The family and type 2 diabetes: a framework for intervention.
Four broad groups of factors have been linked with self-management behavior in type 2 diabetes over time: (1) characteristics of patients, (2) amount and management of stress, (3) characteristics of providers and provider-patient relationships, and (4) characteristics of the social network/context in which disease management takes place. Of these four, social network/context has received the least amount of study and has been described in terms not easily applicable to intervention. In this paper, we identified the social network/context of diabetes management as residing within the family. We defined the family for clinical purposes, reviewed the literature concerning what is known about the link between properties of the family context of care and outcomes in type 2 diabetes and other chronic diseases, and identified areas of family life that are relevant to diabetes management. This information was then used to demonstrate how a family context of care can serve as a clinical framework for integrating all four groups of factors that affect disease management. Implications of this approach for practice and research are described.
Fisher
L
L
The Department of Family and Community Medicine, University of California, San Francisco (Drs Fisher, Bartz, and Skaff)
Chesla
C A
CA
Department of Health Care Nursing, University of California, San Francisco (Drs Chesla and Gilliss)
Bartz
R J
RJ
The Department of Family and Community Medicine, University of California, San Francisco (Drs Fisher, Bartz, and Skaff)
Gilliss
C
C
Department of Health Care Nursing, University of California, San Francisco (Drs Chesla and Gilliss)
Skaff
M A
MA
The Department of Family and Community Medicine, University of California, San Francisco (Drs Fisher, Bartz, and Skaff)
Sabogal
F
F
Department of Medicine, University of California, San Francisco (Dr Sabogal)
Kanter
R A
RA
The Department of Medicine, Kaiser Permanente, San Francisco, California (Dr Kanter)
Lutz
C P
CP
Nutri­tion Counseling Clinic, University of California, San Francisco (Ms Lutz)
D000223:Adaptation, Psychological; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control* / Q000523:psychology*; D005190:Family / Q000523:psychology*; D006801:Humans; D008960:Models, Psychological; D011368:Professional-Family Relations; D012648:Self Care / Q000523:psychology*; D012944:Social Support