"Have to Fight the Demon": Veteran Type 2 Diabetes Mellitus Behavioral Self-Management and Diabetes Specific Risk-Taking Behaviors.
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2025-01
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Abstract
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Diabetes mellitus Type 2 (T2DM) requires a set of life-long, complex self-management strategies that affect both physical and psychosocial aspects of daily life. This study aimed to assess how Veterans with T2DM describe self-management behaviors and to explore whether a framework of diabetes-specificrisk-taking behaviors (originally applied to adolescents with T1DM) is applicable to Veterans with T2DM.Methods
This study employed a secondary qualitative analysis of Veteran interviews (n = 36) using a priori codes based on the Summary of Diabetes Self-Care Activities (SDSCA) and the Diabetes-Specific Risk-Taking Inventory (DSRI) to explore self-management behaviors and to assess the applicability of diabetes-specific risk-taking behaviors among Veterans.Results
We identified themes aligned with each of the SDSCA a priori codes, along with an added code relating to medication, reflecting both self-management behaviors and diabetes-specific risk-taking behaviors: (1) diet: constant negotiation can involve purposeful risk-taking; (2) physical activity: intentional, but also avoided despite consequences; (3) blood-glucose monitoring: personal effort of monitoring can override risk-reduction; (4) foot care: preventing complications; (5) smoking: struggles and successes with quitting; and (6) medication: intent to adhere can be undercut by risk taking and lack of resources.Conclusion
Veterans described self-management behaviors that align with diabetes-specific risk-taking, suggesting that the DSRI framework has potential applicability to this population. Future work exploring diabetes-specific risk-taking behaviors will be critical to helping Veterans successfully manage their T2DM.Type
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Roman Jones, Joanne, Stephanie Hart, Matthew J Crowley, Hayden B Bosworth, Abigail S Shapiro, Madeleine R Eldridge, Chelsea L Whitfield, Teresa Howard, et al. (2025). "Have to Fight the Demon": Veteran Type 2 Diabetes Mellitus Behavioral Self-Management and Diabetes Specific Risk-Taking Behaviors. Journal of primary care & community health, 16. p. 21501319251391012. 10.1177/21501319251391012 Retrieved from https://hdl.handle.net/10161/33900.
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Scholars@Duke
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
Allison A. Lewinski
I am a health services researcher and implementation scientist with a joint appointment at the Duke University School of Nursing (DUSON) and the Durham Veterans Affairs Health Care System (VHA). My expertise spans diabetes distress, qualitative research methods, and virtual care delivery (including telehealth and digital health).
My research examines how virtual care interventions can reduce distress, improve self-management, expand access to evidence-based care, and enhance patient and population health outcomes. I focus on patient-, provider-, and system-level factors that influence the use and effectiveness of virtual care. This work has been funded by competitive grants, published in high-impact journals, presented at national conferences, and used to inform health system decision-making. I am frequently sought by colleagues locally and nationally for expertise in diabetes distress, qualitative methods, and virtual care strategies for grants, projects, and manuscripts.
I strive to improve outcomes for individuals with chronic illness by developing equitable, sustainable virtual care solutions and evaluating their implementation. To optimize these interventions, I apply qualitative and implementation science approaches to ensure alignment among patient needs, care modalities, disease states, and social contexts. My work addresses critical questions: for whom and for what purposes are these interventions effective, in which contexts, and at what points in the care continuum. Ultimately, my research advances the implementation and adoption of virtual care to reduce psychosocial distress and improve health outcomes through patient-clinician interactions and system-level innovations.
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