Self-management Experience of Middle-aged and Older Adults With Type 2 Diabetes: A Qualitative Study

Abstract

Purpose: Diabetes mellitus has been either the fourth or fifth leading cause of death among Taiwanese adults during 1995e2015. Older adults with diabetes are at higher risk of developing diabetic macrovascular and micro-vascular complications. The purpose of this study explored the self-management experiences of middle-aged and older adults with diabetes through a focus group. Methods: Purposive sampling was used to recruit patients with diabetes from the metabolic outpatient clinics of medical centers and regional hospitals in Taiwan. Two focus groups, comprising a total of 23 participants, were employed to collect data, and group discussions were held a total of four times in an education room that was distant from clinical areas. Results: Three themes were generated from analysis of the collected data: (1) "listening to the voice of the body and observing physical changes," (2) "re-recognizing diabetes and challenges," and (3) "selfmanagement implementation dilemmas." This study provided new insights into the experiences of middle-aged and older adults in Taiwan regarding their self-management of diabetes. Conclusion: Healthcare teams should be involved in the self-management education of patients with diabetes as early as possible to reduce patients' anxiety and to develop more patient-centered, culturesensitive clinical skills. In addition to monitoring patients' self-management, healthcare professor should pay more attention to patients' successful adaptation to and coexistence with the disease.

Wavering Diabetic Diet: “I Break the Diet and Then I Feel Guilty and Then I Don’t Go Back to It, In Case I Feel Guilty Again”

“…Social and work situations, as well as personal problems, also generated negative emotions as some participants felt compelled (due to availability) to eat foods outside their recommended diet. Social and environmental stimuli and cues, and bad food choices, have been reported to be some of the main sources for lack of a sense of control over dietary selfcare (Fukuoka et al, 2014;Wu et al, 2019). Thus, the best way to avoid poor dietary intake in such situations was to reduce social events and stay at home, to avoid temptation.…”

“…Thus, the best way to avoid poor dietary intake in such situations was to reduce social events and stay at home, to avoid temptation. Unfortunately, such self-imposed restrictions could result in social isolation (Wu et al, 2019) and precipitate anger and depression (Penckofer et al, 2007). In contrast, Sumlin and Brown (2017) report that African American women felt some freedom (and perhaps were happier) making food choices in social settings and at restaurants because they had the opportunity to eat traditional foods and larger portions compared with eating at home.…”

“…People struggle with old dietary habits because they lose the "traditional food flavours" they are used to when they try to maintain healthier practices (Lee et al, 2019;Sumlin & Brown, 2017). Thus, food itself may have complex meanings, and acquire associations with pleasure, relaxation, reward, and comfort (e.g., Desmet & Schifferstein, 2008;Locher et al, 2005;Wu et al, 2019). For many people with diabetes, following the recommended diet has been associated with the loss of the pleasure of eating, a feeling of restriction, and frustration at their inability to choose desired foods (Peres et al, 2008;Schure et al, 2019;Wu et al, 2019).…”

“…Thus, food itself may have complex meanings, and acquire associations with pleasure, relaxation, reward, and comfort (e.g., Desmet & Schifferstein, 2008;Locher et al, 2005;Wu et al, 2019). For many people with diabetes, following the recommended diet has been associated with the loss of the pleasure of eating, a feeling of restriction, and frustration at their inability to choose desired foods (Peres et al, 2008;Schure et al, 2019;Wu et al, 2019). They have also expressed negative attitude toward food as they struggle between "good food" and "bad food" and perceive "food as the enemy" (Fukuoka et al, 2014).…”

“…Kiguli et al (2019) investigated dietary patterns and practices and reported financial constraints limiting food choices, while Schure et al (2019) explored dietary beliefs and self-management practices, of which participants reported frustration with dietary maintenance. The need for self-control and self-efficacy over dietary intake, as well as dietary restrictions and struggling with traditional dietary habits, have also been reported (Lee et al, 2019;Thojampa, 2019;Wu et al, 2019). According to Wu et al (2019), dietary restrictions produced anger that resulted in poor dietary intake, while lack of self-control (poor dietary intake due to social pressure) resulted in a sense of guilt.…”