PUBLIC HEALTH RESEARCH PROGRAM

To meet the challenges of the rising prevalence of chronic diseases, such as type 2 diabetes, new approaches to healthcare delivery in primary healthcare are needed.

The Good Diabetes Care –research project has in two recent studies investigated two approaches to quality of care among patients with type 2 diabetes: 1. autonomy support by one’s physician based on Self-determination theory (SDT), and 2. the Chronic Care Model (CCM), a patient-centered framework to enhance evidence-based chronic care.

The first study investigated the impact of perceived autonomy support, autonomous motivation and self-care competence on success in increasing physical activity (PA). Autonomous motivation predicted success in increasing PA even after controlling for the effect of other important life-context factors. Autonomous motivation mediated the effect of perceived autonomy support from a doctor on success in increasing PA. The findings were in line with the SDT. Doctor–patient relationships and lifestyle interventions should focus on promoting self-motivated reasons for health behavior change.

The second study investigated the validity and reliability of the Patient Assessment of Chronic Illness Care (PACIC) scale, which measures the extent to which care is congruent with CCM, focusing on self-management support – comprising collaborative goal setting, problem solving and follow-up – and planned proactive care. The findings of the study suggested comparable psychometric properties of the Finnish PACIC scale as of the original English instrument, and reasonable levels of validity and reliability. The PACIC scale also showed the hypothesized relationships with quality of care and outcome measures.

The findings indicate quite strong associations between CCM-concordant care – as perceived by patients – and an autonomy supportive health care climate as studied in the first study. Both include a patient-centered approach; the CCM, however, takes into account the whole primary healthcare team and also resources in the community. The Finnish Ministry of Social Affairs and Health recommends the CCM as a tool for improving quality of chronic illness care in health centers. The PACIC scale is now validated among patients with type 2 diabetes in Finland and can be used to evaluate quality of care in primary healthcare.

The ‘Good Diabetes Care’ –Study is a cross-sectional survey study among patients with type 2 diabetes in five municipalities in Southern and Central Finland (response rate 56%; n= 2866; mean age 63 years; 56% men) with a sample from the register of the Social Insurance Institution of Finland. The study focuses on the effectiveness of diabetes care and aims to find the best possible means by which primary healthcare can achieve favorable outcomes in diabetes care.

Original Articles

Koponen AM, Simonsen N, Suominen SB. Success in increasing physical activity (PA) among patients with type 2 diabetes: a self-determination theory perspective. Health Psychol Behavior Med 6: 104-119, 2018 (DOI: 10.1080/21642850.2018.1462707)

Simonsen N, Koponen AM, Suominen S. Patients’ assessment of chronic illness care: a validation study among patients with type 2 diabetes in Finland. BMC Health Serv Res 18: 412, 2018 (doi:10.1186/s12913-018-3206-7)