Background: Stigma is an important construct that can be shared and recalled by family members affected by diabetes. Stigma and disclosure beliefs are formed and passed down by families in the multigenerational context of diabetes. Insulin is an object of stigma in diabetes treatment, influencing health behavior and quality of life. Methods: Hospitalized adults in a Northeast Coast Metropolitan area in the United States of America with diabetes who were newly initiated onto insulin were surveyed to assess the validity and reliability of the family social consequences of diabetes treated with insulin. The survey items were factor analyzed and tested for internal consistency reliability. The predictive ability of the survey to assess diabetes-specific health-related quality-of-life was assessed. Results: The survey identified two highly valid and reliable components that measure recollections of family stigma and family disclosure within the context of insulin use in the multigenerational legacy of diabetes. Family stigma explained 59% variance, and family disclosure explained 70% variance. The survey significantly predicted diabetes-related health quality of life (R2 = 0.35, P = 0.02) with family stigma contributing uniquely to explaining variance in quality-of-life scores. Conclusion: Family stigma and disclosure are measurable constructs capable of predicting quality of life. In the presence of recollections of family stigma and disclosure of insulin use, individuals experience sub-optimal health-related quality of life. Nurses and diabetes educators can assess the impact of family experiences on health outcomes.
Introduction: Women with gestational diabetes mellitus (GDM) have a higher prevalence of periodontal disease, whilst oral health is implicated in blood glucose management and GDM development. Oral health may also impact birth weight and prematurity; however, it is often an overlooked topic in maternity care. The complexity and intensity of GDM, and the higher prevalence of psychological distress associated with this condition, call for a tailored approach to oral health care in GDM. Oral health deserves more attention in GDM considering its impact on diabetes and pregnancy-related outcomes. Aim and methods: This study aimed to explore the support needs of women regarding oral health care within the context of GDM management and to identify specific intervention strategies to address these needs. Semi-structured interviews inspired by co-design principles were conducted, and thematic analysis was used to analyse the data. The output was the development of a theory and evidence-derived care delivery model for healthcare professionals (HCPs) to promote oral health in GDM. Results and conclusions: The model instructs HCPs in oral health care delivery in GDM. Specifically, the model describes what is needed to engage women with GDM in oral health care and proposes specific intervention strategies to accommodate these needs. The model can also be applied in maternity care to provide HCPs with a structured approach to addressing oral health. The utilisation of our model may improve oral health status, blood glucose management, and health outcomes for women with GDM.
Background: Individuals with type 1 diabetes (T1D) are increasingly living into older age, when cognitive impairment (CI) may co-exist. T1D further increases the risk of CI, which can result in physical, psychological, and social impacts in the individual, their families, and/or informal carers. These factors also present professional challenges for the healthcare professionals (HCPs) who support them. Diabetes specialist nurses (DSNs) are well positioned to provide insights on the impact of CI in this group, suggest potential support solutions, and identify care delivery pathways aimed at improving outcomes. Previous research in this area is very limited. Methods: Data were collected via individual semi-structured interviews with a purposive sample of eight Finnish DSNs, with experience of working with older adults with T1D and CI. Interviews were audio-recorded and transcribed verbatim. Inductive thematic analysis was conducted to analyse the data. Findings: Four key themes were identified: 1) indicators of CI; 2) impact of CI; 3) professional challenges; 4) solutions and care delivery. Our findings suggest a lack of consistent CI screening practices in this group and multiple impacts on an individual’s ability to self-manage. Potential hazards and increased care needs, in turn, affect their families/close social networks, as well as care providers. Participants suggested several solutions, including: the value of a consistent therapeutic nurse/patient/family relationship, non-stigmatising early screening and identification of CI, advanced care planning, and patient education involving the person and their families. Incorporating a multi-disciplinary team approach, and the development of CI-specific education and guidelines for carers, HCPs, and policy makers, were identified as key priorites. Conclusion: There are several impacts of T1D complicated by CI. However, our participants were able to identify mitigating strategies and solutions that deserve further exploration and implementation. Whilst this study was based in Finland, the results may be applicable to other geographical locations with similarly increasing prevalence rates of CI in T1D.
Background: Adolescents with type 1 diabetes mellitus (T1D) often face challenges in achieving optimal glycaemic control, which can lead to long-term complications. This study aimed to test the effect of an eHealth care programme on glycaemic control and empowerment among adolescents with T1D who exhibited poor glycaemic control. Methods: This 1-year quasi-experimental study recruited 51 adolescents with T1D and suboptimal glycaemic control. Participants were allocated to an intervention group and a matched comparison group drawn from the National Diabetes Quality Register. Changes in glycaemic control metrics between the two groups as well as the empowerment scores within the intervention group were computed. Results: The mean percent time above range (% TAR) decreased from 70.00 to 57.43% among the intervention group. A significant reduction in %TAR was observed in the intervention group compared to the comparison group (P < 0.001). However, no significant changes were found in other glycaemic control metrics between the two groups. The intervention group showed a significant improvement in the total Gothenburg Young Persons Empowerment Scale (GYPES) score, with the median score increasing from 60.67 [interquartile range (IQR) (59.00, 66.19)] at baseline to 63.65 [IQR (62.85, 64.12)] post-intervention (P = 0.002). Conclusion: The eHealth care programme significantly reduced %TAR and improved empowerment scores among adolescents with T1D, indicating it could effectively support adolescents with poor glycaemic control. A randomised study is needed to confirm these findings and assess long-term effects.
Introduction: Type 2 diabetes (T2D) is a public health issue with increasing prevalence, projected to affect 1.27 billion people in 2050. Its onset can largely be prevented or delayed by lifestyle changes. Access to screening is crucial for early diagnosis and treatment to avoid complications due to long-term elevated blood glucose levels. Studies have shown that populations with low socioeconomic status (SES) are among those groups that are more prone to developing T2D. With rising incidence and prevalence of the disease, prevention measures specifically targeting vulnerable groups such as socioeconomically disadvantaged populations, become increasingly relevant. The objective of the scoping review is to investigate what types of interventions have been tested and reported regarding prevention of T2D targeting low socioeconomic populations and that are applicable in a high-income country. Methods: Studies addressing T2D prevention interventions tailored for populations with low SES that are applicable in high-income countries will be included. A systematic search strategy to identify peer-reviewed literature was developed in consultation with research librarians. Databases searched are Cinahl, PubMed and Web of Science. Interventional studies of various designs will be included and the researchers will independently assess studies for inclusion. The results of the study inclusion process will be reported in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram. Analysis of the data will be presented using a narrative approach, as studies are expected to have heterogeneous design features and variable outcome measures. Discussion: The results will provide an overview of tested T2D prevention intervention studies targeting populations with low SES and will be used to inform and guide the research team and healthcare management for future interventions in Malmö.
Background: Diabetes-related hospital readmissions within 30-days are costly and an indicator of suboptimal care resolution. Nurse-led transitional care interventions may improve glucose control and reduce emergency department recidivism following hospital discharge in very low-income populations. Methods: An intention-to-treat design with randomization of participants (n = 108) compared conventional care to transitional care coordination that included diabetes specialty appointments, monthly support telephone calls, medication management, and tailored diabetes self-management education. Both the control and intervention group received a diabetes specialist and primary care appointment. Results: There was a significant difference between the control and intervention groups (P = 0.018) from baseline to study-end with the intervention group experiencing a 1.9% mean change (SD, P = 0.003) in A1c in those with baseline poor glucose control (A1c>9%) and a trend toward all cause emergency department recidivism (P = 0.06). Both the control and intervention groups benefitted from linkages to specialist care, but the nurse-led group had greater outcome improvements. Conclusion: Hospitalized patients with poor glucose control (A1c>9%) benefit from a nurse-led intervention to provide tailored transitional care and diabetes self-management education. Results of this study showed clinical improvements in glucose control and reduction in 30-day hospital readmissions.
Introduction: Nurses are valuable care providers to people with diabetes, yet day-to-day diabetes management most heavily relies on self-care practice. Inaccurate self-perceptions of diabetes knowledge among nurses may be linked to inadequate adherence to self-care practice among people with diabetes. Methods: The present study is a rapid review of perceived and actual diabetes care-related knowledge among nurses since an unusual inverse correlation of perceived and actual knowledge was first reported by Drass and colleagues in 1989. Results: Seventeen studies in 10 countries met the eligibility criteria for full review. Discussion: Low-to-moderate positive correlations revealed a discrepancy between perceived and actual knowledge among various nursing fields. Conclusion: Nurses with an accurate assessment of their own diabetes knowledge may be better equipped to not only treat people with diabetes, but also promote self-care practice through formal or informal interaction.
Background: Diabetes has far-reaching negative impacts on the biological, physiological and psychosocial health of people living with the disease and their families, placing a heavy burden on health systems worldwide. Self-management education and support have a critical role to play but are insufficiently used. Therefore, there is a need to develop and implement effective support interventions for this population. Methods: This study protocol comprises the development and feasibility testing phases of a virtual nursing intervention named PIAVIR (Pratique infirmière avancée virtuelle – Virtual advanced nursing practice), using the Medical Research Council framework for developing complex interventions. PIAVIR is based on humanistic-centred theories of education: adult learning theory, experiential learning and transformative learning, as well as the results from focus group interviews with healthcare professionals and people with type 1 or type 2 diabetes. The feasibility testing will include 60 participants recruited and randomised to either the intervention group with immediate access to the intervention for 6 months or to the waiting-list control group with access to the intervention after a 6-month waiting time. Both groups will be followed-up for another 6 months post-intervention. Outcome measures will be collected at baseline, 6 months and 12 months. Findings will be evaluated against predetermined feasibility criteria and changes in metabolic and psychosocial outcomes. Results: This paper presents the study protocol and describes and discusses the development and feasibility phases of the PIAVIR virtual intervention. The results of the feasibility study cover primarily: acceptability, feasibility, recruitment and completion of the newly developed intervention, as well as metabolic and psychosocial measures. Conclusion: This study contributes to the development of effective virtual self-management education and support interventions and informs a larger randomised controlled trial to examine the effectiveness of the intervention in different populations and multiple sites.
Aim: This study aimed to assess the prevalence and associated factors of excessive daytime sleepiness (EDS) in patients with type 2 diabetes mellitus (T2DM). Methods: We conducted a cross-sectional study in Beijing, China, from November 2015 to October 2016, and patients with T2DM were invited to participate. Structured questionnaires were used to collect data. EDS was assessed using the Epworth Sleepiness Scale (ESS), and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Logistic regression analysis was used to evaluate factors associated with EDS. Results: Of the 224 patients with T2DM, 24 (10.7%) had EDS. The proportions of anxiety, depression, and comorbid anxiety and depression were significantly different between the EDS and non-EDS groups. ESS scores, anxiety scores, and depression scores were positively correlated. Logistic regression analysis showed that mild anxiety (OR 11.055; 95% CI 2.272–53.785; P = 0.003), moderate to severe anxiety (OR 33.223; 95% CI 4.896–225.440; P < 0.001), and mild depression (OR 6.227; 95% CI 1.319–29.399; P = 0.021) were associated with EDS in patients with T2DM. These associations remained significant after adjustment for age, sex, body mass index, diabetes duration, and apnoea–hypopnoea index. In addition, the severity of obstructive sleep apnoea–hypopnoea syndrome was not significantly associated with EDS, anxiety, depression, and comorbid anxiety and depression in this study. Conclusions: The prevalence of EDS was high in patients with T2DM, and anxiety and depression were significantly associated with EDS. When developing interventions to improve EDS in patients with T2DM, healthcare providers may need to consider interventions that target anxiety and depression.
Background: Foot ulceration is a common complication of type 2 diabetes, which can lead to amputations and earlier mortality. National footcare guidelines recommend routine foot surveillance, preventative self-management patient education and prompt referral to professional footcare services when complications occur. However, little is known about how people living with type 2 diabetes experience diabetes footcare in Switzerland. The aim of this study was to explore the experiences of people living with type 2 diabetes who are at high risk for foot complications, when accessing and using professional footcare, in the context of the Swiss healthcare system. Method: Individual, in-depth semi-structured telephone interviews were conducted with adults with type 2 diabetes (n = 9) recruited from two regional hospitals and two primary care practices in the German-speaking region of Switzerland. Data were analysed thematically using Framework Analysis. Results: Three themes with subthemes were generated from the data: 1) footcare, the neglected component of diabetes management; 2) perceived roles of healthcare professionals; and 3) signposting within the healthcare system. The findings illustrated ambiguity and lack of consistency in the provision of services, which do not always align to national guidelines, as well as a lack of clarity of the roles of healthcare professionals in relation to diabetic footcare. Conclusion: The experiences of participants in this study highlight the need for increased awareness and new ways of working, including alignment to national guidelines and a clarification of the roles and responsibilities of multidisciplinary healthcare professionals, including general practitioners, diabetes nurses and specialist podiatrists within primary care in Switzerland.
Introduction: Managing the impacts of the menopause can be a tedious experience for many women, and when coupled with diabetes, the challenges are multiplied. Literature searches confirm a dearth of information and support to help women with these dual conditions. Methods: A Patient Public Involvement exercise involving an online survey disseminated electronically via social media amongst the Type 1 diabetes online community. It comprised five closed questions and one open question to elicit priority needs. The survey was supplemented with a subsequent Twitter chat. The paper conforms to the guidance for reporting of patient and public involvement in health and social care research (GRIPP). Results: Of the 184 women who completed the survey across the United Kingdom, most were aged between 40 and 59 years (n = 167, 90.8%). Although 137 (72.8%) women reported that menopause had impacted on their diabetes, only a minority (n = 50, 27.2%) indicated that it had ever been discussed with them. The overarching theme from the open question was of an overall Lack of awareness about the impacts of menopause, with the following subthemes: 1) Need for information about menopause, 2) An additional burden, 3) Symptoms of diabetes or menopause? and 4) Communication – expectations of care. Conclusions: Women need information, support and guidance during this phase of life. This oft overlooked aspect of care is engendering frustration and suboptimal diabetes management and will be a topic raised with increasing frequency in general practice and diabetes specialities. The management of diabetes and menopause deserves more attention across the diabetes community.
Background: Differences in diabetes regulation between patients from different ethnic background have been described. This may be reduced by regular visits to a diabetes nurse (RVDN) with the same mother tongue. We explored whether equal access to diabetes-related care, including RVDN with the same mother tongue, may result in similar diabetes regulation among ethnic minorities and Dutch natives. Methods: Patients with type 2 diabetes and an annual comprehensive diabetes evaluation were included in this study. For the analysis, we emphasized on the data of patients with RVDN and used descriptive statistics and nonparametric tests for between group comparisons. Results: From a total of 983 patients, 581 patients had RVDN of whom 266 (46%) Dutch natives, 199 (34%) Turks/Moroccans, and 116 (20%) patients from other ethnicities. Within the group of patients with RVDN, Turks/Moroccans had higher median fasting plasma glucose levels as compared with Dutch natives and other ethnic minorities (8.4 vs 7.9 and 7.3 mmol/L, P < 0.001), and a higher HbA1c level was found for both the Turks/Moroccans and other ethnic minorities, as compared to Dutch natives (62 vs 55 mmol/mol, P < 0.001). In addition, only 22% of Turks/Moroccans and 26% of other minorities achieved the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD)-recommended HbA1c target ≤53 mmol/mol, compared to 39% in Dutch natives. Conclusions: In patients with RVDN with the same mother tongue, we still found disparities in HbA1c levels between Dutch natives, Turks/Moroccans and other ethnic minorities. Other factors beyond Dutch language skills are likely to interfere.
This case report is related to a 61-year-old man with multimorbidity presenting with a chronic diabetic foot ulcer treated in a sub-rural hospital. The patient was treated according to the standard of care supported by national guidelines including some advanced wound therapies, without result. The interdisciplinary team concluded that the wound could not heal because of the patient’s multiple comorbidities. However, against all expectations, the patient finally healed after a strict bed rest. This case emphasises the crucial role of offloading, patient adherence and its difficulty of assessment for wound care practitioners. This is a reflective case report that demonstrates commonly the use of expensive advanced wound care therapies without positive outcomes and then the need to come back to basic treatments. Reflective practice is an important part of evidence-based practice, and a case report is a good way to engage the process.
Background: Type 1 diabetes mellitus requires complex skills of self-care that, during adolescence, need to be adapted to continuous major changes. Therefore, adolescents could struggle in performing adequate self-care, with consequences on glycaemic control. Caregivers’ contribution to self-care could be useful for reaching health outcomes. Existing studies lacked a theoretical framework, and tools administered for measuring adolescents’ self-care and caregivers’ contribution to self-care were not theory grounded. Aim: To describe adolescents’ self-care and caregiver contribution to self-care within the theoretical framework of the middle-range theory of self-care of chronic illness. Methods: A cross-sectional observational study was conducted enrolling 153 adolescent-caregiver dyads. The Self-Care of Diabetes Inventory (SCODI), including self-care maintenance, monitoring and management, was administered to adolescents. The Caregiver Contribution to Self-Care of Diabetes Inventory (CC-SCODI), including caregiver contribution to self-care maintenance, monitoring and management, was administered to caregivers. We analysed the differences in caregiver contribution according to adolescents’ self-care level and the differences in caregiver characteristics according to their contribution to self-care level. Results: Adolescents mostly obtained adequate scores for self-care maintenance (74%), monitoring (52%) and management (58%). Caregivers mostly obtained adequate scores for contribution to self-care maintenance (72%) and monitoring (52%), and almost adequate scores for contribution to self-care management (41%). Scores were consistent within the dyads for self-care monitoring and management: high caregiver contribution when adequate adolescent self-care and vice-versa (P < 0.001). Higher caregiver self-efficacy in contributing to patient self-care was associated with higher caregiver contribution to self-care maintenance (P = 0.022), monitoring (P < 0.001) and management (P < 0.001). Conclusion: Caregivers can contribute significantly to the self-care of adolescents with type 1 diabetes. Health professionals could implement interventions aimed at improving caregivers’ contribution through enhancing caregiver self-efficacy in contributing to patient self-care. Researchers could deepen the understanding of the relationship between adolescent self-care and caregiver contribution to self-care, as well as the determinants of caregiver contribution to self-care, and its effects on health outcomes.
Background: Survey data suggest that women with Type 1 diabetes mellitus have a higher prevalence of sexual dysfunction (SD) compared with women with Type 2 diabetes or without diabetes. However, little is known about how women with Type 1 diabetes experience SD or its impact on their lives. This exploratory study sought to elicit women with Type 1 diabetes’s experiences of SD and identify their ideas on how SD could be better addressed in diabetes care. Method: A qualitative study using semi-structured interviews was conducted at a diabetes centre in South West of England hospital. A purposeful sample of six women with Type 1 diabetes (<50 years of age) and experience of SD were interviewed. The interviews lasted 20–30 min and were analysed using Interpretive Phenomenological Analysis. Findings: The study identified four superordinate themes: barriers to sex, impact of SD, personal support and ideas for improving support with SD. The majority of the themes were underpinned by diabetes specific factor such as hypoglycaemia, body image and diabetes management (technology and glucose regulation). This study found that women’s perspectives on their sexual identities and behaviours were mediated by emotional and interpersonal issues. This study also highlighted the lack of support provided by healthcare professionals (HCPs) in addressing SD. Conclusion: The findings indicate that SD is a complex issue that needs to be given more attention by HCPs, so that the women can approach sex positively in their lives. HCPs need to be enabled to initiate conversations around SD in their consultations.
Background: Adolescence is a challenging time for young people with Type 1 diabetes, associated with worsening glycaemia and disengagement with care. To improve support, we co-designed with young people a novel psychosocially modelled programme of diabetes education (the Youth Empowerment Skills [YES] programme). This study aimed to estimate the clinical impact and feasibility (recruitment, retention and participant experiences) of this programme. Methods: A pilot study using mixed-methods was conducted to assess process and outcomes, involving a pre- and post-exposure assessment of glycaemic control, programme participation data, service utilisation and qualitative semi-structured interviews (analysed using Framework Analysis). Participants were recruited from two hospital diabetes centres in Southeast London. The intervention was conducted in local community centres. Participants were young people with Type 1 diabetes aged 15–21 years. The YES programme involves contact with an outreach youth worker and attending a 3-day psychologically modelled course encompassing social learning, peer facilitation and simulation exercises. The primary outcome was change in HbA1c at 6 and 12-months post-intervention. Secondary outcomes included diabetes-related hospital admissions and incident diabetic ketoacidosis (DKA). Results: Twenty-six young people participated in the programme, mean age 18 (±1.7) years. Uptake was 34% (n = 26) of those approached, with 96% (n = 25) programme completion. Pre-exposure (12 month mean) HbA1c was 93.5 (±29.7) mmol/mol (10.7%), and at 12 months post-exposure, it was 85.1 (±25.4) mmol/mol (10%) (P = 0.01), with 46% (n = 12) of participants achieving a reduction in their HbA1c ≥5.5 mmol/mol (0.5%). Unplanned hospital admissions and DKA rates reduced by 38 and 30%, respectively. The qualitative data identified positive psychosocial impacts including increased diabetes engagement and activation. Active ingredients were social learning, peer support and experiential learning. Participants emphasised the importance of the youth worker in engaging with the programme. Conclusion: The evaluation indicates that the YES programme helps improve young people’s self-confidence in managing diabetes, enhances diabetes engagement and improves clinical outcomes.
Background: Diabetes mellitus was found to be one of the most common comorbidities for pneumococcal diseases. Pneumococcal vaccinations can reduce morbidity and mortality in this patient population. The purpose of this study was to estimate pneumococcal vaccination rate of these populations in inpatient hospital setting. Materials and methods: We performed a retrospective chart review involving adult patients with diabetes who were admitted to King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia between the period of March 2016 and March 2017. Results: A total of 1087 eligible patients were included. The overall vaccination rate for pneumococcus was 1.6% among the vaccine-eligible subjects. The most common risk factors were older age (65 years old or over – 53.9%), chronic renal failure (28.2%) and chronic heart failure (27%), respectively. The majority of the patients in this study were eligible for pneumococcal vaccine (77.6%) due to one or more risk factor other than diabetes mellitus. The mean number of other risk factors other than diabetes mellitus was 1.5 (SD 1.1, 95% CI 1.39–1.53). None of the included patients had documentation on pneumococcal vaccination status. Conclusion: The pneumococcal vaccine coverage rates among hospitalised patients with diabetes were low in a tertiary care teaching hospital in Saudi Arabia. Further studies are needed to assess the impact of electronic interventions in promoting vaccination assessment and administration among patients with diabetes.
In Sweden, each year approximately 700 children develop Type 1 diabetes. Living with the illness is a challenge for youth and requires adjustments to lifestyle, and to manage school. The aim was to describe youths’ experiences of living with Type 1 diabetes in relation to school. A qualitative research design was used and interviews were performed with eight girls and five boys with Type 1 diabetes. The interviews were subjected to qualitative content analysis. Three themes were identified: to be friends with the diabetes, striving for normality and receiving support from others. Results showed a need to increase the understanding of T1D and diabetic competence within the Swedish school system and knowledge of youths’ own experiences is vital in this work. Living with T1D was a struggle for normality, independency and the youth needed to be friends with diabetes to handle everyday self-management. Although there are demanding life and school circumstances, it eventually becomes possible for the youth to handle the illness and to integrate and manage diabetes in school.
The term asylum seeker refers to a person of foreign nationality who seeks protection and residence permit in another state. Refugee status is granted to an asylum seeker who is given asylum. Around 1.3 million asylum seekers during years 2015 and 2016 arrived in Europe. Asylum seekers are a highly heterogeneous group in terms of cultural backgrounds, religion, education and language skills. In their countries of origin, asylum seekers have faced oppression, possibly even violence, which may cause them to be suspicious of other people, especially the authorities, also in the country where they are seeking asylum. Due to the aforementioned factors, asylum seekers are a vulnerable group from the perspective of research. An increasing amount of research is conducted globally in different fields of science among asylum seekers, also in the field of diabetes research. It has been shown that asylum-seekers carry a high risk of developing diabetes, and the prevalence of diabetes among them has been shown to be higher as compared with the reference population, already six months after arrival. Post-traumatic stress disorder, which is common among refugees, may be related to high levels of Type 2 diabetes among them. Clinicians, scientists and policymakers need to take several issues into account when assessing and treating diabetes among vulnerable immigrants. Recently, a need for research among asylum seekers has been recognised, but on the other hand, the discussion has emerged on the ethical acceptability of research in this population. There are several ethical issues to be a need for identification of Issues under discussion include what should be taken into account and which ethical questions emerge in particular? The research process consists of versatile steps connected to interpersonal interactions. The professional ethics of the researcher plays a key role. Its central elements include respect for human dignity, confidentiality, honesty and fairness. The fundamental question is whether it is generally ethically acceptable to ask a person seeking asylum to participate in a scientific study. Indeed, opinions against such research have been expressed. However, many experts agree that research in asylum seekers can be carried out as long as the principles of research ethics with special considerations are taken into consideration. Research concerning asylum seekers requires careful planning and consideration of the justifications for the study as well as ethically sustainable ways conduct research. Leaning has described the preconditions for ethically acceptable research conducted among asylum seekers. As a starting point, she argues that, as with other vulnerable groups, research may only be conducted when it is necessary or urgent for the health and well-being of the research subjects and only if the study cannot be implemented with a different population. Respect for autonomy, which is closely connected to the voluntary nature of research and the informed consent process, is the most crucial ethical principle of research in human subjects. Voluntariness implies that consent for participation in research is given by a subject without any kind of coercion, and that the research subject has a proper competence to understand what the research entails. Furthermore, the subject must be capable to express his/her decision. Informed consent is culturally bound and it might thus have a different meaning to asylum seekers compared to a researcher. In some cultures, the role of relatives plays a particularly important role in decision-making, and the researcher might thus end up discussing the matter with a head of community/household. However, it must be noted that the consent given by this person does not supersede the consent of refusal given by the individual asked to participate in the study. Further challenges emerge in connection with language; indeed, data collection often requires a professional interpreter who understands both elements related to consent as well as the nature of research. However, there are several issues researchers must take into account in relation to using an interpreter: (1) competence, which involves the interpreter’s linguistic skills and understanding of research, (2) the role of the interpreter, which may be either passive or active and affects the reliability of the research material and (3) cultural factors, which may cause a conflict between the interpreter and the research subject, e.g. regarding factors related to gender. In some situations related to asking for consent and collecting research data, the research subject may only be approached by a researcher who is of the same gender as the research subject. It must also be considered that some concerns related to the protection of privacy may arise if the researcher or interpreter belongs to the same ethnic group as the research subject. ARTICLE International Diabetes Nursing, Vol. 14, 2017, 96–98
Objectives: This analysis aimed to determine how people living in Kuwait perceive their body size and to identify possible determinants of this. Design: Data on perceived body size were gathered as part of a larger cross-sectional Knowledge, Attitudes, Behaviours and Practices (KABP) survey of 1124 participants. Results: Over 60% of participants were either overweight or obese. The overall rate of body size misperception was also high, with 19% of participants underestimating their body size. Gender and diabetes status were found to be associated with body size perception. Conclusions: Many overweight individuals may be underestimating their body size. As such, they may not appreciate the need for behavioural interventions designed to control weight and promote health. There is an evident need to strengthen health education and to address this issue within national policies and community engagement activities.
