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      Experiences of self-management support in patients with diabetes and multimorbidity: a qualitative study in Norwegian general practice

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          Abstract

          Aim:

          The purpose of this study was to explore how patients with diabetes and multimorbidity experience self-management support by general practitioners (GPs), nurses and medical secretaries in Norwegian general practice.

          Background:

          Self-management support is recognised as an important strategy to improve the autonomy and well-being of patients with long-term conditions. Collaborating healthcare professionals (cHCPs), such as nurses and medical secretaries, may have an important role in the provision of self-management support. No previous study has explored how patients with diabetes and multimorbidity experience self-management support provided by cHCPs in general practice in Norway.

          Methods:

          Semi-structured interviews with 11 patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) with one or more additional long-term condition were performed during February–May 2017.

          Findings:

          Patients experienced cHCPs as particularly attentive towards the psychological and emotional aspects of living with diabetes. Compared to GPs, whose appointments were experienced as stressful, patients found cHCPs more approachable and more likely to address patients’ questions and worries. In this sense, cHCPs complemented GP-led diabetes care. However, neither cHCPs nor GPs were perceived to involve patients’ in clinical decisions or goal setting during consultations.

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          Most cited references66

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          Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research.

          Lawrence Palinkas, Sarah M. Horwitz, Carla Green … (2015)
          Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research. However, combining sampling strategies may be more appropriate to the aims of implementation research and more consistent with recent developments in quantitative methods. This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposeful sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.
          Article 0 comments Cited 1366 times – based on 0 reviews     Review now
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            Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being.

            R Ryan, E Deci (1999)
            Human beings can be proactive and engaged or, alternatively, passive and alienated, largely as a function of the social conditions in which they develop and function. Accordingly, research guided by self-determination theory has focused on the social-contextual conditions that facilitate versus forestall the natural processes of self-motivation and healthy psychological development. Specifically, factors have been examined that enhance versus undermine intrinsic motivation, self-regulation, and well-being. The findings have led to the postulate of three innate psychological needs--competence, autonomy, and relatedness--which when satisfied yield enhanced self-motivation and mental health and when thwarted lead to diminished motivation and well-being. Also considered is the significance of these psychological needs and processes within domains such as health care, education, work, sport, religion, and psychotherapy.
            Article 0 comments Cited 576 times – based on 0 reviews     Review now
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              Self-management education: history, definition, outcomes, and mechanisms.

              Kate Lorig, Halsted Holman (2003)
              Self-management has become a popular term for behavioral interventions as well as for healthful behaviors. This is especially true for the management of chronic conditions. This article offers a short history of self-management. It presents three self-management tasks--medical management, role management, and emotional management--and six self-management skills--problem solving, decision making, resource utilization, the formation of a patient-provider partnership, action planning, and self-tailoring. In addition, the article presents evidence of the effectiveness of self-management interventions and posits a possible mechanism, self-efficacy, through which these interventions work. In conclusion the article discusses problems and solutions for integrating self-management education into the mainstream health care systems.
              Article 0 comments Cited 514 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Prim Health Care Res Dev
                Journal ID (iso-abbrev): Prim Health Care Res Dev
                Journal ID (publisher-id): PHC
                Title: Primary Health Care Research & Development
                Publisher: Cambridge University Press (Cambridge, UK )
                ISSN (Print): 1463-4236
                ISSN (Electronic): 1477-1128
                Publication date (Electronic, collection): 2020
                Publication date (Electronic): 15 October 2020
                Volume: 21
                Electronic Location Identifier: e44
                Affiliations
                [1 ]PhD Candidate, Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University , Oslo, Norway
                [2 ]Assistent Professor, Faculty of Health Sciences, Department of Physiotherapy, OsloMet University , Oslo, Norway
                [3 ]Assistent Professor, MD, Department of General Practice, Institute for Health and Society, University of Oslo , Oslo, Norway
                [4 ]Professor, Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University , Oslo, Norway
                [5 ]Assistent Professor, Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University , Oslo, Norway
                Author notes
                Author for correspondence: Monica Sørensen, PhD Candidate, Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University , St. Olavs Plass, P.O. Box 4, 0130Oslo, Norway. E-mail: monica.sorensen@ 123456helsedir.no
                Author information
                https://orcid.org/0000-0003-2503-6459
                Article
                Publisher Item ID: S1463423620000432
                DOI: 10.1017/S1463423620000432
                PMC ID: 7681169
                PubMed ID: 33054888
                SO-VID: 4186f75e-c567-4256-aa23-23b8b9c44412
                Copyright © © Cambridge University Press 2020
                License:

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

                History
                Date received : 21 November 2019
                Date revision received : 01 August 2020
                Date accepted : 01 September 2020
                Page count
                Figures: 1, Tables: 2, References: 72, Pages: 8
                Categories
                Subject: Research

                Keywords: general practice,self-management support,type 1 diabetes mellitus,type 2 diabetes mellitus
                Data availability:
                Keywords: general practice, self-management support, type 1 diabetes mellitus, type 2 diabetes mellitus

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