Diabetes Management and Self-Care Among Emerging Adults: Emerging Adult and Diabetes Care Provider Perceptions of Self-Management Influences, Visit Interaction, and a Tool to Enhance Diabetes Care at Visits Restricted; Files Only
Wolf, Rachel (Spring 2021)
Published
Abstract
Background: While the number of emerging adults with diabetes (EAWD) increases, health outcomes among EAWD remain suboptimal with frequent rates of poor glycemic control. Interventions are needed to facilitate age-appropriate care for EAWD. Event history calendars (EHC) have been used to facilitate patient provider communication and contextualized care. The purpose of this study was to investigate perspectives of EAWD and healthcare providers regarding diabetes self-management influences and EAWD-provider diabetes visit interactions and to develop an EHC tailored for EAWD diabetes care visits.
Methods: The study used a mixed method exploratory sequential design. Focus groups and interviews with EAWD and interviews with healthcare providers from a public healthcare system were conducted to identify influences on self-management as well as perspectives on current and desired interactions with diabetes providers. Qualitative findings were used to inform EHC development. In quantitative follow up, EAWD and providers reviewed the EHC for content validity, feasibility, and utility for clinical use, including cognitive benefits for EAWD and communication benefits for EAWD and providers.
Results: EAWD and providers both identified intrapersonal, interpersonal, and structural influences on diabetes self-management. Both EAWD and providers described psychological burden complicated by life stage tasks and responsibilities associated with emerging adulthood as well as resource barriers to optimal management. Providers perceived lack of EAWD engagement as a challenge to EAWD care. Both EAWD and providers perceived that additional value could be gained from EAWD-provider interactions and valued the importance of the EAWD-provider relationship in care. The EHC was well received by EAWD and providers in regard to feasibility and utility. EHC topics rated as highly relevant by both EAWD and providers included diabetes supplies, medications, physical activity, stress, and diet. Several other EHC topics may require additional review, and feasibility could be improved with revision.
Conclusions: EAWD and providers value tailored, contextualized information for diabetes care. With additional assessment and development, an EAWD specific EHC may provide a feasible tool to improve diabetes care and communication for EAWD at diabetes visits.
Table of Contents
Table of Contents
Introduction ……………………………………………………………………………………………………………….…….……….1
Specific Aims ……………………………………………………………………………………………….…….……………...………2
Background and Significance …………….…………………………………………………………….…..……………......………5
Theoretical Framework …………………………………………………………………………………..….…………….....………11
Summary and Scientific Premise ………………………………………………………………………..………………...........…13
Approach ……………………………………………………………………………………………………………..…………….…….14
Paper 1: Perceptions of Emerging Adults with Diabetes regarding Influences on Self-Management
and Interactions with Diabetes Care Providers at Diabetes Care Visits …………….………………..............…23
Abstract ………………………………………..………………………………………………….………………..………….……...……24
Introduction …………….………………………….………………………….……………………………….……………..…25
Research Design and Methods ………...………………………………………………………………..……………………27
Results …………………………………………..…………………………………………………………………...……………29
Discussion ……………………………………….……………………………………………………………….…..………..…40
Conclusion …………………………………..…………………………………………………………………..……….. ..……44
References ……………………………………………………………………………………………………………….……..….46
Tables and Figures …………………………………………………………………………………………………………..…..50
Paper 2: Diabetes Care Provider Perceptions Regarding Emerging Adult Diabetes
Self-Management Influences and Patient Provider Visit Interactions ….…………..……….......................……...……56
Abstract ……………………………………………………..……………………………………………………..…...……………...……57
Introduction …………….…………………………….………………………………………………………..…………………58
Research Design and Methods ……………..…………………………………………………………..………………..……60
Results …………………………………………..…………………………………………………………………………..………61
Discussion ……………………………………….……………………………………………………………..……………..……72
Conclusion …………………………………..………………………………………………………………..…………..…….…77
References …………………………………………………………………………………………………………………..…..….79
Tables and Figures …………………………………………………………………………………………………………….…..83
Paper 3: Event History Calendar Development and Validity Testing for Improved Patient Provider
Communication and Diabetes Management for Emerging Adults with Diabetes …………...….....................…87
Abstract ……………………………………………………..……………………………………………………..……....….………...……88
Introduction …………….…………………………….…………………………………………………………....………………89
Theoretical Framework ……………..…………………………………………………………..…………….………..……..…91
Research Design and Methods ……………..…………………………………………….…………..……………..........…….…....…92
Results …………………………………………..…………………………………………………………………..……..........…96
Discussion ……………………………………….……………………………………………………………..………………...…99
Conclusion …………………………………..………………………………………………………………..…………...….……104
References …………………………………………………………………………………………….………………..….……..........……106
Tables and Figures ………………………………………………………………………………………………………….....….110
Integrative Summary …………………………………………………………………………………..……………………….……..……122
References ………………………………………………………………………………………………………………………………..……132
Appendices ………………………………………………………………………………………………………………………….…….…..139
Appendix 1: Emerging Adult Demographic Questionnaire ………………………………..…..…….……..........……140
Appendix 2: Emerging Adult Event History Calendar Questionnaire ………………..………………............…….144
Appendix 3: Provider Event History Calendar Questionnaire ……………………………………….............……....150
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