Showing papers on "Diabetes management published in 1999"

An office-based intervention to maintain parent-adolescent teamwork in diabetes management. Impact on parent involvement, family conflict, and subsequent glycemic control.

Abstract: OBJECTIVE: To design and evaluate an office-based intervention aimed at maintaining parent-adolescent teamwork in diabetes management tasks without increasing diabetes-related family conflict. RESEARCH DESIGN AND METHODS: There were 85 patients (aged 10-15 years, mean 12.6 years) with type 1 diabetes (mean duration 5.5 years; mean HbA1c 8.5%) who were randomly assigned to one of three study groups--teamwork, attention control, and standard care--and followed for 24 months. At each visit, parent involvement in insulin administration and blood glucose monitoring was assessed. The teamwork and attention control interventions were integrated into routine ambulatory visits over the first 12 months (four medical visits). Measures of diabetes-related family conflict were collected at baseline and after 12 months. All patients were followed for an additional 12 months with respect to glycemic control. RESULTS: In the teamwork group, there was no major deterioration (0%) in parent involvement in insulin administration, in contrast to 16% major deterioration in the combined comparison (attention control and standard care) group (P

Diabetes management in a health maintenance organization. Efficacy of care management using cluster visits.

Abstract: OBJECTIVE: To evaluate the effectiveness of a cluster visit model led by a diabetes nurse educator for delivering outpatient care management to adult patients with poorly controlled diabetes. RESEARCH DESIGN AND METHODS: This study involved a randomized controlled trial among patients of Kaiser Permanente's Pleasanton, CA, center who were aged 16-75 years and had either poor glycemic control (HbA1c > 8.5%) or no HbA1c test performed during the previous year. Intervention subjects received multidisciplinary outpatient diabetes care management delivered by a diabetes nurse educator, a psychologist, a nutritionist, and a pharmacist in cluster visit settings of 10-18 patients/month for 6 months. Outcomes included change (from baseline) in HbA1c levels; self-reported changes in self-care practices, self-efficacy, and satisfaction; and utilization of inpatient and outpatient health care. RESULTS: After the intervention, HbA1c levels declined by 1.3% in the intervention subjects versus 0.2% in the control subjects (P < 0.0001). Several self-care practices and several measures of self-efficacy improved significantly in the intervention group. Satisfaction with the program was high. Both hospital (P = 0.04) and outpatient (P < 0.01) utilization were significantly lower for intervention subjects after the program. CONCLUSIONS: A 6-month cluster visit group model of care for adults with diabetes improved glycemic control, self-efficacy, and patient satisfaction and resulted in a reduction in health care utilization after the program.

The psychometric properties of the diabetes management self-efficacy scale for patients with type 2 diabetes mellitus

Abstract: This article summarizes the development and validation of a scale to measure the level of self-efficacy of patients with type 2 diabetes mellitus. Self-efficacy is described as people's belief in their capability to organize and execute the course of action required to deal with prospective situations. This self-efficacy scale was developed based on the self-care activities these patients have to carry out in order to manage their diabetes. The following psychometric properties of this scale were established: content validity, construct validity, internal consistency and stability. The original scale contained 42 items. A panel of five experts in diabetes and four self-efficacy experts evaluated the original scale two times for relevance and clarity. This content validity procedure resulted in a final scale which consisted of 20 items. Subsequently, patients with type 2 diabetes were asked to complete this 20-item scale and further tests were done with the 94 usable responses. Factor analysis identified four factors, all of which were related to clusters of self-care activities used to manage diabetes which comprised this scale. The internal consistency of the total scale was alpha=0.81 and the test-retest reliability with a 5-week time interval was r=0.79 (P < 0.001).

Correlates of physical activity in a sample of older adults with type 2 diabetes.

Abstract: OBJECTIVE: Physical activity is integral to the management of type 2 diabetes. Unfortunately, the majority of adults with type 2 diabetes do not regularly engage in physical activity. The purpose of this study was to assess physical activity behavior and its correlates (i.e., physical activity knowledge, barriers, and performance and outcome expectations) in older adults with type 2 diabetes. RESEARCH DESIGN AND METHODS: A subgroup of 260 adults with type 2 diabetes was identified from a larger stratified random sample of adults aged > or = 55 years. Participants completed an interviewer-administered survey designed from focus group findings and social learning theory. RESULTS: The majority of the respondents (54.6%) reported 0 min of weekly physical activity. This was especially true of older female respondents. Performance expectation scores were lower among respondents who were in the oldest age-group, namely, white women. Physical activity knowledge varied by age-group, and barriers to physical activity were prevalent in all groups. The following are significant correlates of reported weekly physical activity: younger age, more education, fewer motivational barriers, and greater perceived health and performance expectations. CONCLUSIONS: Given the importance of physical activity to diabetes management, the low prevalence of physical activity found in this and other studies should raise concerns among clinicians. Future research to identify predictors of physical activity is needed to guide clinicians in the promotion of physical activity.

Use of automated telephone disease management calls in an ethnically diverse sample of low-income patients with diabetes.

Abstract: OBJECTIVE: We examined whether low-income patients with diabetes were able and willing to use automated telephone disease management (ATDM) calls to provide health status information that could improve the quality of their care. RESEARCH DESIGN AND METHODS: A total of 252 adults with diabetes, 30 of whom spoke Spanish as their primary language, were enrolled at the time of clinic visits in a Department of Veterans Affairs health care system (n = 132) or a county health care system (n = 120). Patients received ATDM calls for 12 months and responded to queries using their touch-tone telephones. We examined 1) whether patients completed ATDM assessments consistently over the year and used the calls to report their self-monitored blood glucose (SMBG) levels, 2) the characteristics of patients most likely to use the system frequently, 3) whether patients responded consistently within ATDM assessments, and 4) whether ATDM assessments differentiated among groups of patients with different clinical profiles at baseline. RESULTS: Half of all patients completed at least 77% of their attempted assessments, and one-fourth completed at least 91%. Half of all patients reported SMBG levels during at least 86% of their assessments. Patients completed assessments and reported glucose levels consistently over the year. Health status indicators were the most important determinants of assessment completion rates, while socioeconomic factors were more strongly associated with patients' likelihood of reporting SMBG data during assessments. Patients' responses within assessments were consistent, and the information they provided during their initial assessments identified groups with poor glycemic control and other health problems. CONCLUSIONS: Most low-income patients with diabetes can and will use ATDM calls as part of their care. The information they provide is reliable and has clinical significance. ATDM calls could improve the information base for diabetes management while relieving some of the pressures of delivering diabetes care under cost constraints.

Insulin pump therapy in type 1 pediatric patients: now and into the year 2000.

Abstract: There are a number of medical conditions such as growth failure in children, pregnancy, lipid abnormalities, and early complications that are improved by the meticulous glycemic control that can be achieved with insulin pump therapy (CSII). By using an insulin pump, many patients with severe hypoglycemia, the dawn phenomenon, extremes of glycemic excursion, recurrent diabetic ketoacidosis (DKA) and hypoglycemia unawareness have amelioration of these problems. However, pump therapy involves problems such as weight gain, recurrent ketosis due to pump failure, infections, and risk of hypoglycemia. Owing to many developmental issues, young children may not be able to wear the pump without parental supervision. We have used the pump at night time only in these patients. This has allowed children of 7-10 years of age to benefit from improved nocturnal glycemia without the risk of pump therapy when they are without an adult to help. We have also used the pump in subjects with recurrent DKA and in our general patient population (mean age 13.6+/-3.9 years). In our pump cohort, CSII led to improvement in quality of life, knowledge, adherence, and responsibility. A reduction in hypoglycemia, DKA rate and mean HbA(1c) was associated with pump usage. For this to occur, however, pump education must be geared to the pediatric subject and his/her family. Education materials and tools help in learning how to use the pump and how to deal with the intricacies of basal and bolus dosing, and the effect of exercise, food and illness on diabetes management. The pump has improved since it was first introduced and these modifications have made it easier, more painless and less hazardous. With the development of continuous glucose sensors and implantable pumps, the next century will see pump therapy lead to the artificial pancreas.

Implementing practice guidelines for diabetes care using problem-based learning. A prospective controlled trial using firm systems.

Abstract: OBJECTIVE: A controlled trial with 15-month follow-up was conducted in two outpatient clinics to study the effects of using the problem-based learning technique to implement a diabetes clinical practice guideline. RESEARCH DESIGN AND METHODS: A total of 144 patients with type 2 diabetes aged 25-65 years in two internal medicine outpatient clinics were enrolled in the study. African-Americans and Hispanics made up > 75% of the patients. Doctors and staff in one of the clinics were trained in the use of a clinical practice guideline based on Staged Diabetes Management. A problem-based learning educational program was instituted to reach consensus on a stepped intensification scheme for glycemic control and to determine the standards of care used in the clinic. HbA1c was obtained at baseline and at 9 and 15 months after enrollment. RESULTS: At 9 months, there was a mean -0.90% within-subject change in HbA1c in the intervention group, with no significant changes in the control group. The 15-month mean within-subject change in HbA1c of -0.62% in the intervention group was also significant. Among intervention patients, those with the poorest glycemic control at baseline realized the greatest benefit in improvement of HbA1c. The intervention group also exhibited significant changes in physician adherence with American Diabetes Association standards of care. CONCLUSIONS: Clinical practice guidelines are an effective way of improving the processes and outcomes of care for patients with diabetes. Problem-based learning is a useful strategy to gain physician support for clinical practice guidelines. More intensive interventions are needed to maintain treatment gains.

In vivo glucose sensing for diabetes management: progress towards non-invasive monitoring

Abstract: A device for continuous in vivo monitoring of glucose concentration in people with diabetes has been a clinical and research priority for many years but now has an urgency which is probably unquestioned in diabetes care. The purpose of this article is to explain recent advances in technology that are bringing glucose sensors closer to routine use and to highlight some of the remaining problems. Important new technologies include artificial receptors for glucose, tissue fluid sampling techniques, and new approaches to non-invasive sensing, such as fluorescence lifetime measurements.

Diabetes in urban African-Americans. XVII. Availability of rapid HbA1c measurements enhances clinical decision-making.

Abstract: OBJECTIVE: To assess the impact of rapid-turnaround HbA1c results on providers9 clinical decision-making and on follow-up HbA1c levels. RESEARCH DESIGN AND METHODS: The research design was a randomized clinical trial in which rapid HbA1c results were made available to providers on even days of the month (rapid, n = 575), but delayed by 24 h on odd days (conventional, n = 563). Adjustment of therapy for patients with type 2 diabetes was considered appropriate if therapy was intensified for HbA1c values >7% or not intensified for HbA1c values 7% (67 vs. 63%, P = 0.33). For both groups, intensification was greatest for patients on insulin (51%) compared with patients on oral agents (35%) and diet alone (14%) (P 7%, rapid HbA1c results had a favorable impact on follow-up HbA1c independent of the decision to intensify therapy (P = 0.03). CONCLUSIONS: Availability of rapid HbA1c determinations appears to facilitate diabetes management. The more favorable follow-up HbA1c profile in the rapid HbA1c group occurs independently of the decision to intensify therapy, suggesting the involvement of other factors such as enhanced provider and/or patient motivation.

Nurses’ perceptions: issues that arise in caring for patients with diabetes

Abstract: Nurses’ perceptions: issues that arise in caring for patients with diabetes Nurses’ perceptions in caring for persons with diabetes have been little studied. To address this gap in the literature, a sample of nurses from a large Mid-western health care system were surveyed on nurses’ perceptions of: (i) problems encountered in the care of patients with diabetes; (ii) problems encountered by patients and/or family member(s) in diabetes management; and (iii) nurses’ suggested solutions. A randomly selected list of 200 registered nurses obtained from the health system’s Department of Human Resources included inpatient, outpatient, emergency department, medical centre and home health care nurses. The sample was stratified to include 25% inpatient and 75% outpatient nurses. Of the 200 surveys mailed, 136 were returned (68% response rate). Twenty-four per cent of the 136 nurses reported they did not provide care for patients with diabetes. Of 103 nurses providing care to patients with diabetes, 98% were female, 91% were Caucasian, 76% were between the ages of 30 and 49 years, 57% worked in outpatient settings, 35% worked in primary care, and 42% had a bachelor’s degree or higher. Of those with practice guidelines, 84% found the practice guidelines helpful. These nurses also perceived that they, as nurses, needed more education to improve their care of diabetes patients; few nurses believed it was within the scope of their practice to change treatment regimens. The perception of most nurse respondents was that acceptance of diabetes, knowledge deficits and non-compliance were primary patient problems in the management of diabetes. Nurses’ perceptions of solutions to the problems centred on education of nurses and patients, and reinforcement of the importance of follow-up care.

Primary care physicians' perceptions of diabetes management. A balancing act.

Abstract: BACKGROUND Studies demonstrate significant shortfalls in the quality of care for diabetes. Primary care physicians' views of the management of diabetes have been inadequately explored. The objective of our study was to describe primary care physicians' attitudes toward diabetes, patients with diabetes, and diabetes care. METHODS In-depth interviews were conducted by a trained research interviewer with a sample of 10 family physicians and 9 internists in Connecticut. Interviews lasted an average of 60 minutes and were audiotaped and transcribed. Data were interpreted by a multidisciplinary team using a standard qualitative text analysis methodology. Themes from each interview were used to identify and develop overall themes related to the areas of inquiry. RESULTS Physicians' goals were congruent with current guidelines emphasizing the importance of good glycemic control and prevention of complications. However, physicians noted the challenge of balancing the multiple goals of ideal diabetes care and the realities of patient adherence, expectations, and circumstances. The majority of physicians described a patient-centered management style, but a substantial minority described a more paternalistic approach. Physicians did not identify or describe office systems for facilitating diabetes management. Differences between family physicians and internists did not emerge. CONCLUSIONS The complexity of diabetes care recommendations coupled with the need to tailor recommendations to individual patients produces wide variation in diabetes care. Improvement in care may depend on (1) prioritizing diabetes care recommendations for patients as individuals, (2) improving physicians' motivational counseling skills and enhancing their ability to deal with challenging patients, and (3) developing office systems and performance enhancement efforts that support cost-effective practice and patient adherence.

Gaining freedom: self-responsibility in adolescents with diabetes

Abstract: This exploratory, qualitative pilot study explored the meaning of the chronic illness experience for adolescents with diabetes in relation to taking on responsibility for their own care. Four adolescents aged 15 to 17 years with insulin-dependent diabetes mellitus participated in indepth interviews. Gaining freedom was the central phenomenon that captured the process of gaining self-responsibility in diabetes management during adolescence. Three themes marked the process: (a) making it fit; (b) being ready and willing; and (c) having a safety net of friends. These adolescents described a gradual transition from dependence to independence in learning to manage their diabetes. These findings should cause advanced practice nurses to re-evaluate their frameworks for adolescents with diabetes and develop a collaborative approach. Intervention strategies must be developed that incorporate adolescent developmental needs, determine readiness and motivation to learn, and provide opportunities to practice independence in self-management.

Evaluation of a food label nutrition intervention for women with type 2 diabetes mellitus.

Abstract: Objective To evaluate an educational intervention about the food label designed specifically for women with type 2 diabetes mellitus. Design A pretest-posttest control group design. Participants received random group assignment. Subjects/setting Forty-three women aged 40 to 60 years with type 2 diabetes living in a rural community in Pennsylvania participated. Forty participants (93%) completed the program. Intervention Nine weekly group sessions were developed on the basis of findings from previous research among this sample. Principles from Ausubel's learning theory were also incorporated into program design and evaluation. Main outcome measures The effectiveness of the food label education program on participants' knowledge was determined using a multiple-choice test designed to measure declarative and procedural knowledge. A skills inventory assessed participants' perceived confidence in using the food label. The validity and reliability of the instruments had been established previously. Statistical analyses Analysis of variance was performed to compare groups. Paired t tests compared pretest and posttest results. Results The experimental group showed a greater gain than the control group in total knowledge ( P P P P Conclusions Women with diabetes need more education about the food label. This intervention is an effective outpatient education program. Participant knowledge and perceived confidence in using the food label improved significantly as a result of the intervention. Future research should assess retention of knowledge gained and the impact of the intervention on metabolic measures of diabetes management and control. J Am Diet Assoc. 1999;99: 323–328 .

Research-based practice implications for patients with diabetes. Part II: Diabetes self-efficacy.

Abstract: Part I of this two-part research article that describes diabetes knowledge pre- and post-home care instruction was reported in last month's issue of Home Healthcare Nurse. As indicated, foundational knowledge is a necessary prerequisite to effective diabetes management. This article reports on patients' self-efficacy for diabetes management before and after home care and demonstrates that boosting a person's judgment of his or her ability to perform specific diabetes activities is an important next step toward improving self-care.

Development of a community-based diabetes management program for Pacific Islanders.

Abstract: PURPOSEhis study examined the perception of diabetes among a sample of Pacific Islanders in Honolulu, Hawaii. All 23 participants were diagnosed with type 2 diabetes, ranged in age from 21 to 70 years, and had glycosylated hemoglobin levels of 5.8% to 13.9%.METHODSFour focus groups were held in English and audiotaped. Outreach workers served as translators and comoderators. The content of transcripts was analyzed with Ethnograph software by investigators. The priority issues were confirmed by the comoderators and participants.RESULTSParticipants perceived diabetes as full of complications, emotions, symptoms, and behavior changes. Responses to hyperglycemia were fear, frustration, and uncertainty. Barriers to staying on the prescribed diet were habit, cultural ritual, ideal body image, and limited budget.CONCLUSIONSParticipants suggested that helpful activities would include walking/support group, cooking class, community healthy food store, translated material, and family participation. A community-based...

Knowledge and use of the food label among senior women in the management of type 2 diabetes mellitus.

Abstract: Food selection is a key component in the management of diabetes. The foods selected affect the caloric and nutrient composition of the diet and blood glucose levels among people with diabetes. The nutrition information on the food label can guide decisions for food purchases. Whether senior women with diabetes use and comprehend the nutrition information on the food label has not been determined. Therefore, the purpose of this study was to assess knowledge and beliefs about the food label and diabetes management among women with type 2 diabetes mellitus =65 years of age. Focus groups were conducted and participants (n=24) completed a knowledge test about the food label. Analysis involved extensive review of the videotapes and transcripts of the focus groups. Participants reported that they referred to the nutrition information on the label when grocery shopping. Yet, comprehension of terms and product claims on the label was poor. The mean score on the food label knowledge test was only 49%. Misconceptions about the nutritional management of diabetes also were noted. Thus, senior women with diabetes need additional education about the food label to facilitate application of the information in meal planning and to manage diabetes successfully.

American Diabetes Association guide to medical nutrition therapy for diabetes

Abstract: The Challenge: Integrating Nutrition Therapy into Diabetes Management Nutrition Issues Related to Glucose and Lipid Goals/Outcomes Nutrition Issues of Special Populations Nutrition Therapy for Hypertension, Nephropathy, Gastropathy, and Others Nutrition Self-Management Education Much More

Knowledge, attitudes and behaviors related to physical activity among Native Americans with diabetes.

Abstract: Objective Native Americans (NA) have higher diabetes morbidity and mortality compared to other ethnic groups. Although exercise plays an important role in diabetes management, little is known about exercise among Native Americans with diabetes. Our goal was to describe knowledge, attitudes and behaviors related to exercise in Native American participants in New Mexico. Design Bilingual community members administered a questionnaire to assess knowledge, stage of change (a measure of exercise readiness), and physical activity behavior. Hemoglobin A1c (HbA1c) was measured by DCA 2000 analyzer. Height and weight were measured to calculate body mass index (BMI). Average random blood glucose (RBS) levels and diabetes duration were assessed through chart audit. Setting Questionnaires were completed in offices in or near the communities. Participants 514 Native Americans with diabetes were identified as potential participants, 40% (142 women, 64 men) participated. Results 37% of participants knew exercise lowers blood sugar. 82% reported they were in the preparation, action, or maintenance stage of change for exercise behavior. Seventy seven percent of this population did not meet the Surgeon General's recommendation for accumulating 30 minutes of leisure time endurance exercise on most days of the week. However, 67% of participants fell within the "high activity" category for all moderate and vigorous activities. Average age, BMI and HbA1c were 58.5 yrs., 30.5 kg/m2, 8.6%, respectively. Conclusions Interventions to increase physical activity awareness and participation could improve diabetes management and overall health for Native Americans. When evaluating physical activity, researchers need to consider usual activities of daily living and leisure time activities specific to that population. Failure to do so would be ethnocentric and could lead to inappropriate conclusions.

Gender and the capacity of women with NIDDM to implement medical advice.

Abstract: This qualitative study of women with non-insulin dependent diabetes mellitus (NIDDM) examined constructions of their diabetes management and socio-familial relationships as potential sources of support. Semi-structured interview data was collected from 16 women. The transcripts were analysed with the aim of examining the ways in which gender relations structured women's accounts of health-related behaviours. Women talked about themselves as wives, mothers, being pregnant and parenting, and friends of other women in ways that demonstrated how caring for others impeded their capacity to care for themselves. Meeting the food preferences of husbands and dietary requirements of diabetic husbands were dominant themes in women's accounts of marriage, and in various ways women justified their husbands' lack of support. Furthermore, the care of others during pregnancy and parenting was also an obstacle to women caring for themselves. An awareness of the gender politics inherent within social and family contexts is crucial to improving the effectiveness of medical advice for diabetes management.

Gender and the capacity of women with NIDDM to implement medical advice

Abstract: This qualitative study of women with non-insulin dependent diabetes mellitus (NIDDM) examined constructions of their diabetes management and socio-familial relationships as potential sources of support. Semi-structured interview data was collected from 16 women. The transcripts were analysed with the aim of examining the ways in which Sender relations structured women's accounts of health-related behaviours. Women talked about themselves as wives, mothers, being pregnant and parenting, and friends of other women in ways that demonstrated how caring for others impeded their capacity to care for themselves. Meeting the food preferences of husbands and dietary requirements of diabetic husbands were dominant themes in women's accounts of marriage, and in various ways women justified their husbands' lack of support. Furthermore, the care of others during pregnancy and parenting was also an obstacle to women caring for themselves. An awareness of the gender politics inherent within social and family contexts is crucial to improving the effectiveness of medical advice for diabetes management.

Diabetes Education Needs of Family Members Caring for American Indian Elders

Abstract: PURPOSE This qualitative study investigated diabetes care management among family members of American Indian elders with self-care limitations. Focus groups were used to examine the reasons for and content of diabetes care management, the challenges faced, and the support services needed. METHODS Five focus groups were conducted with family caregivers from six tribes. Caregivers' responses related to care management were identified and categorized into themes. RESULTS Participants reported that they provided assistance with a wide range of diabetes care tasks (e.g., skin and wound care, in-home dialysis) depending on the elder's level of impairment. Caregivers described three major challenges related to diabetes care management: (1) anxiety about in-home care, (2) coping with psychosocial issues, and (3) decision making and communication problems with other family members. They emphasized the importance of developing a care routine for successful diabetes management. CONCLUSIONS Based on these findings, we suggest areas where diabetes educators can assist American Indian family caregivers in meeting the needs of frail elders in the home.

Effect of diabetes education on glucose control.

Abstract: After diabetes education, 39 adult diabetic patients were randomized to either an education group or control group. The two groups received identical medical care and follow-up, except that the education group met with their diabetes educator on at least a quarterly basis. Neither group showed any statistically significant change in their glycosylated hemoglobin values, although the education group did have a 4% drop after initial education compared to a 6% rise in the control group. The education group had a lower attrition rate and a better improvement in self-rated dietary compliance. Education remains the cornerstone of diabetes management. Our team identified some trends between the two groups as well as some ideas to improve motivating and developing a stronger and more effective relationship with our patients.

Insulin therapy in children and adolescents with Type 1 diabetes.

Abstract: Considerable advances have been made in insulin pharmacology and pharmacotherapeutics in the 77 years since its discovery by Frederick Banting and Charles Best at the University of Toronto. Nevertheless, even the most sophisticated regimens of diabetes management still do not replace insulin in a physiological manner, i.e. by portal secretion in precise amounts to respond to ingested nutrients and other secretogogues. It is for these reasons that insulin remains just one of many facets of optimal diabetes care. Further advances in the next few years can be expected to change some aspects of insulin therapeutics. However, in the absence of perfect physiological replacement, the goal of diabetes management remains the balancing of the different components of therapy in order to achieve the best possible metabolic control.

Diabetes for Nurses

Abstract: Diagnosis and classification of diabetes Treatment of diabetes Complications of diabetes Education of a person with diabetes Commonly occurring situations which make diabetes more difficult to control Care of diabetes in special groups of people Psychological care Diabetes management in primary health care settings - Cathy Parker.

Have diabetes, will travel.

Abstract: Planning ahead for a trip is always wise, but it is especially important for patients with diabetes. A pretravel office visit gives physicians the opportunity to review diabetes management with pat...

Participatory Epidemiology: Methods of the Living with Diabetes Project

Abstract: This article describes how the principles of participatory research were applied to the study of non-insulin dependent diabetes (NIDDM) in an urban Aboriginal community in Melbourne, Australia The process of developing an appropriate questionnaire and method for the epidemiological study of diabetes was combined with community-controlled initiatives for diabetes management and prevention A close to full time presence in the community and the flexibility of qualitative methods facilitated the development of a quality working relationship between the researcher and community members and the modification of the research to increase direct community benefit Creating a balance between the priorities of research and action proved one of the major challenges during the collection of data Flexibility and communication beyond the completion of the research component were crucial for the development of community-owned diabetes education materials and for consultation and collaboration in the publication of the