Rao Deepa, Lipira Lauren, Kumar Shuba, Mohanraj Rani, Poongothai Subramani, Tandon Nikhil, Sridhar G R, Katon Wayne, Narayan Km Venkat, Chwastiak Lydia, Mohan Viswanathan, Ali Mohammed K
Department of Global Health; Department of Psychiatry and Behavioral Sciences, Health Services University of Washington, Seattle, USA.
Department of Health Services, University of Washington, Seattle, USA.
Int J Noncommun Dis. 2016;1(2):65-75. doi: 10.4103/2468-8827.191979. Epub 2016 Oct 12.
Depression and diabetes are highly comorbid, adversely affecting treatment adherence and resulting in poor outcomes. To improve treatment and outcomes for people dually-affected by diabetes and depression in India, we aimed to develop and test an integrated care model. In the formative phase of this INtegrated DEPrEssioN and Diabetes TreatmENT (INDEPENDENT) study, we sought stakeholder perspectives to inform culturally-sensitive adaptations of the intervention.
At our Delhi, Chennai, and Vishakhapatnam sites, we conducted focus groups for patients with diabetes and depression and interviewed healthcare workers, family members, and patients. These key informants were asked about experiences with diabetes and depression and for feedback on intervention materials. Data were analyzed using a grounded theory approach.
Three major themes emerged that have bearing on adaptation of the proposed intervention: importance of family assistance, concerns regarding patient/family understanding of diabetes, and feedback regarding the proposed intervention (e.g. adequate time needed for implementation; training program and intervention should address stigma).
Based on our findings, the following components would add value when incorporated into the intervention: 1) engaging families in the treatment process, 2) clear/simple written information, 3) clear non-jargon verbal explanations, and 4) coaching to help patients cope with stigma.
抑郁症和糖尿病高度共病，对治疗依从性产生不利影响并导致不良后果。为改善印度糖尿病和抑郁症双重患者的治疗及预后，我们旨在开发并测试一种综合护理模式。在这项综合抑郁症与糖尿病治疗（INDEPENDENT）研究的形成阶段，我们寻求利益相关者的观点，以为干预措施的文化敏感适应性提供信息。
在我们位于德里、金奈和维沙卡帕特南的研究点，我们为糖尿病和抑郁症患者开展了焦点小组讨论，并对医护人员、家庭成员和患者进行了访谈。这些关键信息提供者被问及糖尿病和抑郁症的经历以及对干预材料的反馈。数据采用扎根理论方法进行分析。
出现了三个与所提议干预措施的适应性相关的主要主题：家庭协助的重要性、对患者/家庭对糖尿病理解的担忧以及对所提议干预措施的反馈（例如实施所需的充足时间；培训计划和干预措施应解决耻辱感问题）。
基于我们的研究结果，以下组成部分纳入干预措施时将增加其价值：1）让家庭参与治疗过程，2）清晰/简单的书面信息，3）清晰的非专业术语口头解释，以及4）指导以帮助患者应对耻辱感。
