Enablement according to communication in the type 2 diabetes mellitus patient
DOI:
https://doi.org/10.32385/rpmgf.v41i3.14016Keywords:
Type 2 diabetes mellitus, Literacy, Enablement, Communication, Quality, ControlAbstract
Objectives: To assess the enablement of Person suffering from type 2 diabetes mellitus (PsT2DM), using the Patient Enablement Instrument (PEI), and the doctor communication, evaluated by the Communication Assessment Tool (CAT), according to context variables.
Methods: Observational cross-sectional study, as an academic and clinical issue, at the Mondego and Manuel Cunha Family Medicine Units in Coimbra, Central Portugal, in a convenience sample representative of the population, recruited between July and October 2023. PEI and CAT were applied, along with context variables such as age, gender, educational level, monthly income, and type of family. The last three were used to calculate the Socio-economic Deprivation Index (SEDI). Chi-square tests, non-parametric statistics, and correlation analyses were used.
Results: A n=110 sample, mostly male (57.3%) and old (65.5% aged ≥65 years), living in company (76.4%), with education (52.7%) and monthly income (62.7%) above the minimum, was studied. The last diabetes appointment occurred three to six months ago for 51.8%, and 51.8% judged their disease not to be controlled. Significant differences were found between age and gender (p=0.027), education level (p=0.001), and income (p=0.002). Spearman correlations between SEDI and PEI were weakly significant and negative (ρ=-0.197, p=0.039); between SEDI and CAT were weak, positive, and not significant (ρ=0.084, p=0.382), and between PEI and CAT were negative, weak, and not significant (ρ=-0.119, p=0.217).
Discussion: In a younger male and older female sample, a low level of education and lower income were observed for individuals aged ≥65 years. A higher socioeconomic index was associated with a higher perception of communication quality by the doctor. Higher enablement was noted for lower socio-economic status enablement was. These communication matters are core to health results and well-played by doctors.
Conclusion: General practice doctors must be attentive to the socioeconomics of the PsT2DM with whom they communicate.
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1. Goyal R, Singhal M, Jialal I. Type 2 diabetes [homepage]. Treasure Island: StatPearls Publishing; 2023 [updated 2023 Jun 23]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513253/
2. Diabetes mellitus complications [homepage]. Amboss [cited 2024 Jan 24]. Available from: https://next.amboss.com/us/article/3g0SE2?q=diabetes%20type%202
3. Ogurtsova K, Guariguata L, Barengo NC, Ruiz PL, Sacre JW, Karuranga S, et al. IDF diabetes atlas: global estimates of undiagnosed diabetes in adults for 2021. Diabetes Res Clin Pract. 2022;183:109118.
4. Pintalhão I, Botas P, Pereira C, Santiago LM. Desenvolvimento de tradução para Português do ‘Patient Enablement Instrument’. Rev ADSO. 2013;1(2):18-22.
5. Marques SN. Physician-patient communication and treatment adherence [dissertation]. Coimbra: Faculdade de Medicina da Universidade de Coimbra; 2022. Available from: https://hdl.handle.net/10316/102371
6. Roma CM. Literacia, capacitação, impacto psicológico e comportamental e autocuidados na diabetes tipo 2: estudo-piloto [dissertation]. Coimbra: Faculdade de Medicina da Universidade de Coimbra; 2019. Available from: https://hdl.handle.net/10316/89964
7. Sousa S, Pereira AM, Santiago LM. Patient-centered medicine and self-care of patients with type 2 diabetes: a cross-sectional study. Acta Med Port. 2024;37(1):3-9.
8. Aveiro M, Santiago LM, Ferreira PL, Simões JA. Estudo de fiabilidade da Escala de Capacidade de Controlo da Diabetes: versão breve [Fiability study of Diabetes Empowerment Scale: short version]. Acta Med Port. 2015;28(2):177-81. Portuguese
9. Gonçalves AP. Capacitação pela consulta do doente diabético e o seu impacto na auto-eficácia no controlo da diabetes e na manutenção da terapêutica [dissertation]. Coimbra: Faculdade de Medicina da Universidade de Coimbra; 2017. Available from: https://hdl.handle.net/10316/82218
10. Bugalho A, Carneiro AV. Intervenções para aumentar a adesão terapêutica em patologias crónicas. Lisboa: Centro de Estudos de Medicina Baseada na Evidência; 2004.
11. Nunes CA. Adesão à terapêutica na doença crónica: literacia em saúde, crenças sobre medicamentos e fontes de informação em saúde [dissertation]. Lisboa: Escola Nacional de Saúde Pública, da Universidade Nova de Lisboa; 2020. Available from: http://hdl.handle.net/10362/106689
12. Lam CL, Yuen NY, Mercer SW, Wong W. A pilot study on the validity and reliability of the Patient Enablement Instrument (PEI) in a Chinese population. Fam Pract. 2010;27(4):395-403.
13. Cabral MV, Silva PA. A adesão à terapêutica em Portugal: atitudes e comportamentos da população portuguesa perante as prescrições médicas, os hábitos de saúde e o consumo de medicamentos [Internet]. Lisboa: Imprensa de Ciências Sociais; 2010. Available from: http://hdl.handle.net/10451/11160
14. Vermeire E, Hearnshaw H, Van Royen P, Denekens J. Patient adherence to treatment: three decades of research – A comprehensive review. J Clin Pharm Ther. 2001;26(5):331-42.
15. Griffith S. A review of the factors associated with patient compliance and the taking of prescribed medicines. Br J Gen Pract. 1990;40(332):114-6.
16. Dias AM, Cunha M, Santos A, Neves A, Pinto A, Silva A, et al. Adesão ao regime terapêutico na doença crónica: revisão da literatura. Millenium. 2011;40(16):201-19.
17. Cravo MG. Literacia em saúde e complicações em pessoas com diabetes tipo 2 [dissertation]. Coimbra: Faculdade de Medicina da Universidade de Coimbra; 2018. Available from: https://hdl.handle.net/10316/81890
18. Pedro AR, Amaral O, Escoval A. Literacia em saúde, dos dados à ação: tradução, validação e aplicação do European Health Literacy Survey em Portugal [Health Literacy, from data to action: translation, validation and application of the European Health Literacy Survey in Portugal]. Rev Port Saúde Pública. 2016;34(3):259-75. Portuguese
19. Ribeiro AI, Launay L, Guillaume E, Launoy G, Barros H. The Portuguese version of the European Deprivation Index: development and association with all-cause mortality. PLoS One. 2018;13(12):e0208320.
20. Santos P, Sá AB, Santiago L, Hespanhol A. A árvore da WONCA: tradução e adaptação cultural para português [The WONCA tree: Portuguese translation and cultural adaptation]. Rev Port Med Geral Fam. 2021;37(1):28-35. Portuguese
21. Coelho BM, Santiago LM. Medicina centrada na pessoa: validação populacional de um instrumento de medida pela pessoa [Person-centered medicine: validation of a person perception instrument]. Rev Port Med Geral Fam. 2022;38(3):247-56. Portuguese
22. Santiago LM, Simões JA, Vale M, Faria E, Ferreira PL, Rosendo I. Auto perceção do desempenho da medicina centrada na pessoa em medicina geral e familiar: criação de um instrumento de medição [Self-awareness of performing patient-centered medicine in general practice/family medicine: development of a measurement scale]. Acta Med Port. 2020;33(6):407-14. Portuguese
23. Lamnisos D, Lambrianidou G, Middleton N. Small-area socioeconomic deprivation indices in Cyprus: development and association with premature mortality. BMC Public Health. 2019;19(1):627.
24. Cardoso MC, Santos AS, Fonseca AD, Silva-Junior RF, Carvalho PD, Martins AM. Validity and reliability of the Health Literacy Assessment Scale for adherence to drug treatment among diabetics. Einstein. 2019;17(2):eAO4405.
25. Mead N, Bower P, Roland M. Factors associated with enablement in general practice: cross-sectional study using routinely-collected data. Br J Gen Pract. 2008;58(550):346-52.
26. Sociedade Portuguesa de Diabetologia. Diabetes: factos e números (relatório anual do Observatório Nacional da Diabetes) [homepage]. Lisboa: SPD; 2023 [cited 2024 Feb 4). Available from: https://www.spd.pt/#/observatorio-da-diabetes
27. Ferreira PL, Santana P. Educational level as a determinant for health: a case study of Portugal. Indian Geogr J. 2003;78(1):5-12.
28. Figueiró RB. Capacitação e adesão à terapêutica farmacológica no idoso [dissertation]. Coimbra: Faculdade de Medicina da Universidade de Coimbra; 2021. Available from: https://hdl.handle.net/10316/98570
29. Santiago LM, Aveiro A, Martins AS, Lopes BF, Queirós MI, Coelho T, et al. Differences between type 2 diabetes controlled and uncontrolled patients in Central Portugal’s primary care. Rev Port Diabetes. 2022;17(3):98-106.
30. Administração Central do Sistema de Saúde. Bilhete de identidade dos indicadores dos cuidados de saúde primários para o ano de 2017 [Internet]. Lisboa: Ministério da Saúde; 2017 Apr 11 [cited 2024 Feb 4]. Available from: https://www.acss.min-saude.pt/wp-content/uploads/2016/07/bilhete_identidade_indicadores_contratualizacao_2017.pdf
31. Pinto DF. Características associadas com o impacto psicológico e comportamental da diabetes tipo 2 [dissertation]. Coimbra: Faculdade de Medicina da Universidade de Coimbra; 2017. Available from: https://hdl.handle.net/10316/82738
32. Correia AL. A empatia e a capacitação do consulente em medicina geral e familiar [dissertation]. Coimbra: Faculdade de Medicina da Universidade de Coimbra; 2015. Available from: https://hdl.handle.net/10316/33268
33. Mercer SW, Jani BD, Maxwell M, Wong SY, Watt GC. Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland. BMC Fam Pract. 2012;13:6.
34. Reis AF, Santiago LM, Botas P. Medicina centrada no paciente e capacitação do consulente em medicina geral e familiar [Patient-centered medicine and enablement in the general practice/family medicine setting]. Rev ADSO. 2015;(05):19-32. Portuguese
35. Hojat M, Vergare MJ, Maxwell K, Brainard G, Herrine SK, Isenberg GA, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med. 2009;84(9):1182-91.
36. Loureiro J, Gonçalves-Pereira M, Trancas B, Caldas-de-Almeida JM, Castro-Caldas A. Empatia na relação médico-doente: evolução em alunos do primeiro ano de medicina e contribuição para a validação da escala Jefferson em Portugal [Empathy in the doctor-patient relationship as viewed by first-year medical students: data on validity and sensibility to change of the Jefferson measure in Portugal]. Acta Med Port. 2011;24 Suppl 2:431-42. Portuguese
37. Chinato IB, D’Agostini CL, Marques RR. A relação médico-paciente e a formação de novos médicos: análises de vivências de hospitalização [Doctor patient relationship and training of new doctors: experiences as an inpatient analysis]. Rev Bras Med Fam Com. 2012;7(22):27-34. Portuguese
38. Costa BS. Barreiras à adesão à terapêutica dietética na diabetes mellitus tipo 2 [dissertation]. Porto: Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto; 2020. Available from: https://hdl.handle.net/10216/128252
39. Baptista S. A empatia na intersubjectividade da relação clínica [Empathy in the doctor-patient relationship]. Rev Port Med Geral Fam. 2012;28(3):224-6. Portuguese
40. Bauman AE, Fardy HJ, Harris PG. Getting it right: why bother with patient-centred care? Med J Aust. 2003;179(5):253-6.
41. Amorim IL, Coelho R. Diabetes mellitus tipo 2 e sintomas psicopatológicos [Type II diabetes mellitus and psycopathological symptoms]. Psicol Saúde Doenç. 2008;9(2):319-33. Portuguese
42. Pereira CS, Santiago LM, Rosendo Silva I, Ferreira P. Validation and cultural adaptation of the Problem Areas in Diabetes-5 (PAID-5) Scale to European Portuguese. Acta Med Port. 2024;37(1):36-41.
43. Huang CL, Wu SC, Jeng CY, Lin LC. The efficacy of a home-based nursing program in diabetic control of elderly people with diabetes mellitus living alone. Public Health Nurs. 2004;21(1):49-56.
44. Schoenberg NE, Traywick LS, Jacobs-Lawson J, Kart CS. Diabetes self-care among a multiethnic sample of older adults. J Cross Cult Gerontol. 2008;23(4):361-76.
45. Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA. 2002;288(4):475-82.
46. Monteiro MI. Doctor-patient relationship and its influence on the outcomes: what is the importance of emotional intelligence when approaching the patient? [dissertation]. Coimbra: Faculdade de Medicina da Universidade de Coimbra; 2023. Available from: https://hdl.handle.net/10316/111529
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