Abstract:Although several evidence-based guidelines for managing diabetes are available, few, if any, focus on the psychosocial aspects of this challenging condition. It is increasingly evident that psychosocial treatment is integral to a holistic approach of managing diabetes; it forms the key to realizing appropriate biomedical outcomes. Dearth of attention is as much due to lack of awareness as due to lack of guidelines. This lacuna results in diversity among the standards of clinical practice, which, in India, is a… Show more
“…Furthermore, prior to implementing this culturally-appropriate care model (named IN tegrated DEP r E ssio N and D iabetes Treatm ENT [INDEPENDENT]), we sought to gather information and perspectives from individuals involved in diabetes care in India to ensure the intervention aligns with the cultural and economic context in which it is situated. (Kalra, Balhara, & Mithal, 2013; Kalra, Sridhar, et al, 2013; Sridhar & Madhu, 2002) As its foundation, INDEPENDENT will include, 1) non-physician care coordinators that are trained in basic psychotherapeutic techniques (motivational interviewing, behavioral activation, problem solving techniques), 2) an electronic health record enhanced with guideline-based prompts for physicians, and 3) oversight by specialists to regularly audit and improve clinical decision-making. The goal of this qualitative study was to inform the culturally sensitive intervention modifications necessary for the INDEPENDENT model of diabetes and depression care to be effective in India.…”
Aims
Depression and diabetes are highly comorbid, adversely affecting treatment adherence and resulting in poor outcomes. To improve treatment and outcomes for people dually-affected by diabetes and depression in India, we aimed to develop and test an integrated care model. In the formative phase of this INtegrated DEPrEssioN and Diabetes TreatmENT (INDEPENDENT) study, we sought stakeholder perspectives to inform culturally-sensitive adaptations of the intervention.
Methods
At our Delhi, Chennai, and Vishakhapatnam sites, we conducted focus groups for patients with diabetes and depression and interviewed healthcare workers, family members, and patients. These key informants were asked about experiences with diabetes and depression and for feedback on intervention materials. Data were analyzed using a grounded theory approach.
Results
Three major themes emerged that have bearing on adaptation of the proposed intervention: importance of family assistance, concerns regarding patient/family understanding of diabetes, and feedback regarding the proposed intervention (e.g. adequate time needed for implementation; training program and intervention should address stigma).
Conclusions
Based on our findings, the following components would add value when incorporated into the intervention: 1) engaging families in the treatment process, 2) clear/simple written information, 3) clear non-jargon verbal explanations, and 4) coaching to help patients cope with stigma.
“…The publication of comprehensive guidelines on this topic has improved awareness of the importance of psychosocial care as a part of diabetology praxis. 3,4 Simultaneously, enhanced appreciation of the patient-centered model of care has created an environment where psychosocial aspects are given due consideration.…”
Section: Alexithymia As An Adjective For the Diabetes Care Professionalmentioning
Alexithymia is a personality trait that refers to the inability to express emotions in words. Medical professionals have been criticized for being “alexithymic” by many observers. From a clinician’s perspective, an alexithymic diabetes care professional is one who is unable to empathize with the patient, or to understand the patient’s emotional status and needs. In overzealous attempts at being “patientcentric,” one often tends to undermine the importance of the fact that diabetes care is a two-way process. The diabetes care professional is as important a component of diabetology as the person with diabetes. Balanced models and constructs are available which highlight the equal importance of the physician and other stakeholders of the healthcare system as well. The term we propose is “eulexithymia,” which we define as a balanced ability to express one’s emotions and understand others’ feelings. When used to describe a diabetes care professional, a “eulexithymic” professional is one who understands and responds to a patient’s feelings in a balanced manner, without letting oneself be unduly and inappropriately affected by them.
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