Ms. Amy Weber, student in the Doctor of Public Health program and research manager in the department of health services management and policy in the East Tennessee State University College of Public Health, has co-authored an article in The Qualitative Report. The article, “Putting the Patient Back in Health Care: Health Decision-Making from the Patient’s Perspective,” explored health decision-making processes among people recently diagnosed with type 2 diabetes.
[Photo: Ms. Amy Weber]
Dr. Bill Garris, assistant professor in the department of counseling and human services, is lead author of the article.
Diabetes has risen steadily in the United States. In 1948, about 1 percent of the population had diabetes. Current estimates from the Centers for Disease Control and Prevention are that 30.3 million people in the U.S., 9.4 percent of the population, have the disease while 382 million people globally are estimated to have diabetes. Although type 2 diabetes leads to significant health problems, lifestyle choices can influence disease progression. Although there are many significant consequences to unmanaged diabetes, evidence supports that it is possible to stop, or even reverse, its advance with lifestyle changes. Because of the significant benefits from lifestyle changes, it is important to understand how people make decisions about their health, and what factors influence their thinking.
In August 2017, the researchers conducted a literature review of scholarship maintained by the PsychARTICLES, PubMed, and Web of Science databases spanning the years of 2004 to 2017. Analysis suggested that diagnosis with type 2 was followed by a period of intense emotional and cognitive disequilibrium. Subsequently, the informants were observed to proceed to health decision-making which was affected by three separate and interrelated factors: knowledge, self-efficacy, and purpose. Knowledge included cognitive or factual components and emotional elements. Knowledge influenced the degree of upset or disequilibrium the patient experienced, and affected a second category, agency: the informants’ confidence in their ability to enact lifestyle changes. The third factor, purpose, summarized the personal and deeply held reasons people gave as they made decisions concerning their health, eating, and exercising.
The authors propose this model, grounded in informant stories, as a heuristic, to guide further inquiry. From these stories, the patient is seen as more active and the interrelated influences of knowledge, agency, and purpose, synergistically interact to explain changes in health behaviors.
The Qualitative Report is a peer-reviewed, on-line monthly journal devoted to writing and discussion of and about qualitative, critical, action, and collaborative inquiry and research. It serves as a forum and sounding board for researchers, scholars, practitioners, and other reflective-minded individuals who are passionate about ideas, methods, and analyses permeating qualitative, action, collaborative, and critical study.