Diabetesta sairastavien ravintorasvojen käytön neuvonta perusterveydenhuollossa

Tutkimuksessa kuvattiin tyypin 2 diabeetikoiden ravitsemusneuvonnan, erityisesti ravintorasvoihin kohdentuneen neuvonnan, sisältöjä ja kestoja sekä keskustelun avauksia perusterveydenhuollon hoitajien ja lääkäreiden käynneillä. Seurantatutkimusaineisto kerättiin vuosina 2000 - 2002 videoimalla 17 potilaan neuvontakäynnit, yhteensä 129. Potilaiden käynnit hoitajilla vaihtelivat 2 - 11 käynnin välillä ja lääkäreillä 0 - 7 käynnin välillä seuranta-aikana. Aineisto analysoitiin sisällön erittelyllä. Hoitajat ja lääkärit käyttivät vähän aikaa ravitsemusneuvontaan ja rasvojen käytön neuvontaan. Keskustelujen avaukset painottuivat potilailla ravintorasvan laatuun. Hoitajat ja lääkärit avasivat keskustelut kolesteroliarvoviittauksilla, joihin potilaat usein reagoivat lyhyellä kommentilla. Rasvojen käytön merkityskeskustelut diabeteksen hoidon kannalta olivat vähäisiä. Potilaiden aikaisempaa ravitsemustietämystä ei juuri hyödynnetty keskusteluissa. Tulosten perusteella terveydenhuoltohenkilöstölle tulisi tarjota täydennyskoulutusta ravitsemusneuvonnan sisällöistä ja elintapojen muutoksia tukevista menetelmistä

'I saw what the future direction would be...' : Experiences of diabetes risk and physical activity after diabetes screening

Objectives To improve understanding of how individuals at high risk of type 2 diabetes experience the risk of diabetes and how these experiences relate to the adoption of physical activity as a protective behaviour. Design A qualitative study using semi-structured interview with individuals identified by screening as at high risk of type 2 diabetes. Methods Fourteen individuals, aged 40–64, were interviewed twice, with a 2-year interval between. Participants' experiences of their risk of diabetes and physical activity were assessed. The transcribed interview data were analysed using inductive qualitative content analysis. Results Two themes emerged from the data: a threatening risk perception and a rejected risk perception. The threatening risk perception occurred when the risk was unexpected by the participant, but became internalized through the screening procedure. The threatening perception also involved a commitment to increase physical activity to prevent diabetes. However, short-term anxiety and subsequently emerging hopelessness were also part of this perception. The rejected risk perception involved indifference and scepticism regarding the risk. Here, physical activity behaviour and cognitions appeared to remain unchanged. Rejection also involved difficulties in accepting one's high-risk identity. The rejecting group lacked motivation for increased physical activity, while the other group showed determination regarding increased physical activity, often leading to success. Conclusion Perceptions of the risk of diabetes emerged as threatening or as rejected. Participants' perceptions reflected varying and intertwining emotional, cognitive, and behavioural mechanisms for coping with the risk, all of which should be recognized in promoting physical activity among high-risk individuals.peerReviewe

Health Behaviour among Lithuanian Adult Population, 2002

FINBALT Health Monito

Health Behaviour among Latvian Adult Population, 2002

FINBALT Health Monito

Perceived sufficiency of physical activity levels among adults at high risk of type 2 diabetes. The FIN-D2D study

Purpose. This study assessed the determinants of perceived physical activity levels (PALs) among adults at high risk of diabetes, and the associations with self-reported physical activity. Methods. In total, 10,149 adults participated in the FIN-D2D lifestyle intervention at baseline. Opportunistic screening was used in identifying high risk individuals. Physical activity and perceived PAL sufficiency were assessed and compared. Key risk factors for diabetes and psychosocial and demographic characteristics were analyzed as determinants using logistic regression. Results. PAL sufficiency was rated realistically by 73% of men and 75% of women. Perception of sufficient PAL was more likely among individuals with a smaller waist circumference, a higher level of perceived fitness, and no exercise intention. In men, a higher age, and in women, a lower education, and a lower occupational status, also increased the likelihood of perceiving PAL as sufficient. Out of all the participants, 65% of men and 66% of women were inactive. Among the inactive participants, 20% (men) and 16% (women) overestimated their PAL sufficiency. In both genders such overestimation was predicted by dyslipidemia, a lower waist circumference, a higher level of perceived fitness, and no exercise intention; also (among men) by a higher age and a family history of diabetes, and (among women) by a lower occupational status, and a lower BMI. Conclusions. In diabetes prevention, it is important to recognize the groups that perceive their PAL as sufficient, since they may not see increased PAL as a tool for decreasing their risk of diabetes.peerReviewe

Perceived need to increase physical activity levels among adults at high risk of type 2 diabetes. A cross-sectional analysis within a community-based diabetes prevention project FIN-D2D

Background. Increased physical activity is a cornerstone of type 2 diabetes prevention. The perception of a need to change is considered essential in behaviour change processes. However, the existing literature on individuals' perceived need to change health behaviour is limited. In order to improve understanding of diabetes prevention through increased physical activity levels (PAL), we assessed factors associated with perceiving a need to increase PAL among adults at high risk of diabetes. Methods. Opportunistic screening was used within a primary-care based lifestyle intervention covering 10 149 men and women at high risk of type 2 diabetes. Data were obtained at baseline visits. The explored determinants were demographic, anthropometric/clinical, behavioural and psychosocial characteristics, along with four categories of PAL awareness. Logistic regression was used in the analysis. Results. 74% of men (n=2 577) and 76% of women (n=4 551) perceived a need to increase their PAL. The participants most likely to perceive this need were inactive, had a larger waist circumference, rated their PAL as insufficient, and were at the contemplation stage of change. Smoking, elevated blood pressure, dyslipidaemia, and a family history of diabetes were not associated with this perception. The likelihood was also greater among women with less perceived fitness and less education. Demographic factors other than education did not determine participants' perceived need to increase PAL. PAL overestimators were less likely to perceive the need to increase their PAL than realistic inactive participants. Conclusions. Subjective rather than objective health factors appear to determine the perception of a need to increase PAL among adults at high risk of diabetes. Client perceptions need to be evaluated in health counselling in order to facilitate a change in PAL. Practical descriptions of the associations between metabolic risk factors, PAL, and diabetes are needed in order to make the risk factors concrete for at-risk individuals.peerReviewe