Factors that facilitate patient activation in the self-management of diabetes and depression among participants enrolled in an integrated chronic care model in India

Leslie C M Johnson; Nancy J Thompson; Mohammed K Ali; Nikhil Tandon; Lydia Chwastiak; Viswanathan Mohan

doi:10.1016/j.socscimed.2020.113646

Factors that facilitate patient activation in the self-management of diabetes and depression among participants enrolled in an integrated chronic care model in India

Soc Sci Med. 2021 Feb:270:113646. doi: 10.1016/j.socscimed.2020.113646. Epub 2020 Dec 24.

Authors

Leslie C M Johnson¹, Nancy J Thompson², Mohammed K Ali³, Nikhil Tandon⁴, Lydia Chwastiak⁵, Viswanathan Mohan⁶

Affiliations

¹ Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA; Emory School of Medicine, Emory University, 201 Dowman Drive, GA, 30322, USA. Electronic address: [email protected].
² Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA. Electronic address: [email protected].
³ Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA; Emory School of Medicine, Emory University, 201 Dowman Drive, GA, 30322, USA. Electronic address: [email protected].
⁴ All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar East, New Delhi, Delhi, 110029, India. Electronic address: [email protected].
⁵ Department of Psychiatry and Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA, 98104, USA. Electronic address: [email protected].
⁶ Madras Diabetes Research Foundation, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India. Electronic address: [email protected].

Abstract

Background: The aim of this study was to identify factors that influence patients' motivation and ability to self-manage their diabetes and depressive symptoms.

Methods: From 2016 to 17, in-depth interviews were conducted with 62 patients receiving the INDEPENDENT care model across two clinics in India. Using a realist evaluation approach, a hypothesized program theory for patient activation was tested and refined.

Findings: The refined theory demonstrates that motivation, education, and engagement cumulatively contribute to patient activation.

Conclusion: The results indicate that positive and sustained patient-provider relationships drive patient motivation and enhance implementation of the care model.

Keywords: Asia; Behavioral intervention; Coordinated care; Low-resource; Realist evaluation.

MeSH terms

Depression / therapy
Diabetes Mellitus* / epidemiology
Diabetes Mellitus* / therapy
Humans
India
Patient Participation
Self-Management*

Abstract

MeSH terms

Grants and funding