Barriers to effective diabetes management - a survey of people with severe mental illness.

Mulligan, Kathleen, McBain, Hayley, Lamontagne-Godwin, Frederique ORCID: 0000-0002-9628-7450, Chapman, Jacqui, Flood, Chris, Haddad, Mark, Jones, Julia and Simpson, Alan (2018) Barriers to effective diabetes management - a survey of people with severe mental illness. BMC psychiatry, 18 (1). p. 165. ISSN 1471-244X

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Abstract

People with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of developing type 2 diabetes and have poorer health outcomes than those with diabetes alone. To maintain good diabetes control, people with diabetes are advised to engage in several self-management behaviours. The aim of this study was to identify barriers or enablers of diabetes self-management experienced by people with SMI. Adults with type 2 diabetes and SMI were recruited through UK National Health Service organisations and mental health and diabetes charities. Participants completed an anonymous survey consisting of: Summary of Diabetes Self-Care Activities (SDSCA); CORE-10 measure of psychological distress; a measure of barriers and enablers of diabetes self-management based on the Theoretical Domains Framework; Diabetes UK care survey on receipt of 14 essential aspects of diabetes healthcare. To identify the strongest explanatory variables of SDSCA outcomes, significant variables (p < .05) identified from univariate analyses were entered into multiple regressions. Most of the 77 participants had bipolar disorder (42%) or schizophrenia (36%). They received a mean of 7.6 (SD 3.0) diabetes healthcare essentials. Only 28.6% had developed a diabetes care plan with their health professional and only 40% reported receiving specialist psychological support. Engagement in self-management activities was variable. Participants reported taking medication on 6.1 (SD 2.0) days in the previous week but other behaviours were less frequent: general diet 4.1 (2.3) days; specific diet 3.6 (1.8) days, taking exercise 2.4 (2.1) days and checking feet on 1.7 (1.8) days. Smoking prevalence was 44%. Participants reported finding regular exercise and following a healthy diet particularly difficult. Factors associated with diabetes self-management included: the level of diabetes healthcare and support received; emotional wellbeing; priority given to diabetes; perceived ability to manage diabetes or establish a routine to do so; and perceived consequences of diabetes self-management. Several aspects of diabetes healthcare and self-management are suboptimal in people with SMI. There is a need to improve diabetes self-management support for this population by integrating diabetes action plans into care planning and providing adequate psychological support to help people with SMI manage their diabetes.

Item Type: Article
Additional Information: ** From PubMed via Jisc Publications Router. ** History: received 28-12-2017; accepted 14-05-2018.
Uncontrolled Keywords: Diabetes, Self-management, Service users, Severe mental illness, Theoretical domains framework
Subjects: Medicine and health > Mental health
Medicine and health > Clinical medicine
Medicine and health
SWORD Depositor: Jisc Router
Depositing User: Jisc Router
Date Deposited: 18 Jul 2018 10:03
Last Modified: 18 Jul 2018 10:03
URI: http://repository.uwl.ac.uk/id/eprint/5131

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