BackgroundPrevious research has failed to examine more than one self-care behaviour in type 2 diabetes patients in Ghana. The purpose of this study is to investigate adult Ghanaian type 2 diabetes patients’ adherence to four self-care activities: diet (general and specific), exercise, self-monitoring of blood glucose (SMBG) and foot care.MethodsConsenting type 2 diabetes patients attending diabetes outpatient clinic appointments at three hospitals in the Tamale Metropolis of Ghana completed a cross-sectional survey comprising the Summary of Diabetes Self-Care Activities Measure, and questions about demographic characteristics and diabetes history. Height and weight were also measured. Multiple linear regression analyses were conducted to identify the factors associated with adherence to each of the four self-care behaviours.ResultsIn the last 7 days, participants exercised for a mean (SD) of 4.78 (2.09) days and followed diet, foot care and SMBG for a mean (SD) of 4.40 (1.52), 2.86 (2.16) and 2.15 (0.65) days, respectively. More education was associated with a higher frequency of reported participation in exercise (r = 0.168, p = 0.022), following a healthy diet (r = 0.223, p = 0.002) and foot care (r = 0.153, p = 0.037) in the last 7 days. Males reported performing SMBG (r = 0.198, p = 0.007) more frequently than their female counterparts.ConclusionAdherence to diet, SMBG and checking of feet were relatively low. People with low education and women may need additional support to improve adherence to self-care behaviours in this type 2 diabetes population.

Aims and objectivesTo explore patient and healthcare provider (HCP) perspectives about patients’ barriers to the performance of diabetic self‐care behaviours in Ghana.BackgroundSub‐Saharan African urban populations are increasingly affected by type 2 diabetes due to nutrition transition, sedentary lifestyles and ageing. Diabetic self‐care is critical to improving clinical outcomes. However, little is known about barriers to diabetic self‐care (diet, exercise, medication taking, self‐monitoring of blood glucose and foot care) in sub‐Saharan Africa.DesignQualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.MethodsSemi‐structured interviews were conducted among 23 people living with type 2 diabetes and 14 HCPs recruited from the diabetes clinics of three hospitals in Tamale, Ghana. Interviews were audiotaped and transcribed verbatim. The constant comparative method of data analysis was used and identified themes classified according to constructs of the theory of planned behaviour (TPB): attitudes/behavioural beliefs, subjective norms and perceived behavioural control.ResultsBarriers relating to attitudes included misconceptions that diabetes was caused by spiritual forces or curses, use of herbal medicines, intentional nonadherence, difficulty changing old habits, and feeling or lacking motivation to exercise. Barriers relating to subjective norms were inadequate family support, social stigma (usually by spouses and other members of the community) and cultural beliefs. Perceived behavioural control barriers were poor income levels, lack of glucometers, busy work schedules, long distance to the hospital and inadequate access to variety of foods due to erratic supply of foods or seasonality.ConclusionsBoth patients and HCPs discussed similar barriers and those relating to attitude and behavioural control were commonly discussed.Relevance to Clinical PracticeInterventions to improve adherence to diabetic self‐care should focus on helping persons with diabetes develop favourable attitudes and how to overcome behavioural control barriers. Such interventions should have both individualised and community‐wide approaches.

Aims To determine diabetes patient's adherence to five self‐care behaviours (diet, exercise; medication, self‐monitoring of blood glucose [SMBG] and foot care) in low‐ and middle‐income countries. Design Systematic review. Data sources We searched MEDLINE, CINAHL, PUBMED, SCOPUS, PsycINFO, EMBASE, Cochrane library and EMCARE for the period January 1990 – June 2017. Review Methods Title, abstract and full text screening were done according to eligibility criteria. A narrative synthesis of the literature was conducted. Results A total of 7,109 studies were identified of which 27 met the review eligibility criteria and were included. All the studies used self‐report of adherence to diabetes self‐care. Studies reported adherence rates in two major forms: (a) mean number of days participants performed a recommended dietary behaviour/activity during the past week; and (b) proportions of participants adhering to a recommended self‐care behaviour. Mean number of days per week participants adhered to a self‐care behaviour ranged from 2.34.6 days per week for diet, 5.5–6.8 days per week for medication, 1.8–5.7 days per week for exercise, 0.2–2.2 days per week for SMBG and 2.2–4.3 days per week for foot care. Adherence rates ranged from 29.9%–91.7% for diet, 26.0%–97.0% for medication taking, 26.7%–69.0% for exercise, 13.0%–79.9% for self‐monitoring of blood glucose and 17.0%–77.4% for foot care. Conclusion Although most diabetes patients do not adhere to recommended self‐care behaviours, adherence rates vary widely and were found to be high in some instances. Impact Health services in low‐ and middle‐income countries should monitor adherence to diabetes self‐care behaviours rather than assume adherence and resources should be invested in improving adherence to the self‐care behaviours. Large‐scale accurate monitoring of adherence to diabetes self‐care behaviour is needed and consideration should be given to choice of measurement tool for such exercise.

Introduction and Aims. In Australia, occasion in the preceding month (risky drinking). Risky drinkers obtained alcohol mainly from friends (48%) and parents (19%). After controlling for school year and gender, and adjusting for clustering, parental supply for drinking under 'other' supervision (P = 0.004) and with no supervision (P = 0.007), the number of close friends believed to have consumed alcohol in the past month (P < 0.001), and Aboriginal or Torres Strait

No abstract

There is limited evidence regarding the relative effectiveness of sequential and simultaneous approaches. Given only three of the six trials observed a difference in intervention effectiveness for one health behavior outcome, and the relatively consistent finding that the sequential and simultaneous approaches were more effective than a usual/minimal care control condition, it appears that both approaches should be considered equally efficacious. PROSPERO registration number: CRD42015027876.

Younger age, previous participation in outpatient cardiac rehabilitation, admission to a hospital that provides outpatient cardiac rehabilitation, a discharge diagnosis of acute myocardial infarction, and coronary artery bypass surgery were associated with referral to cardiac rehabilitation. Research testing strategies designed to increase cardiac rehabilitation referral rates are needed and could include testing the potential role of modern quality management methods.

No abstract