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Open Access Portraits of Patient Cognition: How Patients Understand Diabetes Self-Care Portrait de la cognition des patients: la compréhension des autosoins chez les patients souffrant de diabète

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Diabetes self-management is a complex dynamic process. Although patients are given guidelines for self-care, many still struggle with glucose control. This study uses techniques from naturalistic decision-making research to examine how patients with low, moderate, and good glycemic control conceptualize self-care. Eighteen people with type 2 diabetes were interviewed about their experiences with diabetes, understanding of the disease, and self-care behaviour. Qualitative methods were used to analyze responses and describe patterns of cognition. The authors describe participants' understanding of major areas of self-care and its relationship to self-management. The majority of participants failed to adequately understand the disease, typically because they were overwhelmed by or misunderstood rule-based instructions. Understanding of the dynamics underlying glucose regulation was found to be critical for effective self-management. Diabetes educators need to teach patients about the dynamics underlying self-management and to emphasize problem-solving and decision-making skills.

French
L'autogestion du diabète est un processus dynamique complexe. Malgré les directives données aux patients pour leur permettre de s'auto-soigner, beaucoup ont encore de la difficulté à contrôler leur taux de glucose. La présente étude s'appuie sur les techniques de recherche en matière de prise de décision, pour étudier la conceptualisation des autosoins chez les patients ayant un contrôle glycémique faible, modéré et bon. Dix-huit personnes souffrant de diabète de type 2 ont été interrogées sur leur expérience du diabète, leur compréhension de la maladie et leur comportement relié aux autosoins. Des méthodes qualitatives ont été utilisées pour analyser les réponses et décrire les schémas cognitifs. Les auteures décrivent la compréhension des principaux aspects des autosoins et de leur relation avec l'autogestion qu'avaient les participants. Chez la majorité d'entre eux, la compréhension de la maladie était insuffisante — en général, parce que les directives fondées sur des règles les dépassaient ou qu'ils ne les comprenaient pas. La compréhension de la dynamique sous-jacente à la régulation du glucose s'est avérée essentielle à une autogestion efficace. Les éducateurs spécialisés en diabète devront enseigner la dynamique sous-jacente à l'autogestion aux patients et mettre l'accent sur l'aptitude à résoudre les problèmes et à prendre des décisions.

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Keywords: CHRONIC DISEASES; COGNITION; DECISION MAKING; DIABETES; HUMAN FACTORS; PSYCHOLOGY

Document Type: Research Article

Publication date: 2008-09-01

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