Veterans' Interpretation of Diabetes Distress in Diabetes Self-Management: Findings From Cognitive Interviews.
Allison A Lewinski, Abigail Shapiro, Hayden B Bosworth and 9 others
PMID 34559032WHAT IT FOUND
Veterans with type 2 diabetes said distress is constant and shaped by appointments, supplies, pain, mental health, military life, stigma and spirituality.
The Diabetes Distress Scale was mostly clear, but 'last month' was hard to answer.
Key findings
01Veterans said the Diabetes Distress Scale items were clear and captured their emotions and experiences of diabetes distress.
02Veterans found the past-month wording difficult because diabetes distress and self-management are lifelong and can vary day to day.
03Veterans identified additional diabetes distress domains, including access to care, comorbidities, routine disruptions, mental health, military experience, pain, spirituality and stigma.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was small, mostly male, and drawn from Veterans at one southeastern Veterans Health Administration facility, so it may not represent women, transgender Veterans, younger Veterans, or other regions. The interviews were conducted during the pandemic, which may have shaped Veterans' experiences of distress and access to care. One participant completed the Diabetes Distress Scale but did not complete a cognitive interview. Interviews were not transcribed, so analysis relied on the analyst's detailed notes. The study describes how Veterans understood the Diabetes Distress Scale and what they said mattered; it does not test whether using these domains improves diabetes care.
Declared interests
The article lists non-U.S. government and U.S. government non-PHS research support. Dr. Bosworth reports research funds from Sanofi, Otsuka, Johnson and Johnson, Improved Patient Outcomes, Novo Nordisk, and the PhRMA Foundation, and consulting funds from Sanofi, Otsuka, Abbott, and Novartis.
The easy way to misread this
Do not read this as proof that the Diabetes Distress Scale is inadequate or that adding these domains will improve diabetes outcomes. It was a small telephone cognitive interview study of 15 Veterans from one facility, and it reports how they understood the scale and what they said mattered, not an effect on care.