Self-management of type 2 diabetes mellitus: a qualitative investigation from the perspective of participants in a nurse-led, shared-care programme in the Netherlands.
BACKGROUND
Diabetes mellitus is a major public health problem. Little is known about how people with type 2 diabetes experience self-management in a nurse-led, shared-care programme. The purpose of this article is to report an empirically grounded conceptualization of self-management in the context of autonomy of people with type 2 diabetes.


METHODS
This study has a qualitative descriptive, and exploratory design with an inductive approach. Data were collected by means of in-depth interviews. The sample consisted of older adults with type 2 diabetes in a nurse-led, shared-care setting. The data analysis was completed by applying the constant comparative analysis as recommended in grounded theory.


RESULTS
People with type 2 diabetes use three kinds of self-management processes: daily, off-course, and preventive. The steps for daily self-management are adhering, adapting, and acting routinely. The steps for off-course self-management are becoming aware, reasoning, deciding, acting, and evaluating. The steps for preventive self-management are experiencing, learning, being cautious, and putting into practice. These processes are interwoven and recurring.


CONCLUSIONS
Self-management consists of a complex and dynamic set of processes and it is deeply embedded in one's unique life situation. Support from diabetes specialist nurses and family caregivers is a necessity of self-managing diabetes.
Moser
Albine
A
Department of Health Ethics and Philosophy, Care and Public Health Research Institute, Maastricht University, The Netherlands. a.moser@zw.unimaas.nl
van der Bruggen
Harry
H
Widdershoven
Guy
G
Spreeuwenberg
Cor
C
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009720:Nurse Clinicians; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D010349:Patient Compliance; D026684:Personal Autonomy; D036301:Qualitative Research; D012648:Self Care