Dahl Marie, Søndergaard Susanne Friis, Diederichsen Axel, Pouwer Frans, Pedersen Susanne S, Søndergaard Jens, Lindholt Jes
Vascular Research Unit, Department of Surgery, Regional Hospital Central Denmark, Toldbodgade 12, DK-8800, Viborg, Denmark.
Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, DK-8200, Aarhus N, Denmark.
BMC Public Health. 2021 Jan 22;21(1):203. doi: 10.1186/s12889-021-10172-6.
Type 2 diabetes (T2D) is associated with a significantly increased risk of cardiovascular disease (CVD). The DIAbetic CArdioVAscular Screening and intervention trial (DIACAVAS) was designed to clarify whether advanced imaging for subclinical atherosclerosis combined with medical treatment is an effective strategy to develop individualised treatment algorithms for Danish men and women with T2D aged 40-60. But in the DIACAVAS pilot study, the uptake was only 41%. Consequently, we explored how people experienced living with T2D to understand how to improve the uptake in initiatives targeting the prevention of CVD.
We used semi-structured interviews to obtain information on how the respondents experienced having T2D. For supplementary information, we used structured interviews on e.g. socioeconomic factors. From April to October 2019, 17 participants aged 40-60 years were recruited from general practices and diabetes outpatient clinics in Denmark. Several levels of analysis were involved consistent with inductive content analysis.
The participants' experiences of living with T2D fell along two continuums, from an emotional to a cognitive expression and from reactive to proactive disease management. This led to identification of four archetypal characteristics: (I) powerlessness, (II) empowerment, (III) health literacy, and (IV) self-efficacy. These characteristics indicated the importance of using different approaches to facilitate participation in cardiovascular preventive initiatives. Additionally, findings inspired us to develop a model for facilitating participation in future preventive initiatives.
Encouraging people with T2D to participate in cardiovascular preventive initiatives may necessitate a tailored invitation strategy. We propose a model for an invitational process that takes into consideration invitees' characteristics, including powerlessness, empowerment, health literacy and self-efficacy. This model may enhance participation in such initiatives. However, participation is a general concern, not only in relation to cardiovascular prevention. Our proposed model may be applicable in preventive services for people with T2D in general.
2型糖尿病（T2D）与心血管疾病（CVD）风险显著增加相关。糖尿病心血管筛查与干预试验（DIACAVAS）旨在阐明亚临床动脉粥样硬化的高级成像结合药物治疗是否是为40 - 60岁丹麦T2D男性和女性制定个体化治疗方案的有效策略。但在DIACAVAS试点研究中，参与率仅为41%。因此，我们探究了人们患T2D的生活体验，以了解如何提高针对预防CVD的项目的参与率。
我们采用半结构化访谈来获取受访者患T2D的体验信息。为获取补充信息，我们使用了关于社会经济因素等的结构化访谈。2019年4月至10月，从丹麦的普通诊所和糖尿病门诊招募了17名年龄在40 - 60岁的参与者。分析涉及与归纳性内容分析一致的几个层次。
参与者患T2D的体验沿着两个连续体分布，从情感表达到认知表达，以及从反应性疾病管理到主动性疾病管理。这导致识别出四种原型特征：（I）无力感，（II）赋权，（III）健康素养，以及（IV）自我效能感。这些特征表明采用不同方法促进参与心血管预防项目的重要性。此外，研究结果启发我们开发一个促进参与未来预防项目的模型。
鼓励T2D患者参与心血管预防项目可能需要量身定制的邀请策略。我们提出一个邀请流程模型，该模型考虑被邀请者的特征，包括无力感、赋权、健康素养和自我效能感。这个模型可能会提高对此类项目的参与度。然而，参与是一个普遍关注的问题，不仅与心血管预防有关。我们提出的模型可能普遍适用于T2D患者的预防服务。
