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Contemporary Family Therapy

, Volume 37, Issue 1, pp 33–44 | Cite as

Qualitative Trends in Biopsychosocial-Spiritual Treatment for Underserved Patients with Type 2 Diabetes

  • Rola O. AamarEmail author
  • Angela L. Lamson
  • Doug Smith
Original Paper

Abstract

Diabetes is a significant and growing concern for minority and underserved populations, especially in rural communities that have limited resources available for best managing complex biopsychosocial challenges. Thus, it is essential to understand patient-identified needs, challenges, and strengths when managing this disease. This study was completed at a community health center for underserved populations in Eastern North Carolina. A qualitative design was used to explore biopsychosocial-spiritual concerns, strengths, and goals from 294 patients with uncontrolled diabetes. Recursive frame analysis was used to analyze the results from clinician constructed progress notes following an integrated care visit with a diabetes educator, medical family therapist, and dietician. This study focused on understanding biological, psychological, social, spiritual concerns, strengths and treatment goals reported by patients. We found that the most commonly reported concern for patients included managing A1c levels, weight, other medical conditions, depressive symptoms, family and financial stressors. The goals reported were related to these concerns. Common strengths included spirituality, social supports, willingness to change, and knowledge about diabetes. This article also highlights commonly reported collaborative therapeutic interventions and recommendations for approaches to care. The use of a collaborative-care team with a holistic approach to health care may provide patients with more comprehensive care. Patients reported strengths, concerns, and goals that were related to multiple aspects of their health (i.e., biological, psychological, social, and spiritual), therefore, to promote best practices in treating diabetes, providers should focus on each of these areas of health during treatment planning.

Keywords

Biopsychosocial-spiritual Diabetes Collaborative Integrated care Minority/underserved populations 

Notes

Acknowledgments

We would like to thank Dr. Kenny Phelps and Ms. Jodimae Lyttle for their work on the data analysis for this project. We would also like to thank Ms. Amelia Muse for her work on editing the manuscript.

Grateful support to funders

The North Carolina Health and Wellness Trust Fund’s Health Disparities Initiative, RCHN Community Health Foundation and the Geiger Gibson Program in Community Health Policy.

References

  1. American Diabetes Association. (2011). Standards of medical care in diabetes—2011. Diabetes Care, 34, S11–S61. doi: 10.2337/dc10-S011.CrossRefPubMedCentralGoogle Scholar
  2. American Diabetes Association. (n.d.). Living with diabetes: Who’s on your health care team? American Diabetes Association. Retrieved from: http://www.diabetes.org/living-with-diabetes/treatment-and-care/whos-on-your-health-care-team/your-health-care-team.html.
  3. Anderson, D., & Christison-Lagay, J. (2008). Diabetes self-management in a community health center: Improving health behaviors and clinical outcomes for underserved patients. Clinical Diabetes, 26(1), 22–27. doi: 10.2337/diaclin.26.1.22.CrossRefGoogle Scholar
  4. Anderson, R. J., Freeland, K. E., Clouse, R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care, 24(6), 1069–1078. doi: 10.2337/diacare.24.6.1069.CrossRefPubMedGoogle Scholar
  5. Bailey, G. R., Barner, J. C., Weems, J. K., Leckbee, G., Solis, R., Montemayor, D., & Pope, N. D. (2012). Assessing barriers to medication adherence in underserved patients with diabetes in Texas. Diabetes Educator, 38, 271–280. doi: 10.1177/0145721711436134.CrossRefPubMedGoogle Scholar
  6. Bastida, E., & Pagan, J. A. (2002). The impact of diabetes on adult employment and earnings of Mexican Americans: Findings from a community based study. Health Economics, 11(5), 403–413. doi: 10.1002/hec.676.CrossRefPubMedGoogle Scholar
  7. Cattich, J., & Knudson-Martin, C. (2009). Spirituality and relationship: A holistic analysis of how couples cope with diabetes. Journal of Marital and Family Therapy, 35(1), 111–124. doi: 10.1111/j.1752-0606.2008.00105.x.CrossRefPubMedGoogle Scholar
  8. Centers for Disease Control and Prevention. (2011). National diabetes fact sheet: National estimates and general information on diabetes and prediabetes in the United States. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from: http://www.cdc.gov/diabetes/pubs/factsheet11.htm?loc=diabetes-statistics.
  9. Chenail, R., Sommers, C., & Benjamin, J. D. (2009). A recursive frame qualitative analysis of MFT progress note tipping points. Contemporary Family Therapy, 31(2), 87–99. doi: 10.1007/s10591-009-9085-7.CrossRefGoogle Scholar
  10. Chesla, C. A., Fisher, L. F., Mullan, J. T., Skaff, M. M., Gardiner, P., Chun, K., & Kanter, R. (2004). Family and disease management in African-American patients with type 2 diabetes. Diabetes Care, 27, 2850–2855. doi: 10.2337/diacare.27.12.2850.CrossRefPubMedGoogle Scholar
  11. Chesla, C. A., Fisher, L. F., Skaff, M. M., Mullan, J. T., Gilliss, C. L., & Kanter, R. (2003). Family predictors of disease management over one year in Latino and European American patients with type 2 diabetes. Family Process, 42, 375–390. doi: 10.1111/j.1545-5300.2003.00375.x.CrossRefPubMedGoogle Scholar
  12. Cox, D. J., & Gonder-Frederick, L. (1992). Major developments in behavioral diabetes research. Journal of Consulting and Clinical Psychology, 60(4), 628–638. http://dx.doi.org/10.1037/0022-006X.60.4.628.
  13. Egede, L. E., & Ellis, C. (2010). The effects of depression on metabolic control and quality of life in indigent patients with type 2 diabetes. Diabetes Technology and Therapeutics, 12(4), 257–262. doi: 10.1089/dia.2009.0143.CrossRefPubMedCentralPubMedGoogle Scholar
  14. Engel, G. L. (1977). The need for a new medical model: A challenge of biomedicine. Science, 196(4286), 129–136. doi: 10.1126/science.847460.CrossRefPubMedGoogle Scholar
  15. Fisher, E. B., Delamater, A. M., Bertelson, A. D., & Kirkley, B. G. (1982). Psychological factors in diabetes and its treatment. Journal of Consulting and Clinical Psychology, 50(6), 993–1003. http://dx.doi.org/10.1037/0022-006X.50.6.993.
  16. Friis, R., & Nanjundappa, G. (1986). Diabetes, depression, and employment status. Social Science and Medicine, 23(5), 471–475. doi: 10.1016/0277-9536(86)90006-7.CrossRefPubMedGoogle Scholar
  17. Gale, J., Chenail, R., Watson, W. L., Wright, L. M., & Bell, J. M. (1997). Research and practice: A reflexive and recursive relationship—Three narratives, five voices. Marriage and Family Review, 24(3–4), 275–295. doi: 10.1300/J002v24n03_03.CrossRefGoogle Scholar
  18. Halford, W. K., Cuddihy, S., & Mortimer, R. H. (1990). Psychological stress and blood glucose regulation in type 1 diabetic patients. Health Psychology, 9(5), 516–528. http://dx.doi.org/10.1037/0278-6133.9.5.516.
  19. Hodgson, J., Lamson, A., Mendenhall, T., & Crane, R. (Eds.). (2014). Medical family therapy: Advanced applications. New York, NY: Springer International Publishing Co.Google Scholar
  20. Katon, W. J., Von Korff, M., Lin, E. H., Simon, G., Ludman, E., Russo, J., et al. (2004). The pathways study: A randomized trial of collaborative care in patients with diabetes and depression. Archives of General Psychiatry, 61, 1042–1049. doi: 10.1001/archpsyc.61.10.1042.CrossRefPubMedGoogle Scholar
  21. Keeney, B. (1991). Improvisational therapy: A practical guide for creative clinical strategies. New York: Guilford Press.Google Scholar
  22. Lin, E. H., Katon, W., Von Korff, M., Rutter, C., Simon, G. E., Oliver, M., et al. (2004). Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care, 27, 2154–2160. doi: 10.2337/diacare.27.9.2154.CrossRefPubMedGoogle Scholar
  23. Lynch, C. P., Hernandez-Tejada, M. A., Strom, J. L., & Egede, L. E. (2012). Association between spirituality and depression in adults with type 2 diabetes. Diabetes Educator, 38(3), 427–435. doi: 10.1177/0145721712440335.CrossRefPubMedCentralPubMedGoogle Scholar
  24. Marlowe, D., Hodgson, J., Lamson, A., White, M., & Irons, T. (2012). Medical family therapy in a primary care setting: A framework for integration. Contemporary Family Therapy, 34, 244–258. doi: 10.1007/s10591-012-9195-5.CrossRefGoogle Scholar
  25. Minuchin, S. (1974). Families and family therapy. Cambridge: Harvard University Press.Google Scholar
  26. Munhall, P. L., & Chenail, R. J. (2007). Qualitative research proposals and reports: A guide (3rd ed.). Boston: Jones & Bartlett.Google Scholar
  27. Nelson, K. M., Chapko, M. K., Reiber, G., & Boyko, G. (2005). The association between health insurance coverage and diabetes care: Data from the 2000 behavioral risk factor surveillance system. Health Services Research, 40(2), 361–372. doi: 10.1111/j.1475-6773.2005.0d362.x.CrossRefPubMedCentralPubMedGoogle Scholar
  28. Noel, L. (2010). An ethnic/racial comparison of causal beliefs and treatment preferences for the symptoms of depression among patients with diabetes. Diabetes Educator, 36(5), 816–827. doi: 10.1177/0145721710380145.CrossRefPubMedGoogle Scholar
  29. Nouwen, A., Ford, T., Balan, A. T., Twisk, J., Ruggiero, L., & White, D. (2011). Longitudinal motivational predictors of dietary self-care and diabetes control in adults with newly diagnosed type 2 diabetes mellitus. Health Psychology, 30(6), 771–779. http://dx.doi.org/10.1037/a0024500.
  30. Osborn, C. Y., Trott, H. W., Buchowski, M. S., Patel, K. A., Kirby, L. D., Hargreaves, M. K., et al. (2010). Racial disparities in the treatment of depression in low-income persons with diabetes. Diabetes Care, 33(5), 1050–1054. doi: 10.2337/dc09-1929.CrossRefPubMedCentralPubMedGoogle Scholar
  31. Phelps, K. W., Hodgson, J. L., Lamson, A. L., Swanson, M. S., & White, M. B. (2010). Satisfaction with life and psychosocial factors among underserved minorities with type 2 diabetes. Social Indicators Research, 106(2), 359–370. doi: 10.1007/s11205-011-9811-z.CrossRefGoogle Scholar
  32. Phelps, K., Howell, C., Hill, S., Seeman, T., Lamson, A., Hodgson, J., & Smith, D. (2009). A collaborative care model for patients with type II diabetes. Families, Systems, and Health, 27(2), 131–140. doi: 10.1037/a0015027.CrossRefPubMedGoogle Scholar
  33. Piette, J. D., Wagner, T. H., Potter, M. B., & Schillinger, D. (2004). Health insurance status, cost-related medication underuse, and outcomes among diabetes patients in three systems of care. Medical Care, 42(2), 102–109. doi: 10.1097/01.mlr.0000108742.26446.17.CrossRefPubMedGoogle Scholar
  34. Prochaska, J., & DiClemente, C. (1984). The transtheoretical approach: Crossing traditional boundaries of therapy. Homewood: Dow/Jones Irwin.Google Scholar
  35. Rambo, L. R. (1993). Understanding religious conversion. New Haven: Yale University Press.Google Scholar
  36. Remler, D. K., Teresi, J. A., Weinstock, R. S., Ramirez, M., Eimicke, J. P., Silver, S., & Shea, S. (2011). Health care utilization and self-care behaviors of medicare beneficiaries with diabetes: Comparison of national and ethnically diverse underserved populations. Population Health Management, 14(1), 11–20. doi: 10.1089/pop.2010.0003.CrossRefPubMedCentralPubMedGoogle Scholar
  37. Robinson, W. D., Barnacle, R. E. S., Pretorius, R., & Paulman, A. (2004). An interdisciplinary student-run diabetes clinic: Reflections on the collaborative training process. Families, Systems, and Health, 22, 490–496. http://dx.doi.org/10.1037/1091-7527.22.4.490.
  38. Rodriguez, H. P., Chen, J., & Rodriguez, M. A. (2010). A national study of problematic care experiences among Latinos with diabetes. Journal of Health Care for the Poor and Underserved, 21(4), 1152–1168. doi: 10.1353/hpu.2010.0923.PubMedGoogle Scholar
  39. Rosland, A., Heisler, M., & Piette, J. D. (2012). The impact of family behaviors and communication on chronic illness outcomes: A systemic review. Journal of Behavioral Medicine, 35, 221–239. doi: 10.1007/s10865-011-9354-4.CrossRefPubMedCentralPubMedGoogle Scholar
  40. Rosland, A. M., Kieffer, E., Israel, B., Cofield, M., Palmisano, G., Sinco, B., et al. (2008). When is social support important? The association of family support and professional support with specific diabetes self-management behaviors. Journal of General Internal Medicine, 23(12), 1992–1999. doi: 10.1007/s11606-008-0814-7.CrossRefPubMedCentralPubMedGoogle Scholar
  41. Ruggerio, L., Moadsiri, A., Butler, P., Oros, S. M., Berbaum, M. L., Whitman, S., & Cintron, D. (2010). Supporting diabetes self-care in underserved populations: A randomized pilot study using medical assistant coaches. Diabetes Educator, 36(1), 127–131. doi: 10.1177/0145721709355487.CrossRefGoogle Scholar
  42. Ruggerio, L., Oros, S., & Choi, Y. K. (2011). Community-based translation of the diabetes prevention program’s lifestyle intervention in an underserved Latino population. Diabetes Educator, 37(4), 564–572. doi: 10.1177/0145721711411107.CrossRefGoogle Scholar
  43. Schokker, M. C., Keers, J. C., Bouma J., Links, T. P., Sanderman, R., Wolffenbuttel, B. H. R., & Hagedoorn, M. (2010). The impact of social comparison information on motivation in patients with diabetes as a function of regulatory focus and self-efficacy. Health Psychology, 29(4), 438–445. http://dx.doi.org/10.1037/a0019878.
  44. Trief, P. M., Morin, P. C., Izquierdo, R., Teresi, J., Starren, J., Shea, S., & Weinstock, R. S. (2006). Marital quality and diabetes outcomes: The IDEATel project. Families, Systems, and Health, 24, 318–331. http://dx.doi.org/10.1037/1091-7527.24.3.318.
  45. Tunceli, K., Bradley, C. J., Nerenz, D., Williams, L. K., Pladevall, M., & Lafata, J. E. (2005). The impact of diabetes on employment and work productivity. Diabetes Care, 28(11), 2662–2667. doi: 10.2337/diacare.28.11.2662.CrossRefPubMedGoogle Scholar
  46. Weed, L. L. (1964). Medical records, patient care and medical education. Irish Journal of Medical Education, 6, 271–282. doi: 10.1007/BF02945791.CrossRefGoogle Scholar
  47. Weinstock, R. S., Teresi, J. A., Goland, R., Izquierdo, R., Palmas, W., Eimicke, J. P., et al. (2011). Glycemic control and health disparities in older ethnically diverse underserved adults with diabetes. Diabetes Care, 34(2), 274–279. doi: 10.2337/dc10-1346.CrossRefPubMedCentralPubMedGoogle Scholar
  48. Wright, L. M., Watson, W. L., & Bell, J. M. (1996). Belief: The heart of healing in families and illness. New York: Basic Books.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Rola O. Aamar
    • 1
    • 2
    Email author
  • Angela L. Lamson
    • 2
  • Doug Smith
    • 3
  1. 1.Department of Community, Family, and Addiction Services, College of Human SciencesTexas Tech UniversityLubbockUSA
  2. 2.Department of Child Development and Family Relations, 112 Redditt House: Medical Family Therapy Research Academy, College of Human EcologyEast Carolina UniversityGreenvilleUSA
  3. 3.Greene County Health Care Inc.Snow HillUSA

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