Rev Saude Publica. 2006 Apr;40(2):310-7. Epub 2006 Mar 29.

Links
[Eating behavior among type 2 diabetes women]
[Article in Portuguese]

Peres DS, Franco LJ, dos Santos MA.

Departamento de Medicina Social, Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Av. Bandeirantes 3900, Monte Alegre, 14049-900 Ribeirao Preto, SP, Brasil. desiperes@ig.com.br

OBJECTIVE: To explore type 2 diabetes women's thoughts, feelings and behaviors concerning diet. METHODS: A descriptive, exploratory qualitative study was carried out among eight type 2 diabetes women from a primary health care unit in Southeastern Brazil in January 2003. A semi-structured interview was applied for data collection. The theoretical reference was the theory of social representations. The interviews were recorded, transcribed and then their thematic content was analyzed. RESULTS: The study results showed women's difficulty in following the prescribed diet due to several associated meanings, such as loss of eating and drinking pleasure and loss of eating autonomy and free choice. Following the diet elicits an extremely aversive and restrictive attitude, and complying with it is associated to damage to health. The frequent absence of symptoms was mentioned as one reason that prevents compliance to the diet. Other difficulties reported were touching, looking at, and handling foods during their preparation but not being allowed to eat them. Sweet foods revealed to be extremely desired. Transgression and food desire are equally present in their life. Following the recommended diet brings sadness and the act of eating is frequently accompanied by fear, guilt and anger. CONCLUSIONS: Type 2 diabetes women's eating behavior is very complex and needs to be understood from its psychological, biological, social, cultural and economic aspects for promoting more effective educational interventions.

J Nutr Educ. 2001 Jul-Aug;33(4):224-33.

Links

Food selection and eating patterns: themes found among people with type 2 diabetes mellitus.
Savoca M, Miller C.

Department of Nutrition and Foodservice Systems, University of North Carolina at Greensboro, Greensboro, North Carolina 27402-6170, USA.

OBJECTIVE: The objective of this study was to examine the beliefs and perspectives among people with type 2 diabetes mellitus about dietary requirements, food selection and eating patterns, and attitudes about selfmanagement practices. DESIGN: Semistructured, in-depth interviews explored participants' experiences with diabetes prior to their diagnosis, participants' understanding of the guidelines for the nutritional management of diabetes, how participants applied their understanding of dietary guidelines to daily food selection and eating patterns, and the social and personal themes influencing participants' food selection and eating patterns. SUBJECTS: Interviews were conducted with members of a convenience sample of 45 men and women diagnosed with type 2 diabetes for at least 1 year. ANALYSES PERFORMED: Interviews were coded using a conceptual matrix derived from participants' statements. Common characteristics were grouped, and broad themes were identified. RESULTS: Eating patterns were influenced by participants' knowledge of diabetes management. Challenges that participants encountered when applying nutrition recommendations were linked to their prior eating practices. Dietary self-efficacy, social support, and time management were identified as mediating variables that can influence dietary behaviors. IMPLICATIONS: Diabetes nutrition education programs should increase awareness of eating history, spousal support, and time management practices. Future research should include the refinement and validation of a nutritional management model of diabetes. Rev Med Inst Mex Seguro Soc. 2006 Jan-Feb;44(1):47-59.

Links

[Chronic illnesses and education. Diabetes mellitus as a paradigm]

[Article in Spanish]

Viniegra-Velazquez L.

Instituto Mexicano del Seguro Social. leonardo.viniegra@imss.gob.mx

The purpose of this essay is to controvert ideas that prevail about chronic illnesses, using type 2 diabetes mellitus as an example, and to propose another way of thinking, perceiving, and acting towards them. Initially the dominant vision of the disease as a deviation from the health path is confronted with another one that considers it as a specific way of being of certain groups of persons. It brings out how the idea of deviation, when favoring the technical aspects of medical practice, often compares the organism with a machine. On the other hand, the idea of disease as a way of being when rescuing the most distinctive qualities of life, allows a more penetrating understanding of the patient and his illness. Trying to overcome the limitations that the notion of natural history of disease impose, the concept of cultural history of disease is proposed, showing how culture has a determining role in the expression of illnesses. The role and type of education within the strategies of health care in chronic diseases are discussed. Participatory education--particularly in the therapeutic communities of patients--is proposed as the most powerful resource to bring the patient closer to better life circumstances and healthier habits that allow the self-control of the illness.

Rural Remote Health. 2006 Jul-Sep;6(3):606. Epub 2006 Aug 15.

Links
Educating to improve population health outcomes in chronic disease: an innovative workforce initiative across remote, rural and Indigenous communities in northern Australia.
Smith JD, O'Dea K, McDermott R, Schmidt B, Connors C.

RhED Consulting Pty Ltd, NSW, Faculty of Medicine, Health and Molecular Sciences, James Cook University, Townsville, Queensland, Australia. janie.dadesmith@bigpond.com

INTRODUCTION: Like Indigenous populations in other countries, an epidemic of chronic disease has swept across Australia's Indigenous communities in the past decade. The Northern Territory and Queensland health departments initiated preventable chronic disease strategies in 1999 and 2001, respectively. Yet finding innovative ways to translate this to the health workforce was challenging. Through support from the Australian Government, three universities, two health departments and two Indigenous organisations worked in partnership to improve workforce capacity in remote and rural communities through innovative education. METHODS: The methods included: (i) a training needs analysis consisting of 76 semi-structured interviews with key informants, and 35 surveys of remote staff; (ii) a literature and resource review; (iii) the development of a curriculum framework using: the existing competencies and standards across the health disciplines; the identified workforce needs; and what the workforce can impact upon; (iv) a multidisciplinary workshop with 35 educators across northern Australia that resulted in the basis for agreement of the final curriculum content and framework; (v) the development of a chronic disease self-assessment tool that was piloted with remote health staff; (vi) an assisted integration process for key stakeholders. An evaluation framework was also developed, as a separate project, in conjunction with the project partners during this time. RESULTS: This project identified that a paradigm shift is required in the way in which we educate the entire health workforce to deal effectively with the impact of chronic disease across remote, rural and Indigenous populations. In particular a need was found to educate the educators in the chronic care model and in using a population health approach. The training needs analysis identified very little difference between the education and training needs across the rural and remote health disciplines; it was perceived that they managed chronic disease fairly well yet found prevention and early detection to be at the 'hard end'. The main barriers identified were the demands of acute care over chronic disease management, compounded by high workforce turnover in remote areas. The curriculum framework, in particular the domains of remote practice, is being used by

several Australian universities, health departments and non-government organisations in adapting their existing or new education programs. The selfassessment tool was based on the curriculum outcomes and was piloted in 2005 and found to be very useful for pre- and post-training purposes and as a discussion starter for all disciplines and groups. CONCLUSIONS: A practical curriculum framework now exists to integrate a population health approach for the prevention and early detection of chronic disease when educating the primary healthcare workforce. It is relevant to all health disciplines and is flexible in that it can be adapted, or adopted, depending on the educational needs of the disciplinary group. It is being imbedded into numerous undergraduate, postgraduate, and professional development programs in Australia. It includes: the core learning outcomes expected of any workforce, resources, and a self-assessment tool in chronic disease. These tools are assisting educators in the required paradigm shift required of the workforce to alter the single disease based practice model towards a comprehensive and integrated population based approach required for the workforce in the 21st century.