Is adherence a relevant issue in the self-management education of diabetes? A mixed narrative review

Xavier Debussche Endocrinology, Diabetology and Nutrition, CHU Félix Guyon, Saint-Denis, Réunion, France Abstract: While therapeutic patient education is now recognized as essential for optimizing the control of chronic diseases and patient well-being, adherence to treatment...

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Autor principal:	Debussche X
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/6245cc625c2d492ebeae540b4ded54d0
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spelling	oai:doaj.org-article:6245cc625c2d492ebeae540b4ded54d02021-12-02T02:48:10ZIs adherence a relevant issue in the self-management education of diabetes? A mixed narrative review1178-7007https://doaj.org/article/6245cc625c2d492ebeae540b4ded54d02014-07-01T00:00:00Zhttp://www.dovepress.com/is-adherence-a-relevant-issue-in-the-self-management-education-of-diab-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007 Xavier Debussche Endocrinology, Diabetology and Nutrition, CHU Félix Guyon, Saint-Denis, Réunion, France Abstract: While therapeutic patient education is now recognized as essential for optimizing the control of chronic diseases and patient well-being, adherence to treatment and medical recommendations is still a matter of debate. In type 2 diabetes, the nonadherence to therapy, estimated at more than 40%, is perceived as a barrier for improving the prognosis despite recent therapeutic advances. Interventional studies have barely begun to demonstrate the effectiveness of technical and behavioral actions. The aim of this review is to question the concept of adherence in terms of therapeutic education based on quantitative and qualitative data. The research on therapeutic education has shown the effectiveness of structured actions in type 2 diabetes, but adherence is rarely an end point in randomized trials. A positive but inconsistent or moderate effect of education actions on adherence has been shown in heterogeneous studies of varying quality. Program types, outlines, theoretical bases, and curricula to set up for action effectiveness are still being discussed. Qualitative studies, including sociological studies, provide a useful and constructive focus on this perspective. Adherence is a soft and flexible tool available to the patient in his/her singular chronic disease trajectory, and as such, integrates into individual therapeutic strategies, including socio-cultural interactions, beyond the medical explanation of the disease and the patient. Four key elements for the development of structured therapeutic education are discussed: 1) the access to health literacy, 2) the contextualization of education activities, 3) the long-term chronic dimension of self-management, and 4) the organizational aspects of health and care. Rather than focusing the objective on behavioral changes, structured therapeutic education actions should attempt to provide tools and resources aimed at helping individuals to manage their disease in their own context on a long-term basis, by developing health literacy and relational and organizational aspects of the health professionals and system. Keywords: self-management, chronic disease, mixed research, health literacy, social context, lifestyleDebussche XDove Medical PressarticleSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol 2014, Iss default, Pp 357-367 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Specialties of internal medicine RC581-951
spellingShingle	Specialties of internal medicine RC581-951 Debussche X Is adherence a relevant issue in the self-management education of diabetes? A mixed narrative review
description	Xavier Debussche Endocrinology, Diabetology and Nutrition, CHU Félix Guyon, Saint-Denis, Réunion, France Abstract: While therapeutic patient education is now recognized as essential for optimizing the control of chronic diseases and patient well-being, adherence to treatment and medical recommendations is still a matter of debate. In type 2 diabetes, the nonadherence to therapy, estimated at more than 40%, is perceived as a barrier for improving the prognosis despite recent therapeutic advances. Interventional studies have barely begun to demonstrate the effectiveness of technical and behavioral actions. The aim of this review is to question the concept of adherence in terms of therapeutic education based on quantitative and qualitative data. The research on therapeutic education has shown the effectiveness of structured actions in type 2 diabetes, but adherence is rarely an end point in randomized trials. A positive but inconsistent or moderate effect of education actions on adherence has been shown in heterogeneous studies of varying quality. Program types, outlines, theoretical bases, and curricula to set up for action effectiveness are still being discussed. Qualitative studies, including sociological studies, provide a useful and constructive focus on this perspective. Adherence is a soft and flexible tool available to the patient in his/her singular chronic disease trajectory, and as such, integrates into individual therapeutic strategies, including socio-cultural interactions, beyond the medical explanation of the disease and the patient. Four key elements for the development of structured therapeutic education are discussed: 1) the access to health literacy, 2) the contextualization of education activities, 3) the long-term chronic dimension of self-management, and 4) the organizational aspects of health and care. Rather than focusing the objective on behavioral changes, structured therapeutic education actions should attempt to provide tools and resources aimed at helping individuals to manage their disease in their own context on a long-term basis, by developing health literacy and relational and organizational aspects of the health professionals and system. Keywords: self-management, chronic disease, mixed research, health literacy, social context, lifestyle
format	article
author	Debussche X
author_facet	Debussche X
author_sort	Debussche X
title	Is adherence a relevant issue in the self-management education of diabetes? A mixed narrative review
title_short	Is adherence a relevant issue in the self-management education of diabetes? A mixed narrative review
title_full	Is adherence a relevant issue in the self-management education of diabetes? A mixed narrative review
title_fullStr	Is adherence a relevant issue in the self-management education of diabetes? A mixed narrative review
title_full_unstemmed	Is adherence a relevant issue in the self-management education of diabetes? A mixed narrative review
title_sort	is adherence a relevant issue in the self-management education of diabetes? a mixed narrative review
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/6245cc625c2d492ebeae540b4ded54d0
work_keys_str_mv	AT debusschex isadherencearelevantissueintheselfmanagementeducationofdiabetesamixednarrativereview
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Is adherence a relevant issue in the self-management education of diabetes? A mixed narrative review

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