Background: Diabetes mellitus is one of the most challenging and burdensome chronic diseases of the 21st century and More than 1% of the Iranian urban population older than 20 years develops Type 2 diabetes each year. Living with diabetes mellitus has been described as a dynamic personal transitional adaptation, based on restructuring of the illness perceived experience and management of the self. Adaptation to Type 2 Diabetes mellitus is an integral part of diabetes care.This study explored the experiences of facilitators and barriers adaptation to Type 2 Diabetes by Iranian patients.Methods: This study was conducted by using qualitative content analysis. Data were collected via in-depth, semi-structured and face to face interviews with 15 patients with type2 diabetes.Results: Three themes emerged from collected data, including a) individual context with Beliefs, personal background, and previous experience subthemes. b) supportive system with Family, Society and Health organizations subthemes and c) self-comparison with comparison with other diabetes and comparison with other diseases subthemes.Conclusions: Identifying and managing Facilitators and Barriers adaptation to Type 2 Diabetes mellitus are an integral part of diabetes care. This study provides a better understanding of the factors from perspective of patients and it can be utilized by health care providers to adapt their health care and education contents to better meet the needs of people with diabetes. © 2014 Karimi Moonaghi et al.; licensee BioMed Central Ltd

Arshadi Bostanabad, M.

Jouybari, L.

Karimi Moonaghi, H.

McDonald, H.

Namdar Areshtanab, H.

Journal of Diabetes & Metabolic Disorders

English

PubMed

Abstract
                Background
                Diabetes mellitus is one of the most challenging and burdensome chronic diseases of the 21st century and More than 1% of the Iranian urban population older than 20 years develops Type 2 diabetes each year. Living with diabetes mellitus has been described as a dynamic personal transitional adaptation, based on restructuring of the illness perceived experience and management of the self. Adaptation to Type 2 Diabetes mellitus is an integral part of diabetes care.
                This study explored the experiences of facilitators and barriers adaptation to Type 2 Diabetes by Iranian patients.
              
                Methods
                This study was conducted by using qualitative content analysis. Data were collected via in-depth, semi-structured and face to face interviews with 15 patients with type2 diabetes.
              
                Results
                Three themes emerged from collected data, including a) individual context with Beliefs, personal background, and previous experience subthemes. b) supportive system with Family, Society and Health organizations subthemes and c) self-comparison with comparison with other diabetes and comparison with other diseases subthemes.
              
                Conclusions
                Identifying and managing Facilitators and Barriers adaptation to Type 2 Diabetes mellitus are an integral part of diabetes care. This study provides a better understanding of the factors from perspective of patients and it can be utilized by health care providers to adapt their health care and education contents to better meet the needs of people with diabetes.
              </jats:sec

Hossein Karimi Moonaghi

Hossein Namdar Areshtanab

Leila Jouybari

Mohammad Arshadi Bostanabad

Heather McDonald

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Facilitators and barriers of adaptation to diabetes: experiences of Iranian patients

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Golestan University of Medical Sciences Repository

Karimi Moonaghi et al. Journal of Diabetes & Metabolic Disorders 2014, 13:17http://www.jdmdonline.com/content/13/1/17RESEARCH ARTICLE Open AccessFacilitators and barriers of adaptation to diabetes:experiences of Iranian patientsHossein Karimi Moonaghi1, Hossein Namdar Areshtanab1*, Leila Jouybari2, Mohammad Arshadi Bostanabad3and Heather McDonald4AbstractBackground: Diabetes mellitus is one of the most challenging and burdensome chronic diseases of the 21stcentury and More than 1% of the Iranian urban population older than 20 years develops Type 2 diabetes each year.Living with diabetes mellitus has been described as a dynamic personal transitional adaptation, based onrestructuring of the illness perceived experience and management of the self. Adaptation to Type 2 Diabetesmellitus is an integral part of diabetes care.This study explored the experiences of facilitators and barriers adaptation to Type 2 Diabetes by Iranian patients.Methods: This study was conducted by using qualitative content analysis. Data were collected via in-depth,semi-structured and face to face interviews with 15 patients with type2 diabetes.Results: Three themes emerged from collected data, including a) individual context with Beliefs, personalbackground, and previous experience subthemes. b) supportive system with Family, Society and Healthorganizations subthemes and c) self-comparison with comparison with other diabetes and comparison with otherdiseases subthemes.Conclusions: Identifying and managing Facilitators and Barriers adaptation to Type 2 Diabetes mellitus are anintegral part of diabetes care. This study provides a better understanding of the factors from perspective of patientsand it can be utilized by health care providers to adapt their health care and education contents to better meetthe needs of people with diabetes.Keyword: Diabetes melitus, Psychological adaptation, Qualitative researchIntroductionDiabetes mellitus is one of the most challenging andburdensome chronic diseases of the 21st century, and itis a growing threat to the world’s public health [1].Diabetes mellitus currently affects about 285 millionadults worldwide, and this figure is expected to rise toover 400 million adults by 2030 [2]. It is forecast that by2030, 77.6% of diabetic patients will be from the devel-oping countries [3]. Diabetes has increasingly become agreat concern in the developing countries and Iran is noexception. Type 2 diabetes mellitus, a form of diabetesthat is typically acquired in middle aged or older people,accounts for over 90% of all cases of diabetes [4]. The* Correspondence: namdarah871@mums.ac.ir1Department of Post Graduate, Faculty of Nursing and Midwifery, MashhadUniversity of Medical Sciences, Mashhad, IranFull list of author information is available at the end of the article© 2014 Karimi Moonaghi et al.; licensee BioMeCreative Commons Attribution License (http:/distribution, and reproduction in any mediumprevalence of type 2 diabetes is reported to be 1.3 to14.5% in Iran [3]. The chronic nature of the disease andthe severe complications result in pronounced lifestyledisruption, challenging psychosocial adjustment for theindividual and substantial healthcare expenses [5].Chronic illness acts as a stressor and initiates copingwhich can either contribute to or hinder adjustment [6].Psychological, emotional, and social factors play import-ant roles in chronic illness outcomes [7]. After the med-ical diagnosis of chronic illness [e.g., diabetes], patientsare confronted with new situations that challenge theirhabitual coping strategies and go through a process ofpsychosocial adaptation [8]. The potential barriers tohealthy coping are numerous. Some of them consist oflow social support, financial stress or constraint, externallocus of control, lack of access to providers and diabeteseducators, low problem-solving ability [7].d Central Ltd. This is an open access article distributed under the terms of the/creativecommons.org/licenses/by/2.0), which permits unrestricted use,, provided the original work is properly cited.Karimi Moonaghi et al. Journal of Diabetes & Metabolic Disorders 2014, 13:17 Page 2 of 7http://www.jdmdonline.com/content/13/1/17Living with diabetes mellitus has been described as adynamic personal transitional adaptation, based on re-structuring of the illness perceived experience and man-agement of the self. This means dealing with disabilitiesand limitations paired with a search for life meaning andrealistic acceptable identities, that is, separating the per-son of the past from the person of the present, one thathas to overcome personal and social adaptation processto diabetes [9]. Several studies investigated facilitatorsand barriers to management and adaptation to diabetes[10-15]. Cultural traditions and norms present in allpopulations, influence on practices of management andadaptation to disease [16].The majority of studies are based on studies con-ducted in western societies that differ in terms of cul-tural and social backgrounds from the Eastern societies.Also the studies have shown that sociocultural contentand belief systems could influence patients’ experiencesin coping and adaptation to the illness [17,18]. The ob-jective of our study is to explore the facilitators and bar-riers in adaptation to Type 2 diabetes mellitus amongIranian patients with using qualitative research methods.This methodology will allow us to gain deep knowledgeabout complex phenomenon Through exploring the ex-perience and perceptions of those living with diabetes.MethodsThe Ethics Committee of the Mashhad University ofMedical Sciences approved this study. All participantswere given oral and written information about the study,after which they consented to participate.A qualitative study with a content analysis approachwas used for the data collection and analysis. Qualitativeresearch aims to explore, provide deep knowledge andunderstanding of the complex phenomenon under studythat are encountered by clinicians, healthcare providers,policy-makers, and consumers in the healthcare system[19]. Qualitative content analysis focuses on the context-ual meaning to “provide knowledge and understandingof the phenomenon under study [20].Criteria for enhancing the rigor of qualitative studieshave been proposed by Lincoln and Guba [1985] and in-clude credibility, transferability, dependability and con-firmability [21]. In the research process, researchersallocated sufficient time for data collection and haveclose communication with participants. The interviewsreturned the participants for verify the accuracy of re-sults and validate the congruity of findings with theirexperiences. Member checking and ensuring that the re-searcher was represent their ideas. The data were codedand categorized independently by the authors and thenemerged themes were compared. Opinion of experts andthree PhD Candidate of nursing in data analysis as peerchecking were used and discussed over a 2-week period.Regarding rigor, research team discussed and interpretedthe findings until agreement was reached. These itemsenhanced the credibility of data. To increase the depend-ability, one of the researchers collected and analyzed thedata and the other researchers checked and verified theresults. Participants were selected by considering tomaximum variation in terms of gender, age, previousexperience of illness in family economic status, educa-tional, job background and need or lack of need to injec-tion of insulin to provide transferability.Data collection and analysisParticipantsPurposive samples of 15 patients were recruited. Pa-tients were selected on the basis of the following inclu-sion criteria: willingness to participate in the study, aconfirmed diagnosis of type 2 diabetes, passing at least1 year after diagnosis of diabetes, awareness of theirdiagnosis and cognitively and physically able to partici-pate in the study.Data were collected via in-depth, semi-structured andface to face interviews conducted from September 2011to August 2012. All interviews were private and con-ducted at the participant’s discretion with regard to placeand time in Diabetes Association of Iran - TabrizBranch.The interviews were conducted in Persian by corres-pondence author. Each participant was interviewed onlyonce .The analysis was conducted in Persian, and for thepurpose of this article, translated into English. The inter-viewer asked the participants about their experiences ofliving with diabetes. The interviews were tape recordedand transcribed verbatim. The first interviews lasted60–80 min and the next interviews lasted 40–50 min(mean time 45 min).The analysis of collected data began once the firstinterview had been conducted and transcribed. Datawere analyzed using qualitative content analysis tech-niques inspired by Graneheim and Lund man [22]. Theanalysis began by reading through each interview severaltimes to obtain a sense of the whole of participants’ ex-periences. Then, the meaning units, which were words,sentences or paragraphs, that depicted important aspectsof participants’ experiences of living with diabetes, werehighlighted. These meaning units were then condensedto shorten statements that retain the content. In thenext stage, these condensed meaning units, or codes,were abstracted from each interview transcript. Finally,using comparison, reflection and interpretation, thesecodes were grouped into categories and subcategories bythe first three authors. Data collection continued untildata saturation was reached. That is, data collection hadgone on up to when no new code emerged from analysisof the data.

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Facilitators and barriers of adaptation to diabetes: experiences of Iranian patients

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