SENSE MAKING OF COMPREHENSIVE DIABETIC CARE INFORMATION AMONG TYPE 2 DIABETIC PATIENTS ATTENDING ENDOCRINOLOGY CLINIC IN NIGERIA
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Background to the Study
Sense making is the process by which people give meaning to experience. Sense making of information enhances the management of chronic diseases such as type 2 diabetes mellitus. It has been reported that sense making process is the cognitive gap that individuals experience when attempting to make sense of observed data.(Dervin, 1983,1992).Type 2 diabetes mellitus (T2DM) patients understand health information through making sense out of the gathered information (Oftedal, 2011; Stiffler, Cullen & Luna,2014). Sense making is a set of processes initiated when an individual recognizes the inadequacy of their current understanding of events. Sense making is about the interplay between action and interpretation rather than the influence of evaluation on choice (Mills, 2003). Sense making enables individual to comprehend their circumstances. Persons suffering from T2DM receive large amount of information through healthcare providers. Such information has to be processed to enable comprehension. In T2DM management, sense making acts as a stepping stone to decision making and it involves concepts such as cognitive abilities, personal construct, frame of reference and socialization (Weick, Sutcliffe & Obstfeld, 2005). Cognitive ability is the brain – based skills required to carry out any task from the simplest to the most complex. Possession of cognitive abilities is individualistic and is very essential for T2DM management. These abilities include schema, accommodation, assimilation and equilibration (Piaget, 1997). Schema includes the mental and physical actions involved in understanding and knowing (Piaget, 1997). Schema is the organizing of information that will portray a meaning. Persons living with T2DM must be able prioritize information sequentially in order to promote 2 assimilation. It is ability to incorporate new ideas into existing ones (Piaget, 1997). Accommodation is changing and altering our existing schemas in light of new information and putting it into use (Piaget, 1997). Equilibration allows a person to strike a balance between existing and newly acquired knowledge.T2DM patients must be able to strike such a balance in order to effectively manage the disease otherwise cognitive dissonance is triggered. Cognitive dissonance is a situation when an individual encounters ideas or values that contradict initially held attitudes, beliefs, or behaviors (McLeod, 2008). In diabetic education, T2DM patients are confronted with ideas that may differ from initially held beliefs. This results in anxiety and triggers the need to seek additional information to reduce the level of discomfort and make sense of required information. Both personal construct and frame of mind influences information behavior of T2DM patients. In fact, exposure of T2DM patients to information is highly significant in order to erase a situation of information imbalance. Information asymmetry is a situation in which one party in a transaction has more information than the other party (Afzal, 2010; Akerloff, 1970). For instance, doctors definitely have more information than the diabetic patients. Information distribution is assuring the right information is available to the right people at the right time. This is of utmost importance when coping and living with a chronic disease such as type 2 diabetes mellitus. Diabetes mellitus (DM) is a common cause of morbidity and mortality in Nigeria. Over 10 million of the populace in Nigeria suffers from DM with more than 200,000 deaths per year (Okolie, Ehiemere, Iheneacho & Kalu –Igwe, 2009; Nwankwo & Nwankwo, 2010; Pascal, Ofoedu, Uchenna, Nkwakwo, 2013; Chijoke, Adamu & Makusidi, 2014). There are four types of diabetes; Type 1, Type 2, Monogenic and Gestational Diabetes. Type 1 diabetes mellitus (T1DM) is characterized by the destruction of pancreatic beta cells, common among children and young adults 3 (Smelter, Bare, Hinkle&Cheever, 2010; ADA, 2012; 2011.). Type 2 diabetes mellitus (T2DM) is characterized by insulin resistance and impaired insulin secretion and is common among overweight persons over 30 years (Smelter et al 2010). Gestational diabetes mellitus (GDM) refers to a condition in which a woman without diabetes develops high blood glucose during pregnancy. Monogenic diabetes is a rare condition resulting from mutations in a single gene (Hormone Health Network, 2010).T2DM is the most commonly documented type of DM in Endocrine Clinic in Nigeria, accounting for 90% - 95% of all cases (Ogbera & Ekpebegh, 2014). T2DM is difficult to treat but can be managed to reduce the complications. Endocrine clinic is where diabetic patients receive education on managing the diabetes. Diabetic patients have an increased risk of developing a number of serious compilations (IDF, 2012). These complications include retinopathy, neuropathy, nephropathy and vasculopathy. Diabetic retinopathy is the damage of the blood vessels of the retina, potentially leading to blindness, cataracts and glaucoma. Although long- term complications of diabetes develop gradually, they eventually lead to disability and can even be life threatening (Mayo, 2018). Complications experienced by diabetic patients are neuropathy, nephropathy, retinopathy (IDF, 2012). Diabetic neuropathy is the abnormal and decreased sensation of the nerves starting with the feet. When this is combined with damage of blood vessels and a lack of blood supply to the feet, it leads to a diabetic foot. (NICE Clinical Guideline, 2013). Diabetic nephropathy is damage to the kidney which can lead to chronic renal failure, eventually requiring dialysis. Diabetes mellitus is the most common cause of adult kidney failure. Diabetic complications can be managed through comprehensive diabetic care. Comprehensive diabetic care can reduce complications associated with T2DM. Comprehensive care refers to care that encompasses all the details regarding diabetes. You are looking at the big picture, 4 not just a little piece of the puzzle. Comprehensive care is not just treating the problem with medicine, but adding in the latest research, treatments, and patient education. Comprehensive care of T2DM is aimed at regulating patients‟ blood glucose levels (Pascal, Ofoedu, Uchenna, Nkwa & Godswill – Uko, 2012; Ogbera & Ekpegegh, 2014; Jasper, Ogundomade, Opara, Akinrole, Pyiki & Umar, 2014). Effective management primarily depends on patient‟s self-care ability (Brunetti & Kalabalik, 2010). Key elements in comprehensive care of diabetes include tobacco cessation, appropriate levels of physical activity, regulation of dietary intake, and general diabetes self – management education (Redmon, Caccanno, Flavin, Michels, O‟Conner, Roberts, Smith & Sperl – Hillen, 2014). In spite of the fact that studies have identified how diabetic patients can manage the disease condition; achieving effective control is often difficult and can be improved with support from family members and peers (IDF, 2013; CMCD, 2015). To reduce complications, it is important to understand how T2DM patients understand and make sense of self – care information provided at Endocrinology Clinic. Self-care ability is one of the most vital aspects of diabetes management along with guidance provided by medical practitioners. Self-care behaviors include healthy eating, being active, monitoring of blood glucose, compliance with taking medication, good problem solving, risk reduction and healthy coping (Joslin, 2014). Patients depends on medical professionals for education in the practice of self-management of diabetes and embedding continuous diabetes selfcare behaviors has shown to be an effective strategy in management of diabetes (Dialoo, Shojaeizedah, Gharaghi, Niknami & Pourali, 2012; Jackson, Adibe, Okonta & Ukwe, 2014). Despite the fact that self-care information is provided by medical professionals through patient education during routine re-evaluation clinics; T2DM complications still remains prevalent among patients. Factors responsible for the complications include smoking, elevated cholesterol level, 5 obesity, high blood pressure (IDF, 2015; Menke, Casagrande, Geiss & Cowie, 2015). In spite of the fact that studies has been conducted on factors responsible for diabetic complications, very few studies (Hjelm, Albin &Atwine, 2015; Shrivastava, Shrivastava & Ramasamy,2013) have examined how T2DM patients understand information for managing the disease. As such, it becomes imperative to explore why T2DM patients who have been educated on the recommendations for management of the disease still encounter complications.
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