Exploring Barriers to, and Facilitators of, Diabetes Self-Management Among Patients with Kidney Failure Receiving Dialysis
Bibliographic record
Abstract
Diabetes mellitus is the leading cause of kidney failure in Canada and around the globe. The treatment of kidney failure may require dialysis - a life-sustaining therapy. Dialysis therapy places significant demands on patients, adding an extra health burden for those navigating the transition to living with chronic diseases. It is well reported in literature that dialysis patients with diabetes compared to those without diabetes have poorer quality of life, longer lengths of hospital stay, a higher burden of morbidity and mortality, and significantly higher economic costs. However, literature on barriers to, and facilitators of, optimal self-management of diabetes are scant in patients with kidney failure. The aim of this thesis work was to understand, describe and interpret the perspectives of patients on barriers to, and facilitators of, diabetes self-management. A narrative review and interpretive descriptive qualitative study were undertaken to address the study aim. Semi-structured interviews with fourteen patients were conducted. A total of 134 articles were identified whereas eight articles met our inclusion criteria. A review of the articles and qualitative study revealed barriers to and facilitators of diabetes self-management. Emerging themes from the included studies and semi-structured interviews were identified using inductive thematic analysis. Barriers reported by participants were financial and physical limitations, limited access to healthcare services, siloed and fragmented care, increased medical complexity, and the higher burden of health. Facilitators of diabetes self-management were self-management support and education, coordinated care between healthcare providers, and supportive environments. Findings from this thesis work contribute to a broader scientific literature, facilitate further research in this domain to address barriers, and guide resource allocation concerning the improvement of diabetes care and self-management practices among patients with kidney failure on dialysis therapies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.034 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".