Self-care in migrants with type 2 diabetes, during the COVID-19 pandemic.

INTRODUCTION: Type 2 diabetes is increasing globally and particularly affects vulnerable groups in society, such as migrants. Research shows that type 2 diabetes is a risk factor for severe illness when infected with COVID-19. Diabetes-related complications can be prevented with good glycaemic control. In addition, good glycaemic control has been shown to be an important cornerstone for preventing severe illness in individuals infected with COVID-19. In order to maintain good glycaemic control, self-care is needed. The purpose of this article is to describe self-care maintenance and possible changes in self-care maintenance and to explore factors related to unchanged self-care maintenance in migrant patients with type 2 diabetes during the COVID-19 pandemic. The second aim is to describe well-being, social support, and the need for support from healthcare services during the COVID-19 pandemic in migrant patients with type 2 diabetes. DESIGN/METHOD: A triangulation design with cross-sectional data collection was used. Both quantitative and qualitative data were collected and interpreted together in a triangulation design. Patients were selected by a diabetes nurse from a computer system at a health center in south-eastern Sweden and invited to participate in the study. A questionnaire was translated into the languages most commonly used at the clinic and sent out to 332 migrant patients who had been diagnosed with type 2 diabetes and treated in primary care. This questionnaire assessed self-care maintenance for diabetes (questions inspired by the Self-Care of Diabetes Inventory), with questions added to every item to assess changes during the pandemic. When changes occurred, we asked the participants to elaborate. Open-ended questions asked the participants how they would like to receive information when there are changes in their healthcare. Descriptive statistical analyses were used for the quantitative data and qualitative data was analyzed using a directed approach to content analysis. RESULTS: In total, 79 participants answered the questionnaire (mean age 69 ± 11, 51% male, 47% born in the Middle East). Of these, 76% stated a change in self-care. More than half (58%) stated changes in maintaining an active lifestyle, 40% had changed their physical exercise, and 38% had changed their behavior to avoid getting sick. Participants said that this change was due to staying at home or canceling social activities because they feared meeting people during the pandemic. Others were more physically active than before on a regular basis during the pandemic due to taking walks to get fit, as a precaution related to COVID-19, and having greater awareness about how to avoid getting sick. Approximately one-quarter of the participants experienced a change in contact with healthcare due to poorer access to care, with fewer doctors' appointments and care being postponed during the pandemic. More than half (58%) would like to receive information about healthcare changes by a letter in the regular mail. Social support had changed for 35% of the participants, with less support from family and friends due to the risk of being infected with COVID-19. CONCLUSION: The COVID-19 pandemic led to societal restrictions that changed the way of life for many individuals. Migrant patients with type 2 diabetes, who are already a vulnerable group regarding self-care, had difficulties in maintaining good living habits during the pandemic. During crises such as COVID-19, support with self-care, such as closer contact with healthcare providers, is vital. CLINICAL RELEVANCE: Knowledge about how the COVID-19 pandemic has affected migrants with type 2 diabetes can be used to support healthcare providers in identifying individuals who are at high risk of suffering from the consequences of their diabetes associated with the pandemic.

Patterns of self-care decision-making and associated factors: A cross-sectional observational study.

OBJECTIVE: The aim of this study was to identify for the first time patterns of self-care decision-making (i.e. the extent to which participants viewed contextual factors influencing decisions about symptoms) and associated factors among community-dwelling adults with chronic illness. METHODS: This was a secondary analysis of data collected during the development and psychometric evaluation of the 27-item Self-Care Decisions Inventory that is based on Naturalistic Decision-Making (n = 430, average age = 54.9 ±â€¯16.2 years, 70.2 % female, 87.0 % Caucasian, average number of chronic conditions = 3.6 ±â€¯2.8). Latent class mixture modeling was used to identify patterns among contextual factors that influence self-care decision-making under the domains of external, urgency, uncertainty, cognitive/affective, waiting/cue competition, and concealment. Multivariate multinomial regression was used to identify additional socio-demographic, clinical, and self-care behavior factors that were different across the patterns of self-care decision-making. RESULTS: Three patterns of self-care decision-making were identified in a cohort of 430 adults. A 'maintainers' pattern (48.1 %) consisted of adults with limited contextual influences on self-care decision-making except for urgency. A 'highly uncertain' pattern (23.0 %) consisted of adults whose self-care decision-making was largely driven by uncertainty about the cause or meaning of the symptom. A 'distressed concealers' pattern (28.8 %) consisted of adults whose self-care decision-making was highly influenced by external factors, cognitive/affective factors and concealment. Age, education, financial security and specific symptoms were significantly different across the three patterns in multivariate models. CONCLUSION: Adults living with chronic illness vary in the extent to which contextual factors influence decisions they make about symptoms, and would therefore benefit from different interventions.

Symptom characteristics, perceived causal attributions, and contextual factors influencing self-care behaviors: An ecological daily assessment study of adults with chronic illness.

OBJECTIVE: Insights into how symptoms influence self-care can guide patient education and improve symptom control. This study examined symptom characteristics, causal attributions, and contextual factors influencing self-care of adults with arthritis, asthma, chronic obstructive pulmonary disease, diabetes, or heart failure. METHODS: Adults (n = 81) with a symptomatic chronic illness participated in a longitudinal observational study. Using Ecological Daily Assessment, participants described one symptom twice daily for two weeks, rating its frequency, severity, bothersomeness, duration, causes, and self-care. RESULTS: The most frequent symptoms were fatigue and shortness of breath. Pain, fatigue, and joint stiffness were the most severe and bothersome. Most participants engaged in active self-care, but those with fatigue and pain engaged in passive self-care (i.e., rest or do nothing), especially when symptoms were infrequent, mild, somewhat bothersome, and fleeting. In people using passive self-care, thoughts, feelings, and the desire to conceal symptoms from others interfered with self-care. CONCLUSION: Most adults with a chronic illness take an active role in managing their symptoms but some conceal or ignore symptoms until the frequency, severity, bothersomeness, or duration increases. PRACTICE IMPLICATIONS: When patients report symptoms, asking about self-care behaviors may reveal inaction or ineffective approaches. A discussion of active self-care options may improve symptom control.

Lessons learned from the MOMENT study on how to recruit and retain a target population online, across borders, and with automated remote data collection.

Increasingly, studies use social media to recruit, enroll, and collect data from participants. This introduces a threat to data integrity: efforts to produce fraudulent data to receive participant compensation, e.g., gift cards. MOMENT is an online symptom-monitoring and self-care study that implemented safeguards to protect data integrity. Facebook, Twitter, and patient organizations were used to recruit participants with chronic health conditions in four countries (USA, Italy, The Netherlands, Sweden). Links to the REDCap baseline survey were posted to social media accounts. The initial study launch, where participants completed the baseline survey and were automatically re-directed to the LifeData ecological momentary assessment app, was overwhelmed with fraudulent responses. In response, safeguards (e.g., reCAPTCHA, attention checks) were implemented and baseline data was manually inspected prior to LifeData enrollment. The initial launch resulted in 411 responses in 48 hours, 265 of which (64.5%) successfully registered for the LifeData app and were considered enrolled. Ninety-nine percent of these were determined to be fraudulent. Following implementation of safeguards, the re-launch yielded 147 completed baselines in 3.5 months. Eighteen cases (12.2%) were found fraudulent and not invited to enroll. Most fraudulent cases in the re-launch (15 of 18) were identified by a single attention check question. In total, 96.1% of fraudulent responses were to the USA-based survey. Data integrity safeguards are necessary for research studies that recruit online and should be reported in manuscripts. Three safeguard strategies were effective in preventing and removing most of the fraudulent data in the MOMENT study. Additional strategies were also used and may be necessary in other contexts.

Developing a Culturally Appropriate Tool to Support Self-Care in Migrants with Type 2 Diabetes - A Co-Design Study.

Introduction: Migrants, especially from the Middle East, experience poorer health outcomes and face greater difficulties in accessing healthcare compared to native populations and there is a need for culturally appropriate education for this vulnerable group. The purpose of this study is to describe the process of developing a culturally appropriate tool to support self-care in migrants with type 2 diabetes. Methods: In this Co-design study, a tool for supporting self-care in migrants with type 2 diabetes was developed. Migrant patients with type 2 diabetes, healthcare providers and researchers participated in the process, which was based on six elements; engage, plan, explore, develop, decide and change. From February 2021 to December 2022, idea groups were conducted, and a tool was developed through brainstorming, prioritizing and prototyping. Results: In total, 14 migrant patients, ten health care providers and four researchers participated in the Co-design process. The patients wished to receive information about type 2 diabetes self-care behaviour in their own languages. The healthcare providers asked for clear instructions on where to guide their patients regarding reliable information about diabetes in the patient's own language. All participants agreed that information can be presented in different formats, either: text (paper or online), audio-visual via recorded videos and/or lectures and pictures. Discussion: The Co-design process led to several important insights and experiences related to the importance of diverse cultural backgrounds. When conducting a Co-design study with end-users as stakeholders, it is significant that the stakeholders have a diverse background in experiences, both as patients as well as those who deliver or implement the health service. In this study it was of great importance to include patients with diverse backgrounds regarding; gender, age, health literacy, occupation, years living in Sweden and duration of diabetes.

Cultural competence in healthcare professionals, specialised in diabetes, working in primary healthcare-A descriptive study.

Self-care is the most important cornerstone of diabetes treatment. As self-care is affected by cultural beliefs, it is important for healthcare professionals to be able to adapt their educational approach and to be culturally competent. The aim of this study was to describe the cultural competence in Swedish healthcare professionals, specialised in diabetes care and to examine related factors for cultural competence. The healthcare professionals' perceived level of cultural competence was measured across three domains-Openness and awareness, Workplace support and Interaction skills-in 279 Swedish healthcare professionals from all 21 regions of Sweden, using the Cultural Competence Assessment Instrument (Swedish version-CCAI-S). Descriptive statistics were used to describe cultural competence in healthcare professionals, and linear regression was conducted to examine factors related to cultural competence. Of the healthcare professionals studied, 58% perceived that they had a high level of Openness and awareness, 35% perceived that they had a high level of Interaction skills and 6% perceived that they had a high level of Workplace support. Two factors were found to be related to cultural competence, namely, high percentage of migrant clients at the healthcare clinic and whether the healthcare professionals previously had developed cultural competence through practical experience, education and/or by themselves. In conclusion, most healthcare professionals perceived that they had cultural openness and awareness but need more support from their workplace to improve their interaction skills. Cultural competence-related education could support the healthcare professionals to develop interaction skills.

Development of a group-based diabetes education model for migrants with type 2 diabetes, living in Sweden.

AIM: To develop a diabetes education model based on individual beliefs, knowledge and risk awareness, aimed at migrants with type 2 diabetes, living in Sweden. BACKGROUND: Type 2 diabetes is rapidly increasing globally, particularly affecting migrants living in developed countries. There is ongoing debate about what kind of teaching method gives the best result, but few studies have evaluated different methods for teaching migrants. Previous studies lack a theoretical base and do not proceed from the individuals' own beliefs about health and illness, underpinned by their knowledge, guiding their health-related behaviour. METHODS: A diabetes education model was developed to increase knowledge about diabetes and to influence self-care among migrants with type 2 diabetes. The model was based on literature review, on results from a previous study investigating knowledge about diabetes, on experience from studies of beliefs about health and illness, and on collaboration between researchers in diabetes care and migration and health and staff working in a multi-professional diabetes team. FINDINGS: This is a culturally appropriate diabetes education model proceeding from individual beliefs about health and illness and knowledge, conducted in focus-group discussions in five sessions, led by a diabetes specialist nurse in collaboration with a multi-professional team, and completed within three months. The focus groups should include 4-5 persons and last for about 90 min, in the presence of an interpreter. A thematic interview guide should be used, with broad open-ended questions and descriptions of critical situations/health problems. Discussions of individual beliefs based on knowledge are encouraged. When needed, healthcare staff present at the session answer questions, add information and ensure that basic principles for diabetes care are covered. The diabetes education model is tailored to both individual and cultural aspects and can improve knowledge about type 2 diabetes, among migrants and thus increase self-care behaviour and improve health.

Lower knowledge about diabetes among foreign-born compared to Swedish-born persons with diabetes-A descriptive study.

AIM: To compare foreign- and Swedish-born persons, diagnosed with type 2 diabetes, to study whether there are dissimilarities in knowledge about diabetes and to study determinants of knowledge. DESIGN: A cross-sectional descriptive study was conducted. METHOD: Data were collected between September 2014 and March 2016, using the standardized Diabetes Knowledge Test (DKT), statistically analysed. RESULTS: The results showed dissimilarities in knowledge between foreign- and Swedish-born persons, supporting the hypothesis that foreign-born persons had lower knowledge about diabetes than Swedish-born persons. There was a relationship between poor knowledge and country of birth, marital status and employment status. Country of birth was the strongest independent determinant of knowledge about diabetes. The risk of poor knowledge was ten times higher among persons born in the Middle East or in another country outside Europe compared with Swedish-born persons. Other influencing factors for poor knowledge about diabetes were being not gainfully employed and living alone.

Anaesthetists' perceptions of facilitative weaning strategies from mechanical ventilator in the intensive care unit (ICU): a qualitative interview study.

AIM: This study aimed to examine anaesthetists' perceptions of facilitative weaning from the mechanical ventilator in the intensive care unit (ICU). METHODS: Explorative qualitative interviews in a phenomenographic reference frame with a purposive sample of 14 eligible anaesthetists from four different ICUs with at least one year of clinical experience of ICU and of ventilator weaning. FINDINGS: Four categories of anaesthetists' perceptions of facilitative decision-making strategies for ventilator weaning were identified. These were the instrumental, the interacting, the process-oriented and the structural strategies" for ventilator weaning. The findings refer to a supportive multidisciplinary holistic ICU quality of care. Choice of strategy for ventilator weaning was flexible and individually tailored to the patients'. CONCLUSIONS: Choice of strategy was flexible and individually adjustable. Introduction of evidence-based guidelines from ventilator weaning is necessary in the ICU. The guidelines should also cover the responsibilities of various professional groups. Regular evaluations of methods and strategies used in practice need to be implemented. This may facilitate decision-making strategies for ventilator weaning in practice at the ICU. Greater attention needs to focus on family members' experiences. The strategies should be an integral part of continuous staff training.