life.

Time-restricted eating (TRE) is a novel intervention that allows eating and drinking within a certain time window and has shown positive effects on body weight in few studies. Weight loss strategies that easily can be integrated into daily life are needed, but knowledge about how TRE affects daily life is lacking. This study examined how individuals having overweight or obesity at high risk of type 2 diabetes performed TRE in daily life, with a focus on how the timing of eating changed the organisation and rhythms of daily activities. Semi-structured interviews were conducted with participants enrolled in a randomised controlled trial studying the effect of a 12-week TRE intervention focusing on a self-selected daily 10-h window between 6 AM and 8 PM. Seventeen participants from the intervention group were interviewed at baseline and end of intervention, and data were analysed using a thematic analysis approach. Participants found TRE simple and appealing due to the unrestricted dietary intake. In general, participants did not change their food preferences and continued to eat three main daily meals. However, participants had to increase their awareness of the time of day, reshuffle ordinary daily activities and plan their intake more carefully. Two participants reported fully adherence every day, whereas all other participants reported one to several episodes of intake outside their window during the 12 weeks. Social evening activities and collective rhythms were largest barriers. Our findings suggest that TRE interventions would benefit from a broader perspective on daily life and an expanded view on families and friends as joint units of intervention. TRE interventions should consider individuals' daily rhythms and help them develop practical solutions to integrating new eating practices.

Implementing a collaborative model in health education practice: a process evaluation of a health education programme targeting users with mental health problems.

BACKGROUND: Users with mental health problems (users) have a substantially higher risk of developing type 2 diabetes than the general population. Recent studies show that traditional lifestyle interventions focusing solely on exercise and diet among users have limited effect. Studies suggest collaborative models as a starting point for health behaviour change are more beneficial, but implementation in practice is a challenge. Using the Medical Research Council's guidance for process evaluation, we explored implementation of a collaborative model in health education activities targeting users. The collaborative model focused on involving users in agenda setting and reflection about readiness to change health behaviour and was supported by dialogue tools (e.g., quotes and games). Educators received 3 days of training in applying the model. METHODS: Collected data included questionnaires for users (n = 154) and professionals (n = 158), interviews with users (n = 14), and observations of health education activities (n = 37) and the professional development programme (n = 9). Data were analysed using descriptive statistics and systematic text condensation. RESULTS: Ninetysix percent (152) of professionals tested the model in practice and tried at least one tool. Users reported that the model supported them in expressing their thoughts about their health and focused on their needs rather than the agenda of the professional. Ninetythree percent (143) of users strongly agreed that professionals were open-minded and responsive. However, observations showed that some professionals overlooked cues from users about motivation for health behaviour change. Furthermore, professionals identified lack of involvement from their managers as a barrier to implementation. CONCLUSIONS: Implementation of a collaborative model was feasible in practice. Training of professionals in active listening and involvement of managers prior to implementation is crucial.

Group-based, person-centered diabetes self-management education: healthcare professionals' implementation of new approaches.

BACKGROUND: Healthcare professionals' person-centered communication skills are pivotal for delivering successful diabetes education. Many healthcare professionals favor person-centeredness as a concept, but implementation in practice remains challenging. Today, programs have often a fixed curriculum dominated by biomedical issues. Most person-centered methods are developed targeting individual consultations, although group-based programs are a widespread and efficient method of support. Person-centeredness in group-based programs requires a change in practice towards addressing biopsychosocial issues and facilitating group processes. The objective of this study was to explore how healthcare professionals implement new approaches to facilitate group-based, person-centered diabetes education targeting people with type 2 diabetes. METHODS: The study was guided by action research and divided into three studies: investigation, development, and pilot using a variety of qualitative methods. In the first study; observations across five settings were conducted. Forty-nine group participants and 13 professionals took part; the focus was to investigate approaches that supported or hindered person-centeredness in groups. Observations were supplemented by interviews (n = 12) and two focus groups (n = 16) with group participants, as well as interviews (n = 5) with professionals. In the second study; 14 professionals collaborated in two workshops to develop new approaches. In the third study, new approaches were pilot-tested using observations in three settings. Twenty-five group participants and five professionals took part. The analysis of the pilot test led to the final workshop where six professionals took part. RESULTS: Implementation was characterized by three categories. Some professionals chose not to implement the methods because they conflicted with their practice relying on the biomedical model. Other incorporated some approaches but was unable to structure the process, leaving participants uncertain about the aim. Finally, one setting succeeded with implementation, tailoring content and processes to group participants' needs. CONCLUSION: The use of action research created context-sensitive approaches and increased professionals' readiness to implement. More attention should be paid to systematic training of professionals. Training should be structured stepwise incorporating techniques directed towards existing skills including ample time to train and reiterate skills.

How to achieve a collaborative approach in health promotion: preferences and ideas of users of mental health services.

BACKGROUND: Collaborative approaches to consensus building or decision-making are beneficial in health-promoting activities targeting users of mental health services (users). However, little is known about how to achieve a collaborative approach in practice. AIM: The purpose of this study was to explore: (1) users' preferences and ideas related to achieving a collaborative approach in health-related communication and (2) perspectives of healthcare and social work professionals and family members on users' ideas and preferences. METHODS: Data were collected through interactive workshops with users (n = 15), professionals (n = 21) and users' family members (n = 12). Data were analysed using systematic text condensation. RESULTS: Users provided three recommendations for establishing a collaborative approach in communication about health: (1) involving users in deciding the agenda and setting for health-promoting activities; (2) exchanging knowledge between users and professionals about health and values; and (3) exploring users' motivation for change. Users and professionals had diverging perceptions of the value of establishing a collaborative approach. Professionals regarded relationship building and health promotion as separate phenomena, whereas users perceived relationship building as inherently health promoting. Family members of users requested specific guidance and support with regard to clarifying and fulfilling the best possible support role as a family member. CONCLUSIONS: The findings suggest that a collaborative approach in health promotion may be difficult to achieve without a focus on professional development for healthcare and social work professionals.

An ethnographic investigation of healthcare providers' approaches to facilitating person-centredness in group-based diabetes education.

AIM: To investigate approaches among healthcare providers (HCPs) that support or hinder person-centredness in group-based diabetes education programmes targeting persons with type 2 diabetes. METHODS: Ethnographic fieldwork in a municipal and a hospital setting in Denmark. The two programmes included 21 participants and 10 HCPs and were observed over 5 weeks. Additionally, 10 in-depth semi-structured interviews were conducted with patients (n = 7) and HCPs (n = 3). Data were analysed using systematic text condensation. RESULTS: Hindering approaches included a teacher-centred focus on delivering disease-specific information. Communication was dialog based, but HCPs primarily asked closed-ended questions with one correct answer. Additional hindering approaches included ignoring participants with suboptimal health behaviours and a tendency to moralize that resulted in feelings of guilt among participants. Supporting approaches included letting participants set the agenda using broad, open-ended questions. DISCUSSION: Healthcare providers are often socialized into a biomedical approach and trained to be experts. However, person-centredness involves redefined roles and responsibilities. Applying person-centredness in practice requires continuous training and supervision, but HCPs often have minimum support for developing person-centred communication skills. Techniques based on motivational communication, psychosocial methods and facilitating group processes are effective person-centred approaches in a group context. CONCLUSION: Teacher-centredness undermined person-centredness because HCPs primarily delivered disease-specific recommendations, leading to biomedical information overload for participants.

The potential of a self-assessment tool to identify healthcare professionals' strengths and areas in need of professional development to aid effective facilitation of group-based, person-centered diabetes education.

BACKGROUND: Healthcare professionals' person-centered communication skills are pivotal for successful group-based diabetes education. However, healthcare professionals are often insufficiently equipped to facilitate person-centeredness and many have never received post-graduate training. Currently, assessing professionals' skills in conducting group-based, person-centered diabetes education primarily focus on experts measuring and coding skills on various scales. However, learner-centered approaches such as adequate self-reflective tools have been shown to emphasize professional autonomy and promote engagement. The aim of this study was to explore the potential of a self-assessment tool to identify healthcare professionals' strengths and areas in need of professional development to aid effective facilitation of group-based, person-centered diabetes education. METHODS: The study entails of two components: 1) Field observations of five different educational settings including 49 persons with diabetes and 13 healthcare professionals, followed by interviews with 5 healthcare professionals and 28 persons with type 2 diabetes. 2) One professional development workshop involving 14 healthcare professionals. Healthcare professionals were asked to assess their person-centered communication skills using a self-assessment tool based on challenges and skills related to four educator roles: Embracer, Facilitator, Translator, and Initiator. Data were analyzed by hermeneutic analysis. Theories derived from theoretical model 'The Health Education Juggler' and techniques from 'Motivational Interviewing in Groups' were used as a framework to analyze data. Subsequently, the analysis from the field notes and interview transcript were compared with healthcare professionals' self-assessments of strengths and areas in need to effectively facilitate group-based, person-centered diabetes education. RESULTS: Healthcare professionals self-assessed the Translator and the Embracer to be the two most skilled roles whereas the Facilitator and the Initiator were identified to be the most challenged roles. Self-assessments corresponded to observations of professional skills in educational programs and were confirmed in the interviews. CONCLUSION: Healthcare professionals self-assessed the same professional skills as observed in practice. Thus, a tool to self-assess professional skills in facilitating group-based diabetes education seems to be useful as a starting point to promote self-reflections and identification of healthcare professionals' strengths and areas of need of professional development.

Differences in social relations between persons with type 2 diabetes and the general population.

AIMS: Poor social support and lack of social network are well-established risk factors for morbidity and mortality in general populations. Good social relations, such as social support and network contacts, are associated with better self-management and fewer psychosocial problems in persons with type 2 diabetes. The aim of this study was to investigate whether persons with type 2 diabetes have poorer social relations than the general population. METHODS: We conducted a cross-sectional survey in three settings: a specialist diabetes clinic (SDC) (n = 1084), a web panel (WP) consisting of persons with type 2 diabetes (n = 1491) and a sample from the 2010 Danish Health and Morbidity Survey, representative of the general population (n = 15,165). We compared social relations using multivariate logistic regression. RESULTS: Compared to the general population, persons with type 2 diabetes more often lived without a partner (SDC, OR 1.75, 95% CI 1.49-2.06; WP, OR 1.64, 95% CI 1.43-1.87), met with family less than once a month (SDC, OR 1.78, 95% CI 1.40-2.27; WP, OR 2.35, 95% CI 1.94-2.84) and were less certain they could count on help from others in case of illness (WP, OR 1.23, 95% CI 1.08-1.41). CONCLUSIONS: Our findings suggest that persons with type 2 diabetes have poorer social relations than the general population. From a public health point of view, special attention is needed with regards to strengthening existing networks and establishing alternative networks among persons with type 2 diabetes.

Feasibility of time-restricted eating in individuals with overweight, obesity, prediabetes, or type 2 diabetes: A systematic scoping review.

OBJECTIVE: This systematic scoping review aimed to map and synthesize research on feasibility of time-restricted eating (TRE) in individuals with overweight, obesity, prediabetes, or type 2 diabetes, including recruitment rate, retention rate, safety, adherence, and participants' attitudes, experiences, and perspectives. METHODS: The authors searched MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature from inception to November 22, 2022, supplemented by backward and forward citation search. RESULTS: From 4219 identified records, 28 studies were included. In general, recruitment was easy and median retention rate was 95% among studies with <12 weeks duration and 89% among studies ≥12 weeks. Median (range) adherence to the target eating window for studies <12 and ≥12 weeks was 89% (75%-98%) and 81% (47%-93%), respectively. Variation in adherence among participants and studies was considerable, indicating that following TRE was difficult for some people and that intervention conditions influenced adherence. These findings were supported by qualitative data synthetized from seven studies, and determinants of adherence included calorie-free beverages outside the eating window, provision of support, and influence on the eating window. No serious adverse events were reported. CONCLUSIONS: TRE is implementable, acceptable, and safe in populations with overweight, obesity, prediabetes, or type 2 diabetes, but it should be accompanied by support and options for individual adjustments.

Designing a Co-created Intervention to Promote Motivation and Maintenance of Time-Restricted Eating in Individuals With Overweight and Type 2 Diabetes.

OBJECTIVE: To design an appealing time-restricted eating (TRE) intervention by exploring behavioral and social mechanisms to improve TRE adoption and maintenance among people with type 2 diabetes (T2D) and overweight. Time-restricted eating is an intermittent fasting regimen suggested to improve glycemic control and body weight. METHODS: Intervention development combined coherence theory and empirical data (workshops and semistructured interviews with the target group, their relatives, and health care professionals [HCPs]). Abductive analysis was applied. RESULTS: The analysis suggested designing the TRE intervention in 2 phases: a short period with strict TRE, followed by a longer period focusing on adapting TRE to individual needs with support from HCPs, relatives, and peers. To reinforce TRE motivation and maintenance, HCPs should adopt a whole-person approach that focuses on participants' previous experiences. CONCLUSIONS AND IMPLICATIONS: Important intervention elements to promote TRE adoption and maintenance are suggested to include a 2-phase design and support from professionals, family, and peers.

The relationship between changes in health behaviour and initiation of lipid-lowering and antihypertensive medications in individuals at high risk of ischaemic heart disease.

BACKGROUND: It has been hypothesised that health conscious individuals tend to take better care of themselves by greater adherence to preventive medications. We examined, whether long-term changes in dietary habits and physical activity were associated with initiation of lipid-lowering and antihypertensive medications. METHODS: The study population consisted of two subsamples from the population-based cohort Inter99 study (1999-2006) in Copenhagen, Denmark: one with systolic blood pressure > 140 mmHg (N = 557) and one with total cholesterol > 7 mmol/L (N = 314). At a health examination, individuals completed a questionnaire about health behaviour and had their blood pressure and cholesterol measured at baseline and after five years. Data on medications were obtained through linkage to the Registry of Medical Product Statistics. RESULTS: Positive changes in physical activity (odds ratio =3.50; 95% CI 1.23-7.54) and in dietary habits (odds ratio = 2.08; 95% CI 1.03-4.21) were associated with an increased initiation of lipid-lowering medications. With respect to antihypertensives, no association was observed in terms of physical activity, but for diet, a positive trend in terms of initiation was observed among those with positive changes in dietary habits (odds ratio = 1.58; 95% CI 0.96-2.59). CONCLUSION: Generally, we observed health conscious behaviour in terms of increased initiation of preventive medications among those who reported positive changes in health behaviour. This study therefore suggests that more attention should be given to identifying individuals and groups, who are less health conscious and thereby less likely to engage in either preventive medications or changes in health behaviours.

People with type 2 diabetes' experiences of emotional support in Australian general practice: a qualitative study.

BACKGROUND: Diabetes distress, experienced by up to 40% of people with type 2 diabetes (T2D), is the negative emotional response to the burden of living with and managing diabetes. It is associated with suboptimal glycaemia and diabetes self-management. Research indicates that people with diabetes do not recall being asked about emotional distress by healthcare professionals. AIM: To explore the experiences, needs, and expectations of people with T2D regarding emotional support received in Australian general practice. DESIGN & SETTING: Exploratory qualitative study in Victoria, Australia. METHOD: Semi-structured interviews were undertaken to explore emotional health and support received in general practice in 12 adults with T2D who primarily attend general practice. Interviews were audio-recorded, transcribed verbatim, and analysed using the framework approach. RESULTS: The following three major themes were identified: (1) Beneath the surface of diabetes care; (2) Importance of GP-patient relationship; and (3) Communication counts. Participants experienced diabetes care as focused primarily on medical management rather than the emotional aspects of living with T2D. While people's experiences of diabetes care in general practice primarily focused on physical health, the GP care beyond the presenting complaint has an essential role in identifying emotional issues and enabling support. Emotional issues were more likely to be discussed and acknowledged by the GP where there was a long-standing relationship between GP and patient. CONCLUSION: Pre-existing positive GP-patient relationships and supportive communication enable people with 2TD to raise emotional issues as part of diabetes care.

Do immigrants from Turkey, Pakistan and Yugoslavia receive adequate medical treatment with beta-blockers and statins after acute myocardial infarction compared with Danish-born residents? A register-based follow-up study.

PURPOSE: We undertook a study investigating whether immigrants from Turkey, Pakistan and Yugoslavia received adequate medical treatment with beta-blockers and statins after acute myocardial infarction (AMI) when compared with Danish-born residents and explored whether associations between patient origin and medical treatment were mediated by socioeconomic status (SES). METHODS: This register-based follow-up study consisted of individuals >17 years of age, admitted to hospital with AMI between 2001 and 2005 (n=25,443). Danish-born residents were compared with immigrants from Turkey, Pakistan and Yugoslavia. Individuals were identified by civil registration number, and data were obtained through linkage to the national registers of hospitalisations and drug prescriptions. Odds of initiating treatment and hazard ratios (HR) of terminating treatment were estimated. Mediators such as income and employment were included in the models. RESULTS: Pakistanis were less likely than Danish-born residents to initiate treatment with beta-blockers after AMI [odds ratio 0.52; 95% confidence interval (CI) 0.34-0.80]. Immigrants from Turkey (HR 1.36; 95% CI 1.07-1.73) and Pakistan (HR 1.59; 95% CI 1.21-2.08) were more likely to terminate treatment with beta-blockers before being recommended to do so. Estimates did not change markedly when income and education were included in the models. CONCLUSIONS: The results of this study suggest that immigrants from Pakistan and Turkey do not receive adequate medical treatment with beta-blockers after a first AMI compared with Danish-born residents. Mediators such as income and employment may not be sufficient indicators of SES when the effect of patient origin on medical treatment is explored. A lower SES of immigrants, communication problems between doctor and patient and doctors' attitudes towards immigrants may explain ethnic differences in medical treatment after AMI.

A Qualitative Exploration of Facilitators and Barriers for Diabetes Self-Management Behaviors Among Persons with Type 2 Diabetes from a Socially Disadvantaged Area.

BACKGROUND: Enhancing diabetes self-management (DSM) in patients with type 2 diabetes (T2D) can reduce the risk of complications, enhance healthier lifestyles, and improve quality of life. Furthermore, vulnerable groups struggle more with DSM. AIM: To explore barriers and facilitators related to DSM in vulnerable groups through the perspectives of patients with T2D and healthcare professionals (HCPs). METHODS: Data were collected through three interactive workshops with Danish-speaking patients with T2D (n=6), Urdu-speaking patients with T2D (n=6), and HCPs (n=16) and analyzed using systematic text condensation. RESULTS: The following barriers to DSM were found among members of vulnerable groups with T2D: 1) lack of access to DSM support, 2) interference and judgment from one's social environment, and 3) feeling powerless or helpless. The following factors facilitated DSM among vulnerable persons with T2D: 1) a person-centered approach, 2) peer support, and 3) practical and concrete knowledge about DSM. Several barriers and facilitators expressed by persons with T2D, particularly those who spoke Danish, were also expressed by HCPs. CONCLUSION: Vulnerable patients with T2D preferred individualized and practice-based education tailored to their needs. More attention should be paid to training HCPs to handle feelings of helplessness and lack of motivation among vulnerable groups, particularly among ethnic minority patients, and to tailor care to ethnic minorities.