Basics of qualitative research: Grounded theory procedures and techniques

Diabetes self-management education (DSME) is a critical element of care for all people with diabetes and is necessary in order to improve patient outcomes. The National Standards for DSME are designed to define quality diabetes self-management education and to assist diabetes educators in a variety of settings to provide evidence-based education. Because of the dynamic nature of health care and diabetes-related research, these Standards are reviewed and revised approximately every 5 years by key organizations and federal agencies within the diabetes education community.

A Task Force was jointly convened by the American Association of Diabetes Educators and the American Diabetes Association in the summer of 2006. Additional organizations that were represented included the American Dietetic Association, the Veteran's Health Administration, the Centers for Disease Control and Prevention, the Indian Health Service, and the American Pharmaceutical Association. Members of the Task Force included a person with diabetes; several health services researchers/behaviorists, registered nurses, and registered dietitians; and a pharmacist.

The Task Force was charged with reviewing the current DSME standards for their appropriateness, relevance, and scientific basis. The Standards were then reviewed and revised based on the available evidence and expert consensus. The committee convened on 31 March 2006 and 9 September 2006, and the Standards were approved 25 March 2007.

Diabetes self-management education (DSME) is the ongoing process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. This process incorporates the needs, goals, and life experiences of the person with diabetes and is guided by evidence-based standards. The overall objectives of DSME are to support informed decision-making, self-care behaviors, problem-solving and active collaboration with the health care team and to improve clinical outcomes, health status, and quality of life.

Before the review of the individual Standards, the Task Force identified overriding principles based on existing evidence that would …

/pdf/national-standards-for-diabetes-self-management-education-2tec6l36is.pdf

National Standards for Diabetes Self-Management Education

CAROLÉ MENSING, RN, MA, CDE (TASK FORCE CHAIR) JACKIE BOUCHER, MS, RD, LD, CDE MARJORIE CYPRESS, MS, C-ANP, CDE KATIE WEINGER, EDD, RN KATHRYN MULCAHY, MSN, RN, CDE PATRICIA BARTA, RN, MPH, CDE GWEN HOSEY, MS, ARNP, CDE WENDY KOPHER, RN, C, CDE, HTP ANDREA LASICHAK, MS, RD, CDE BETTY LAMB, RN, MSN MAVOURNEEN MANGAN, RN, MS, ANP, C, CDE JAN NORMAN, RD, CDE JON TANJA, BS, MS, RPH LINDA YAUK, MS, RD, LD, CDE KIMBERLYDAWN WISDOM, MD, MS CYNTHIA ADAMS, PHD

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(04)17277-2.pdf

Self-management interventions for chronic illness

With recent improvements in the early detection, diagnosis, and treatment of cancer, people with cancer are living longer, and their cancer may be managed as a chronic illness. Cancer as a chronic illness places new demands on patients and families to manage their own care, and it challenges old paradigms that oncology's work is done after treatment. As a chronic illness, however, cancer care occurs on a continuum that stretches from prevention to the end of life, with early detection, diagnosis, treatment, and survivorship in between. In this article, self-management interventions that enable patients and families to participate in managing their care along this continuum are reviewed. Randomized controlled trials of self-management interventions with cancer patients and families in the treatment, survivorship, and end-of-life phases of the cancer care continuum are reviewed, and the Chronic Care Model is presented as a model of care that oncology practices can use to enable and empower patients and families to engage in self-management. It is concluded that the need for a common language with which to speak about self-management and a common set of self-management actions for cancer care notwithstanding, oncology practices can now build strong relationships with their patients and formulate mutually agreed upon care plans that enable and empower patients to care for themselves in the way they prefer.

https://onlinelibrary.wiley.com/doi/pdf/10.3322/caac.20093

Self-management: Enabling and empowering patients living with cancer as a chronic illness†‡

Self-management approaches for people with chronic conditions: a review.

Research attention has turned towards investigating the motivations and experiences of those who volunteer under conditions that benefit both giver and recipient. The purpose of this paper is to examine the motivation of 22 older volunteers as they embarked on training to become lay leaders of an arthritis self-management programme. Data were collected through semi-structured telephone interviews at two points in time, before training and six weeks after training. Volunteerism was motivated by three key needs: to fill the vocational void left by retirement, to feel a useful member of society by helping others and to find a peer group. These key motivations remained important throughout the six weeks of the study. The costs of volunteering were perceived as time, responsibility, invasion of social life, failure, anxiety, and the duration and intensity of training. Nonetheless, older volunteers valued finding a purpose, reported less pain and an increased desire to ‘get on with life'. Results suggest that volunteering in later life can help to offset losses associated with retirement and decline in health. Further research, incorporating standard measures of health status, is needed if the impact of volunteering on the health of this study population is to be more fully understood.

Volunteerism among older people with arthritis

Objective

To determine whether undergoing training to become a lay leader and conducting an arthritis self-management course is associated with improvements in physical and psychological health status, arthritis self-efficacy, use of self-management techniques, and visits to the general practitioner. In addition, we aimed to describe the experiences of training and course delivery from the older volunteers' perspective.



Methods

21 participants completed all assessments and had a median age of 58, median disease duration of 10 years, and either osteoarthritis (n = 13) or rheumatoid arthritis (n = 8). The study was a pretest–posttest design with qualitative data collected at 3 points in time: before training, 6 weeks after training, and 6 months after training. Quantitative data were collected through self-administered postal questionnaires at baseline and 6-month followup.



Result

Six months after training, participants reported small, significant increases in arthritis self-efficacy for pain (P = 0.002), cognitive symptom management (P = 0.004), and communication with their physician (P = 0.024) and a small, significant decrease in depressed mood (P = 0.04). Qualitative data supported these findings, with participants reporting more confidence, happiness, and a changed outlook on life in general. Volunteerism was associated with altruistic behavior and with filling the vocational void caused by retirement.



Conclusion

Findings support the value of volunteerism and training to become lay leaders in arthritis self-management programs. Volunteers reported positive changes both in themselves and in course participants. They enjoyed helping similar others and being involved in a worthwhile activity, and they valued their newly acquired status as lay leaders. Many had begun to apply their newfound knowledge about self-management to their own situation, reporting less pain and more willingness “to get on with life.”

https://onlinelibrary.wiley.com/doi/pdf/10.1002/1529-0131%28200108%2945%3A4%3C378%3A%3AAID-ART351%3E3.0.CO%3B2-T

Volunteers' experiences of becoming arthritis self-management lay leaders: "It's almost as if I've stopped aging and started to get younger!".

Objective: To document women's experiences of admission to hospital with a pregnancy-related complication, hypertension, from their own perspective. Methods: Qualitative descriptive study. The views of 12 women admitted to hospital with hypertension were obtained through semi-structured interviews. Issues explored included understanding of the condition, information needs, expectations and beliefs. Results: Women were searching for an explanation to help make sense of their situation. Some women were faced with the paradox of being admitted to hospital (thus indicating a problem) in the absence of any symptoms, such as swelling. This resulted in women feeling that they were frauds and not deserving of a hospital bed. Some women also felt that bed rest and medication could be done at home particularly as they 'felt fine'. Women experienced a roller coaster of emotional highs and lows depending upon the latest information given to them by staff particularly concerning likely discharge date. Upward and downward social comparisons were evident as women observed others being delivered of a healthy baby or lacking adequate support. Most women had satisfactory social support form husbands/partners and family. Conclusions: Women could be assisted in their search for meaning by affirmation concerning their status as worthy of hospital care, provision of consistent information, and satisfactory social support.

Women's experiences of hospitalisation with hypertension during pregnancy: feeling a fraud

Objective The aim of this study was to examine the training experiences of a group of older volunteers in preparation for delivering an arthritis self-management course as a lay leader.Design The study was a pre-test post-test design with data collected at three points in time: before attending training; 6 weeks, and 6 months after training.Setting This study recruited participants from three training courses for lay leaders run in Leicester, Shrewsbury and Skipton.Method Data were collected through a baseline questionnaire and interviews. The sample comprised 22 older people with arthritis. The majority of participants were women, with either osteoarthritis or rheumatoid arthritis.Results Volunteering to become a lay leader was motivated by the need to fill the vocational void left by retirement, to feel a useful member of society by helping others and to find a peer group. Expectations included gaining a greater understanding of arthritis, peer support and the opportunity to meet similar people. At foll...

Jenny Hainsworth

Papers

Self-management approaches for people with chronic conditions: a review.

Volunteerism among older people with arthritis

Volunteers' experiences of becoming arthritis self-management lay leaders: "It's almost as if I've stopped aging and started to get younger!".

Women's experiences of hospitalisation with hypertension during pregnancy: feeling a fraud

The training experiences of older, volunteer lay leaders on an arthritis self-management course