title: Is adherence a relevant issue in the self-management education of diabetes? A mixed narrative review.
abstract: While therapeutic patient education is now recognized as essential for optimizing the control of chronic diseases and patient well-being, adherence to treatment and medical recommendations is still a matter of debate. In type 2 diabetes, the nonadherence to therapy, estimated at more than 40%, is perceived as a barrier for improving the prognosis despite recent therapeutic advances. Interventional studies have barely begun to demonstrate the effectiveness of technical and behavioral actions. The aim of this review is to question the concept of adherence in terms of therapeutic education based on quantitative and qualitative data. The research on therapeutic education has shown the effectiveness of structured actions in type 2 diabetes, but adherence is rarely an end point in randomized trials. A positive but inconsistent or moderate effect of education actions on adherence has been shown in heterogeneous studies of varying quality. Program types, outlines, theoretical bases, and curricula to set up for action effectiveness are still being discussed. Qualitative studies, including sociological studies, provide a useful and constructive focus on this perspective. Adherence is a soft and flexible tool available to the patient in his/her singular chronic disease trajectory, and as such, integrates into individual therapeutic strategies, including socio-cultural interactions, beyond the medical explanation of the disease and the patient. Four key elements for the development of structured therapeutic education are discussed: 1) the access to health literacy, 2) the contextualization of education activities, 3) the long-term chronic dimension of self-management, and 4) the organizational aspects of health and care. Rather than focusing the objective on behavioral changes, structured therapeutic education actions should attempt to provide tools and resources aimed at helping individuals to manage their disease in their own context on a long-term basis, by developing health literacy and relational and organizational aspects of the health professionals and system.
authors.affiliation: Endocrinology, Diabetology and Nutrition, CHU Félix Guyon, Saint-Denis, Réunion, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Debussche
keywords: chronic disease; health literacy; lifestyle; mixed research; self-management; social context
references.citation: BMC Fam Pract. 2013 Jul 21;14:103
references.pmid: 23870537
references.citation: J Rural Health. 2005 Spring;21(2):172-7
references.pmid: 15859055
references.citation: Sociol Health Illn. 1982 Jul;4(2):167-82
references.pmid: 10260456
references.citation: BMJ. 2008 Mar 1;336(7642):459-60
references.pmid: 18276663
references.citation: Soc Sci Med. 2005 Apr;60(7):1423-35
references.pmid: 15652676
references.citation: Patient Educ Couns. 2009 Aug;76(2):174-80
references.pmid: 19560895
references.citation: Diabetes Metab. 2014 Jun;40(3):169-75
references.pmid: 24503191
references.citation: J Am Coll Cardiol. 2012 Mar 20;59(12):1120-1
references.pmid: 22421308
references.citation: Cochrane Database Syst Rev. 2011 May 11;(5):CD007768
references.pmid: 21563160
references.citation: Rech Soins Infirm. 2012 Sep;(110):45-59
references.pmid: 23091916
references.citation: J Gen Intern Med. 2004 Dec;19(12):1228-39
references.pmid: 15610334
references.citation: Patient Educ Couns. 2000 May;40(2):187-94
references.pmid: 10771372
references.citation: Soc Sci Med. 1985;20(1):29-37
references.pmid: 3975668
references.citation: Soc Sci Med. 2003 Feb;56(3):449-64
references.pmid: 12570966
references.citation: Diabet Med. 2007 Jan;24(1):55-62
references.pmid: 17227325
references.citation: BMJ. 2007 Nov 10;335(7627):968-70
references.pmid: 17991978
references.citation: Soc Sci Med. 2004 Jun;58(12):2655-66
references.pmid: 15081213
references.citation: Sociol Health Illn. 2003;25:58-74
references.pmid: 14498930
references.citation: Soc Sci Med. 1991;32(6):689-96
references.pmid: 2035045
references.citation: Patient Educ Couns. 2007 Mar;65(3):407-15
references.pmid: 17081720
references.citation: Med Care. 2005 Jun;43(6):521-30
references.pmid: 15908846
references.citation: Patient Educ Couns. 2007 Jul;67(1-2):21-31
references.pmid: 17420109
references.citation: Clin Ther. 2011 Jan;33(1):74-109
references.pmid: 21397776
references.citation: Am Fam Physician. 2005 Oct 15;72(8):1454, 1456
references.pmid: 16273815
references.citation: BMJ. 2013 Sep 18;347:f5272
references.pmid: 24048296
references.citation: Health Educ Behav. 2003 Apr;30(2):170-95
references.pmid: 12693522
references.citation: Sociol Health Illn. 2007 Jan;29(1):27-45
references.pmid: 17286704
references.citation: Ann Behav Med. 2003 Aug;26(1):1-7
references.pmid: 12867348
references.citation: Health Soc Work. 2011 Nov;36(4):249-58
references.pmid: 22308877
references.citation: Diabetes Care. 2014 Jan;37 Suppl 1:S144-53
references.pmid: 24357210
references.citation: Cochrane Database Syst Rev. 2005 Apr 18;(2):CD003417
references.pmid: 15846663
references.citation: Soc Sci Med. 2014 May;108:97-105
references.pmid: 24632054
references.citation: Diabetes Metab. 2013 May;39(3):250-7
references.pmid: 23523643
references.citation: Soc Sci Med. 2004 Sep;59(6):1307-13
references.pmid: 15210101
references.citation: Soc Sci Med. 1998 Dec;47(12):2113-25
references.pmid: 10075251
references.citation: Cochrane Database Syst Rev. 2013 Feb 28;(2):CD008722
references.pmid: 23450587
references.citation: Soc Sci Med. 1994 Jan;38(1):59-66
references.pmid: 8146716
references.citation: J Gen Intern Med. 2010 Apr;25(4):284-90
references.pmid: 20131023
references.citation: Qual Health Res. 2007 Jul;17(6):772-85
references.pmid: 17582020
references.citation: Patient Educ Couns. 2004 Jun;53(3):291-8
references.pmid: 15186866
references.citation: BMC Health Serv Res. 2012 Jul 23;12:213
references.pmid: 22824531
references.citation: Cardiovasc Diabetol. 2012 Aug 02;11:91
references.pmid: 22856504
references.citation: Diabetes Care. 2002 Feb;25(2):269-74
references.pmid: 11815494
references.citation: BMC Health Serv Res. 2007 Apr 17;7:55
references.pmid: 17439645
references.citation: Prim Care Diabetes. 2007 Feb;1(1):25-33
references.pmid: 18632016
references.citation: Ann Pharmacother. 2007 Oct;41(10):1569-82
references.pmid: 17712043
references.citation: Health Soc Care Community. 2013 Jul;21(4):339-51
references.pmid: 23009718
references.citation: Patient Educ Couns. 2010 Apr;79(1):55-61
references.pmid: 19709844
references.citation: Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000011
references.pmid: 18425859
references.citation: Cochrane Database Syst Rev. 2009 Jan 21;(1):CD005268
references.pmid: 19160249
references.citation: Front Pharmacol. 2013 Jul 25;4:91
references.pmid: 23898295
references.citation: Diabetes Care. 2004 Dec;27(12):2800-5
references.pmid: 15562188
references.citation: Am J Public Health. 2011 Dec;101(12):2253-60
references.pmid: 21680932
references.citation: Soc Sci Med. 2004 Feb;58(4):851-62
references.pmid: 14672598
references.citation: Lancet. 2004 Oct 23-29;364(9444):1523-37
references.pmid: 15500899
references.citation: Sociol Health Illn. 1983 Jul;5(2):168-95
references.pmid: 10261981
references.citation: Health Aff (Millwood). 2010 Dec;29(12):2197-205
references.pmid: 21134920
references.citation: Diabetes Metab Syndr Obes. 2014 Feb 12;7:45-53
references.pmid: 24550679
references.citation: BMJ. 2006 Jul 1;333(7557):15
references.pmid: 16790458
references.citation: Soc Sci Med. 1995 Jul;41(2):181-95
references.pmid: 7667681
references.citation: Soc Sci Med. 2003 Feb;56(4):671-84
references.pmid: 12560003
references.citation: Diabetes Care. 2004 May;27(5):1218-24
references.pmid: 15111553
references.citation: Soc Sci Med. 2008 Dec;67(12):2072-8
references.pmid: 18952344
references.citation: Br J Community Nurs. 2013 Jun;18(6):267-74
references.pmid: 24046923
references.citation: BMJ. 1998 Mar 28;316(7136):978-83
references.pmid: 9550958
references.citation: Qual Health Res. 2009 Aug;19(8):1100-15
references.pmid: 19638603
references.citation: Diabetes Care. 2012 Jun;35(6):1364-79
references.pmid: 22517736
references.citation: Diabetes Metab. 2012 Feb;38(1):46-53
references.pmid: 22030240
references.citation: Qual Health Res. 2011 Jun;21(6):853-71
references.pmid: 21429946
references.citation: Diabetes Metab Syndr Obes. 2012;5:407-17
references.pmid: 23226028
references.citation: Diabetes Metab. 2008 Sep;34(4 Pt 1):375-81
references.pmid: 18635386
references.citation: Diabetes Care. 2001 Mar;24(3):561-87
references.pmid: 11289485
references.citation: Sociol Health Illn. 2003;25:23-40
references.pmid: 14498928
references.citation: Cochrane Database Syst Rev. 2005 Apr 18;(2):CD003638
references.pmid: 15846672
references.citation: Diabetes Care. 2005 Mar;28(3):527-32
references.pmid: 15735182
references.citation: N Engl J Med. 2008 Feb 7;358(6):580-91
references.pmid: 18256393
references.citation: Soc Sci Med. 2013 Dec;98:141-8
references.pmid: 24331892
references.citation: N Engl J Med. 2008 Oct 9;359(15):1577-89
references.pmid: 18784090
references.citation: Fam Syst Health. 2012 Dec;30(4):322-9
references.pmid: 23148981
references.citation: N Engl J Med. 2005 Aug 4;353(5):487-97
references.pmid: 16079372
references.citation: Diabetologia. 2002 Sep;45(9):1231-9
references.pmid: 12242455
references.citation: Soc Sci Med. 1990;30(11):1149-59
references.pmid: 2113714
references.citation: J Adv Nurs. 2012 Mar;68(3):496-510
references.pmid: 22010971
references.citation: Arch Intern Med. 2006 Sep 25;166(17):1836-41
references.pmid: 17000939
references.citation: Diabetes Metab. 2006 Feb;32(1):50-5
references.pmid: 16523186
references.citation: J Immigr Minor Health. 2012 Dec;14(6):1071-81
references.pmid: 22350920
references.citation: PLoS One. 2012;7(3):e32412
references.pmid: 22403654
references.citation: Diabetes Res Clin Pract. 2008 Mar;79(3):377-88
references.pmid: 17643546