Clark Myra L, Utz Sharon W
Myra L Clark, Sharon W Utz, University of Virginia School of Nursing, Charlottesville, VA 22908-0782, United States.
World J Diabetes. 2014 Jun 15;5(3):296-304. doi: 10.4239/wjd.v5.i3.296.
Diabetes is the sixth leading cause of death in the United States. To date, most research and resulting clinical strategies have focused on the individual with short-term health improvements that have not been maintained over time. Researchers more recently have recognized the need to consider the social determinants of diabetes and health along with individual factors. The purpose of this literature review is to examine current understanding of the social determinants affecting diabetes and health. A search of medical and nursing literature was conducted using PubMed, PsychInfo, CINAHL and MEDLINE databases, selecting articles published between 2000 and 2013. Search terms included: type 2 diabetes, social determinants, and health determinants. Inclusion criteria were: English language, human studies, social determinants of diabetes and health, and research in the United States. Additional search methods included reference chaining of the literature. Twenty research articles met the inclusion criteria for the review and analysis and included quantitative and qualitative methods. All studies selected for this review were descriptive in nature (n = 20). Fifteen studies were quantitative studies and five were qualitative studies. No intervention studies met inclusion criteria. Each study is summarized and critiqued. Study findings indicate that external or upstream factors consistently affect individuals diagnosed with diabetes, influencing self-management. Significant methodological limitations result directly from small sample sizes, convenience or nonprobability sampling, and low statistical power.
糖尿病是美国第六大主要死因。迄今为止，大多数研究及由此产生的临床策略都聚焦于个体，致力于实现短期的健康改善，但这些改善无法长期维持。最近，研究人员认识到需要在考虑个体因素的同时，兼顾糖尿病和健康的社会决定因素。这篇文献综述的目的是审视当前对影响糖尿病和健康的社会决定因素的理解。我们使用PubMed、PsychInfo、CINAHL和MEDLINE数据库对医学和护理文献进行了检索，选取了2000年至2013年间发表的文章。检索词包括：2型糖尿病、社会决定因素和健康决定因素。纳入标准为：英文文献、人体研究、糖尿病和健康的社会决定因素以及美国的研究。其他检索方法包括文献的参考文献链。20篇研究文章符合综述和分析的纳入标准，涵盖了定量和定性方法。本次综述所选的所有研究本质上都是描述性的（n = 20）。15项研究为定量研究，5项为定性研究。没有干预性研究符合纳入标准。对每项研究进行了总结和批判。研究结果表明，外部或上游因素持续影响被诊断为糖尿病的个体，进而影响自我管理。显著的方法学局限性直接源于样本量小、便利抽样或非概率抽样以及统计效力低。
