College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia.
PLoS One. 2022 Aug 8;17(8):e0271980. doi: 10.1371/journal.pone.0271980. eCollection 2022.
Social determinants of health (SDoH) and type 2 diabetes mellitus (T2DM) are interrelated. The prevalence of T2DM is increased amongst those with suboptimal SDoH. Poor SDoH can also negatively impact T2DM self-management. Social determinants of health are mostly considered at population and community levels, rather than individually or clinically. This qualitative study combines the perspectives of a multidisciplinary cohort of health professionals to identify and explore the impact of social determinants on self-management, and ways they could be incorporated into individual clinical care. Purposively selected participants chose to partake in an in-depth, semi-structured, one-on-one interview or focus group. Data were analysed, and themes identified using a combination of deductive and inductive thematic analysis. Fifty-one health professionals volunteered for the study. Two small focus groups (n = 3 and n = 4) and 44 one-on-one interviews were conducted. The identified themes were: 1) Support for incorporating SDoH into T2DM care, 2) Effect of SDoH on T2DM self-management, 3) Identifying and addressing social need, 4) Requirements for incorporating SDoH into T2DM individual clinical care. Health professionals reported that poor social determinants negatively affect an individual's ability to self manage their T2DM. Person-centred care could be enhanced, and people with T2DM may be more likely to achieve self-management goals if SDoH were included in individual clinical care. To achieve successful and sustained self-management for people with T2DM, health professionals require a thorough understanding of T2DM and the effect of social determinants, respect for client privacy, client trust and rapport, effective communication skills, validated tools for assessing SDoH, team champions, teamwork, ongoing education and training, adequate resources, guiding policies and procedures, and management support. Incorporating SDoH into individual, clinical care for people with T2DM was strongly supported by health professionals. If embraced, this addition to care for individuals with T2DM could improve self-management capacity and enhance person-centred care.
社会决定因素(SDoH)和 2 型糖尿病(T2DM)是相互关联的。那些社会决定因素较差的人,T2DM 的发病率会增加。较差的社会决定因素也会对 T2DM 的自我管理产生负面影响。社会决定因素主要在人群和社区层面考虑,而不是个人或临床层面。这项定性研究结合了多学科健康专业人员的观点,以确定和探讨社会决定因素对自我管理的影响,以及将它们纳入个人临床护理的方法。有针对性地选择参与者选择参加深入的、半结构化的一对一访谈或焦点小组。使用演绎和归纳主题分析相结合的方法对数据进行分析和主题识别。51 名健康专业人员自愿参加了这项研究。进行了两个小型焦点小组(n = 3 和 n = 4)和 44 次一对一访谈。确定的主题是:1)支持将 SDoH 纳入 T2DM 护理,2)SDoH 对 T2DM 自我管理的影响,3)识别和解决社会需求,4)将 SDoH 纳入 T2DM 个人临床护理的要求。健康专业人员报告称,较差的社会决定因素会严重影响个人管理 T2DM 的能力。如果将 SDoH 纳入个人临床护理,以患者为中心的护理可以得到加强,T2DM 患者可能更有可能实现自我管理目标。为了使 T2DM 患者实现成功和持续的自我管理,健康专业人员需要全面了解 T2DM 和社会决定因素的影响,尊重客户隐私、客户信任和融洽关系、有效的沟通技巧、经过验证的 SDoH 评估工具、团队拥护者、团队合作、持续的教育和培训、充足的资源、指导政策和程序以及管理支持。将 SDoH 纳入 T2DM 患者的个人临床护理得到了健康专业人员的大力支持。如果被接受,这种对 T2DM 患者护理的补充可以提高自我管理能力并增强以患者为中心的护理。
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