Date Presented 4/1/2017
The usual diabetes self-management focus on diet, exercise, and medication is often ineffective for people who are economically marginalized. This study provides data about such people’s occupational and psychosocial status, which may impact their ability to self-manage diabetes.
Primary Author and Speaker: Matt Malcolm
Contributing Authors: Tara Klinedinst, Tracy Nelson
PURPOSE: The prevalence of Type 2 diabetes mellitus (T2DM) continues to rise, affecting one in 10 Americans. In managing T2DM, much effort has been devoted to interventions that focus on diet, exercise, and medication. However, research indicates that this long-standing approach does not facilitate sustainable lifestyle changes and that data are needed to determine how an individual’s occupational and psychosocial status impacts his or her ability to manage T2DM. The purpose of this study was to investigate occupational and psychosocial factors in economically marginalized individuals with T2DM who were patients at a safety-net primary care facility. Such data are needed to provide direction for evidence-based occupational therapy (OT) services in primary care.
DESIGN: This was a descriptive study of 50 individuals considered to have low socioeconomic status (SES), who were recruited by flyer or physician referral from a safety-net primary care facility. Inclusion criteria were diagnosis of T2DM, age ≥18 yr, cognitively intact, and patient at the primary care center.
METHOD: Following consent, participants completed a series of questionnaires. Administration of the questionnaires occurred at the primary care center and was delivered by an occupational therapist or OT student. Assessments were the International Physical Activity Questionnaire (IPAQ), Self-Efficacy for Diabetes Scale, Michigan Diabetes Knowledge Test, World Health Organization Quality of Life–Brief, Community Integration Questionnaire, Hospital Anxiety and Depression Scale, and Frenchay Activities Index. Descriptive statistics were used to describe the findings.
RESULTS: The IPAQ revealed that vigorous and moderate activity levels were very low. However, the sum of all activity types indicated that participants were active slightly more than 6 days/wk at 606.7 total metabolic equivalents per week. Average self-efficacy ratings were 7.2 (of 10), which indicated that participants were moderately confident in managing their T2DM. Confidence in exercise received the lowest self-efficacy rating (5.3), and knowing when to visit the doctor received the highest rating (8.5). The average Michigan Diabetes Knowledge Test score was 70.5%. The overall quality of life (QOL) rating was moderate, averaging 3.6 of 5. Specific QOL items revealed low ratings linked to energy levels (3.2 of 5), money (3.1), work satisfaction (2.9), and sex life (2.9); however, QOL for health care access was high (4.2). This sample was moderately integrated with home-based (5.8 of 10) and social-based (7.7 of 12) activities. On average, these individuals experienced moderate levels of anxious (10.7 of 21) and depressive (12.8 of 21) feelings. Finally, the Frenchay Instrumental Activities of Daily Living (IADLs) scale revealed an average score of 27.9 of 45, which is similar to the median normative score of 28.
CONCLUSION: From our results, we generally found that individuals with low SES and T2DM seen in a primary care center were experiencing moderate limitations in occupational and psychosocial status, as specifically related to physical activity, IADLs, self-efficacy, QOL, and community integration, and were experiencing moderate levels of anxious and depressive feelings. These findings are important to OT practice and research as they help describe the characteristics of a population that requires more comprehensive, evidence-based interventions than are typically provided in the primary care setting.
References
Baptista, D. R., Wiens, A., Pontarolo, R., Regis, L., Reis, W. C. T., & Correr, C. J. (2016). The chronic care model for Type 2 diabetes: A systematic review. Diabetology and Metabolic Syndrome, 8, 7. https://doi.org/10.1186/s13098-015-0119-z
Centers for Disease Control and Prevention. (2014). National Diabetes Statistics Report: Estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: Author.
Elder, N. C., & Tubb, M. R. (2014). Diabetes in homeless persons: Barriers and enablers to health as perceived by patients, medical, and social service providers. Social Work in Public Health, 29, 220–231. https://doi.org/10.1080/19371918.2013.776391
Khunti, K., Gray, L. J., Skinner, T., Carey, M. E., Realf, K., Dallosso, H., . . . Davies, M. J. (2012). Effectiveness of a Diabetes Education and Self Management Programme (DESMOND) for people with newly diagnosed Type 2 diabetes mellitus: Three year follow-up of a cluster randomised controlled trial in primary care. BMJ, 344, e2333. https://doi.org/10.1136/bmj.e2333
