Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

'Diabetes Is Nothing': The Experience of Older Singaporean Women Living and Coping with Type 2 Diabetes

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

'Diabetes Is Nothing': The Experience of Older Singaporean Women Living and Coping with Type 2 Diabetes

Article excerpt

The global prevalence of diabetes is predicted to escalate and reach pandemic levels, with estimates that over 366 million people will be affected by this disease by 2030 (Parvez, Kawar, & El Nahas, 2007). The alarming increase in rates of diabetes are attributed to lifestyle modi- fications, such as unhealthy diet, lack of exercise, and increasing stress levels owing to modernisa- tion (Chacko, 2003).

In Singapore, with a population of 4.99 million, 9% of the people between the age of 18-60 years have diabetes and this increases to an alarming 45% in the 60-69 year age group (Ministry of Health Singapore, 2010). The prev- alence of the disease is high among the Indian Singaporeans, however; because the Chinese are the largest ethnic group in Singapore mak- ing up 74.2% of the total population (Statistics Singapore, 2010), they have the highest inci- dence of diabetes. Diabetes contributes to 39.7% of stroke cases and is the sixth most common cause of death in Singapore, making it a major health concern (Lee, 2000).

Effective management of type 2 diabetes mellitus (T2DM) relies on medication adher- ence and lifestyle changes (Meetoo & Allen, 2010). Ineffective management may lead to uncontrolled diabetes, which then adds on the economic burden (Jonsson, 2002). Singapore has adopted a systematic and comprehen- sive approach towards managing patients with chronic disease, including diabetes (Cheah, 2001). This multi-pronged approach to chronic disease management includes self-management, and self-management support by health profes- sionals, as well as patient and family education (Cheah, 2001). In order to facilitate patients in managing the disease, it has been suggested that diabetes education should include the patient's insights and experiences (George & Thomas, 2010). The diabetic disease experience has been explored in many published studies (Chesla, Chun, & Kwan, 2009; Chesla et ah, 2004; Samuel-Hodge et ah, 2000) however, there is no evidence in the literature of any studies concern- ing these issues in Singapore.

The literature describes the experience of liv- ing with T2DM as being unpleasant, involving a life with an altered sense of identity (Broom & Whittaker, 2004) as well as being stigma- tised by others (Broom & Whittaker, 2004; Lin, Anderson, Hagerty, & Lee, 2008). Diabetes does not just affect the individual, but also the family. The symptoms of the disease can cause disharmony in the home, as emotional outbursts are often due to symptoms, such as irritability (Chesla et ah, 2009).

Management of diabetes includes making life- style modifications. Although challenges regard- ing dietary modifications have been highlighted in several studies (Chesla et al., 2009; Stone, Pound, Pancholi, Farooqi, & Khunti, 2005; Tamwoy et al., 2004) including those that are conducted with ethnic groups (Chesla et al., 2009; Stone et al., 2005), few studies mentioned challenges to increasing personal levels of physical activity (Hatcher & Whittemore, 2007; Tamwoy et al" 2004).

Coping, defined as the methods that a per- son undertakes to deal with stressors (Lazarus & Folkman, 1984) is an important construct in understanding how people with diabetes react to and manage the extensive stressors and adjust- ments they experience (Garcia, 2010). The coping strategies used depend on the situation, duration of the available resources, as well as the associated factors (Lazarus & Folkman, 1984).

The person with diabetes relies on emotional support to cope with the stressors of the disease and this can be achieved via shared experience (Stone et ak, 2005). However, it might not be an effective way for everyone, as sharing experiences appears to work better for people from South Asian backgrounds, than those from a British background (Stone et ak, 2005). Some people also feel that it will increase tension and anxiety (Stone et ak, 2005).

Another coping strategy mentioned in the lit- erature is sharing problems and feelings with fam- ily and friends to gain support, encouragement and strength (Iwasaki, Bartlett, & O'Neil, 2005). …

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