Management of chronic illness.

identify the study design (including research methods) and
critically analyse the design in relation to achieving the author(s) aims.

  1. The authors of the article address psychosocial factors which are associated with the
    chronic disease(s). Your critical review will identify and explain how these psychosocial
    factors impact individuals and/or family and their responses to the chronic illness.
  2. Your critical review will explain how (if at all) the article contributes to interdisciplinary
    knowledge (from the behavioural health sciences) for best practice management of chronic

Critical review

Trief and colleagues investigated the psychosocial challenges of adults who live with
diabetes type 1, and ways the psychosocial challenges impact the relationship of their partners.
The aim of the study was to gain better understanding of these psychosocial issues in order to
practice effective management of chronic diseases. The study design is focus group research.
The research method is qualitative research. This research method befits this research study
because data generated from the focus group is based on insights (not rules) of human behaviors.
This is because the study allows all the participants to contribute in discussion as the researchers
listen to discussion content such as tone and emotions of the participants, which help the study to
either learn or confirm facts. In addition, this method of research helps to paint a portrait of local

perspectives such as the regions knowledge of diabetes Type 1, and educational resources
available. The focus group selection criteria ensured people have similar characteristics are
invited to a single session. For example, there four focus groups where two had patients
diagnosed with diabetes type 1 and two with their partners- which increased the quality of data
(Trief et al. 2013).
Ways psychosocial challenges influence patient/family response to chronic illness
The research indicate that patients diagnosed with type 1 diabetes face unique emotional
as well as interpersonal challenges such as substance abuse disorders, medication non-adherence,
eating disorders and poor quality of life. The study identifies four domains including a) impact of
diabetes on patient relationship with the caregiver/partner including the emotional impact of
diabetes and issues regarding child rearing; b) learning the importance of hypoglycemia; c) stress
associated to potential complications; d) advantages of technology (Trief et al. 2013).
According to the article, a small group of people highlighted that the disease had brought
their relationship closer. Patients with supportive was associated with defined acceptance of the
chronic illness, which in turn assured the patient that she/he could get through the hard times.
However, some participants indicated negative impact of diabetes type 1 on their relationship.
This indicated included increase emotional distance such as sexual intimacy issues, difficult
decision making processes, and concerns of children care. Generally, the increase of emotional
stress was associated with constant risks of hypoglycemia (Trief et al. 2013).
Concerns about child bearing issue that was identified by patients as a factor that
negatively impacted their response to type 1 diabetes. Most of the participants had specific
concerns about their ability to bear and raise their children actively. Others had fears of passing

their susceptible genes to their children. The patient stated that they had advices about pregnancy
complications which would put their lives at risk. This stress level was associated with threat of
hypoglycemia. According to this article, the issue of hypoglycemia is identified as the worst
feeling in their lives. Research indicates that this feeling is associated with great fears and
anxiety. Some patients indicated that they had learnt effective coping strategies to help the
patient avoid lows. This included healthy food choices, placing glucagon tablets in each room
and use of insulin pump to reduce hypoglycemia intensity and frequency. The patient partners
seem to be the most worried about hypoglycemia. This is because the ‘low’ just happen at any
time of the day and it is crazy. The low moment is described with increased irritability,
moodiness and conflict which affects their relationship negatively and consequently affected
their response and coping ability to the chronic illness (Trief et al. 2013).
Patients and their partners also highlighted about the constant looming threat of
complication. The patient and their partners were terrified at the thought of blindness and
amputation. Although the patients and their partners were keenly aware that they had to save
organs through proper practice of the disease, most felt frustrated especially when the doctor
identified their condition as brittle or in poor control of their condition. The patient stated that
when blamed for their bad diabetic condition increased their distress as they had sincere efforts
to control the condition. Overall, the patients were aware of potential complications and
emphasized their need for reassurance and non blaming response from their physician and their
partners. The patient partners also experienced similar levels of stress and anxiety of potential
complications associated with diabetes. They also identified specific challenges they went
through such as battling with insurance companies, complete dependence of the patient during
the hypoglycemic episodes and issues of weight control and exercise. These individual factors

cumulatively resulted to higher levels of stress. This indicates that family support is associated
with positive self management practices (Trief et al. 2013).
Ways the article contributes to interdisciplinary knowledge
The study was performed in order to gain better understanding of a richer understanding
of psychosocial factors that affects people diagnosed with diabetes 1. The main themes that have
emerged from this article indicates that partner involvement vary, but the anxiety and fear levels
of hypoglycemia and future complications have significant impact on their well being and their
relationship. From this study several behavioral human aspects in chronic illness is clear; a)
relationships are unique and it is not obvious that all patients have supportive partners or are
overwhelmed by the disease; b) the patient-partner relationship changes are influenced by the
health demands at a particular time. This implies that healthcare providers must assess
individuals relationship so as to tailor make his/her intervention based on the patient unique
needs, so as to cope with the unique challenges effectively and improve their self management
practices (Trief et al. 2013).



Trief, P.M., Sandberg, J. G., Dimmock, J. A., Forken, P. J., Weinstock, R. S. (2013). Personal
and Relationship Challenges of Adults with Type 1 Diabetes: A Qualitative Focus Group
Study. Diabetes Care (36) 2483- 2488