Factors that facilitate patient activation in the self-management of diabetes and depression among participants enrolled in an integrated chronic care model in India

• Authors: Leslie Johnson, Emory University; Nancy Thompson, Emory University; Mohammed Ali, Emory University; Nikhil Tandon, All India Institute of Medical Sciences; Lydia Chwastiak, University of Washington; Viswanathan Mohan, Madras Diabetes Research Foundation
• Journal Title: Social Science and Medicine
• Volume: Volume 270
• Publisher: Pergamon Elsevier Science Ltd. | 2021-01-21, Pages 113646-113646
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.socscimed.2020.113646
• Subjects: Health Sciences, Health Care Management; Engineering, Biomedical; Health Sciences, Occupational Health and Safety
• Keywords: Science & Technology; Social Sciences; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; Social Sciences, Biomedical; Biomedical Social Sciences; Realist evaluation; Coordinated care; Low-resource; Behavioral intervention; Asia

Abstract

Background: The aim of this study was to identify factors that influence patients’ motivation and ability to self-manage their diabetes and depressive symptoms. Methods: From 2016 to 17, in-depth interviews were conducted with 62 patients receiving the INDEPENDENT care model across two clinics in India. Using a realist evaluation approach, a hypothesized program theory for patient activation was tested and refined. Findings: The refined theory demonstrates that motivation, education, and engagement cumulatively contribute to patient activation. Conclusion: The results indicate that positive and sustained patient-provider relationships drive patient motivation and enhance implementation of the care model.