The experiences of and meaning for women living and coping with type 2 diabetes: a systematic review of qualitative evidence.
BACKGROUND
Effective management of diabetes not only relies on lifestyle modification and adherence to a treatment regime, but also the ability to cope with the impact of the disease on daily activities. Stress associated with the multi-caregiver role of women may affect the ability to manage the disease effectively.


OBJECTIVE
To explore the experience of women living and coping with type 2 diabetes.


METHODS
Adult women aged 18 years and above diagnosed with type 2 diabetes.The meaning of living and coping with type 2 diabetes.Qualitative studies, including designs such as phenomenology, grounded theory, ethnography, action research and feminist research.


METHODS
The search strategy used sought only to identify published English research papers from the year 1990 to 2010. A three-step search strategy was undertaken.


METHODS
The retrieved papers were assessed for methodological quality by two independent reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument.


METHODS
Data was extracted using the Joanna Briggs Institute Qualitative Assessment and Review data extraction tool.


RESULTS
The data were synthesised using the Joanna Briggs Institute approach of meta-synthesis by meta-aggregation.


RESULTS
Nine studies were included in the review. Forty-one findings were obtained and then grouped into 11 categories which were then aggregated into four synthesised findings: "Living with type 2 diabetes is emotionally and mentally challenging", "Support (of self, by others, spiritual) provides the ability to cope with diabetes", "Women see their personal responsibility in the management of diabetes and try to maintain their autonomy. Despite this, women place the needs of the family over their own needs thereby resulting in ineffective management" and "Effective management of diabetes is hindered by role duties of women as well as their attitudes and the attitudes of the healthcare providers".


CONCLUSIONS
Women are challenged by their multi-caregiving roles and the complexities of managing their diabetes simultaneously. Holistic, individual psycho-education programs for female patients with diabetes and carer programs educating families and friends will facilitate more effective and successful management.


CONCLUSIONS
As supported by the evidence obtained in this review, diabetic education programs should include strategies that facilitate emotional coping. Family members should be encouraged to attend diabetes management programs or workshops designed for caregivers or family members to enable them to support female family members with diabetes effectively. Education programs for doctors should focus on the therapeutic helping relationship and the role this relationship plays in facilitating improved health outcomes for patients.


CONCLUSIONS
Implementation of action research with interventions that address the key issues identified in this systematic review would be useful. Additionally, further longitudinal studies that link the incidence and severity of complications and quality of life issues associated with diabetes management to such intervention programs will clarify the benefits, modifying factors and barriers. Despite a plethora of literature examining the coping styles and experiences of Caucasian people with diabetes there is a paucity of literature investigating similar issues among Asian populations. Thus further research studies that examine the experience of living and coping with type 2 diabetes in Asian populations are needed to enhance understanding for these patients.
1. Student, Alice Lee Centre for Nursing Studies,Yong Loo Lin School of Medicine, National University of Singapore. The Singapore National University Hospital (NUH) Centre for Evidence-Based Nursing: a Collaborating Centre of the Joanna Briggs Institute. 2. Associate Professor, Curtin University, School of Nursing and Midwifery, Australia. 3. Professor, Monash University, School of Nursing and Midwifery, Australia.
Li Jie
LJ
Min
Vicki Blair
VB
Drury
Beverley Joan
BJ
Taylor