Demands of Multiple Behavior Change in Type 2 Diabetes Risk

Reduction (Demandas de cambio de comportamiento múltiple en

la reducción del riesgo de diabetes tipo 2)

Aporte
The author points out that there are several factors that influence individual understanding and
the implementation of the change in behavior needed. First, education about risk usually takes
place in an environment of limited time and resources, which decreases the ability of health care
professionals to effectively communicate the changes in behavior needed. (Fisher W, 2013)
Second, medical professionals may not adhere to the evidence-based procedures described by
the ADA. In one study, a chart audit revealed less than 80% adherence to ADA guidelines by
primary care professionals. (Kirkman M, 2002) And, third, education for risk reduction of type 2
diabetes does not ensure individual participation in behavioral change. Therefore, the author
decides to do a study in which twelve people at risk of type 2 diabetes participated, who
described their experiences with respect to risk reduction activities.

Proceso
This study used a theoretical research design based on the purpose of understanding individual
experience with multiple behavioral changes in the context of recommendations for the
prevention of type 2 diabetes. Therefore, certain points were developed that will be detailed
below:

Recruitment of participants:

In this milestone, the researchers published flyers in health service delivery sites (for example,
primary care clinics) and in the local community (for example, pharmacies, pharmacies,
cafeterias). The flyers indicated the interest of interviewing people 18 years of age or older who
were told by a health care professional that they were at risk of developing type 2 diabetes or
that they had prediabetes. Participants were also recruited through a snowball sampling method
at the end of each interview.

Data collection:

The person in charge of this milestone was a member of the research team who scheduled
interviews with people who indicated interest in the study and reported having ≥ 2 of the
following criteria related to the risk of diabetes: age> 45 years of overweight defined as body
mass index (BMI2)> 25, family history of diabetes, impaired fasting glucose levels (100-125 mg /
dL) or impaired glucose tolerance (plasma glucose values of 2 h in the oral glucose tolerance test
of 140 - 199 mg / dL), hypertension (> 140/90 mmHg), and / or high density lipoprotein
cholesterol ≤35 mg / dL and / or triglyceride level> 250 mg / dL . In addition, participants
provided information on criteria related to the risk of type 2 diabetes (ie, BMI, family history of
type 2 diabetes), information about their insurance (ie, Medicare, private, both, none) and the
usual place of medical attention. Participants also provided demographic information, including
age, gender, ethnicity, employment status, and relationship status.
Data analysis:

The "coding team" consisted of 1 faculty member and 3 students (1 graduate and 2 non-
graduates). The approach of grounded constructivist theory helped the process of analysis.
(Charmaz, 2010) The data was coded for concepts and relationships between concepts through
an initial and focused coding process. At the beginning, each member independently assigned
conceptual labels to the text sections of each interview in relation to the psychosocial factors
(how the participants described their perceptions and feelings) and the process (how the
participants described their actions). In the focused coding process, the team identified the
commonly coded sections and addressed the suitability of the coding labels. Then, the team
created common themes, compared the topics with the associated data, compared the data
with the associated topics and the refined topics (vice versa). Finally, implicit meanings and
processes, as well as conceptual relationships, were explored.

Resultados
The study was carried out with 12 people (9 women, 3 men) it was possible to extract certain
results which will be detailed below:

✓ The BMI of the participants ranged between 21 and 30 (M = 25, SD = 2.9), and most of the
participants reported a family history of type 2 diabetes (8 yes and 4 no).

✓ 6 of all participants reported that their insurance status was private, 4 of them did not have,
and the last 2 had a contract with Medicare.

✓ With respect to health care services, 8 of the participants reported their usual place of medical
care as a family practice environment and 4 in the office.

✓ The participants were between the ages of 25 and 71 (M = 48, SD = 14.7).

✓ 8 participants described themselves as white or European American, 2 participants identified

as Asian American or Pacific Islander, 1 participant identified as Latino or Hispanic American,
and 1 identified as Indian or Native American.

✓ The majority of the participants were employed (9 yes and 3 no) and married / commitment
ceremony (5 married / engagement ceremony, 3 singles and no partner, 2 divorced, 1 single and
deputy, 1 widower).

✓ The racial and ethnic origin of the participants reflected the racial and ethnic population of
the region (80% white, 12% Latino or Hispanic, 2% Asian, 2% black, 2% 2 races, 1% other races
(unidentified) ), 0.5% Native Hawaiian or Pacific Islander, and 0.5% Native American).

These interviews were key because they revealed how the people at risk built and acted
according to their point of view on the recommendations for risk reduction (ie, behavior
change). Participants discussed follow-up with recommendations such as "observing diet,"
"observing carbohydrates," "exercising more," and "learning more information" (through the
ADA, dietitian, or diabetic education class website). ) changes in diet and physical activity and
discussing the importance of self-education (that is, looking for information on the Internet and
in other places with knowledge about type 2 diabetes). The participants described the personal
and social factors that made the change of behavior beyond their reach out of reach. The results
revealed the participation of facilitators and inhibitors in the influence of people on risk, in the
recommended behavior change, especially in the change of multiple behavior. However, these
issues are likely to be interrelated. Facilitators (eg, routine, education, awareness and attitude)
may be affected by inhibitors (eg, expenses / finances, time, too many changes / options and
lack of information) and vice versa. Both topics indicate experiences with the risk reduction of
type 2 diabetes.

Charmaz, K. (2010). Constructing grounded theory: a practical guide through qualitative

analysis.CA: Sage.

Fisher W, C. D. (2013). What primary care providers can do to address barriers to self-
monitoring blood glucose. Clin Diabetes, 31(1), 34-42.

Kirkman M, W. S. (2002). Impact of a program to improve adherence to diabetes guidelines by

primary care physicians. Diabetes Care, 25(11), 1946-1951.

Spring B, S. K. (2012). Multiple behavior changes in diet and activity: a randomized controlled
trial using mobile technology. JAMA, 172(10), 789-796.