title: How to engage type-2 diabetic patients in their own health management: implications for clinical practice.
abstract: BACKGROUND
  Patient engagement (PE) is increasingly regarded as a key factor in the improvement of health behaviors and outcomes in the management of chronic disease, such as type 2 diabetes. This article explores (1) the reasons for disengagement of diabetic patients and their unique subjective attitudes from their experience and (2) the elements that may hinder PE in health management.
  
  
  METHODS
  29 Type-2 uncontrolled diabetes patients were asked to keep a one-week diary related to their experience of disease management, according to the narrative inquiry qualitative approach. They were interviewed to ascertain reasons for PE. The elicited narratives were subjected to interpretive content analysis.
  
  
  RESULTS
  The findings suggest that patients give meaning to their diabetes and its management through a complex frame of subjective experiential dimensions (cognitive/thinking, behavioral/conative and emotional/feeling), which have an impact on the spheres of daily life that are considered to be crucial in the management of diabetes (diet, physical activity, therapy, doctor-patient relationship) for each patient. These results suggest that PE develops along a continuum featuring four subsequent phases (blackout, arousal, adhesion, eudaimonic project). Several unmet needs related to the different phases of the PE continuum were discovered and illuminated possible types of support.
  
  
  CONCLUSIONS
  Our findings appear to confirm some features of PE detected by previous research, such as a behavioral component. We were also able to shed light on the synergic roles played by other subjective dimensions of patient experience (the cognitive/thinking and the emotional/feeling components) in orienting PE towards the care process. The article suggests a possible framework to deeply understand the PE process useful to orient really attuned actions to support it. These results suggest the importance of developing patient engagement assessment tools that are more firmly grounded in the individual patient experience.
authors: Faculty of Psychology, Università Cattolica del Sacro Cuore, Largo Gemelli 1, Milan 20123, Italy. guendalina.graffigna@unicatt.it.
authors: Guendalina
authors: G
authors: Graffigna
authors: Serena
authors: S
authors: Barello
authors: Chiara
authors: C
authors: Libreri
authors: Claudio A
authors: CA
authors: Bosio
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy; D005260:Female; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D007558:Italy; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012648:Self Care