Avicenna Journal of Clinical Medicine

Volume 31, Issue 3

Original Article

Explaining the Understanding of Elderly Patients with Type 2 Diabetes Regarding Information Therapy Related to Self-care: A Qualitative Study

Masoud Koorki1, Alireza Isfandyari-Moghaddam1,* , Atefeh Zarei1, Sahar Khoshravesh2, Erfan Ayubi3

  1. Department of Knowledge and Information Science, Hamedan Branch, Islamic Azad University, Hamedan, Iran

2 Chronic Diseases (Home Care) Research Center, Institute of Cancer, Avicenna Health Research Institute, Hamadan University of Medical Sciences, Hamadan, Iran

3 Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran

*Corresponding author: Alireza Isfandyari-Moghaddam, Department of Knowledge and Information Science, Hamedan Branch, Islamic Azad University, Hamedan, Iran. Email: ali.isfandyari@gmail.com

EXTENDED ABSTRACT

Background

Information therapy is a relatively new approach that provides patients with health-related information to strengthen their capacity to understand health problems, make informed decisions, and participate in the recovery process [1, 2]. By facilitating access to appropriate information in face-to-face or remote formats, information therapy may support self-care, reduce unnecessary use of health services, and limit avoidable costs associated with chronic disease complications [2, 3]. Diabetes becomes increasingly prevalent with advancing age [4, 5], and it is among the common chronic disorders of later life [6]. The original article notes that diabetes prevalence in older adults is substantially higher than in younger people and that type 2 diabetes affects a considerable proportion of Iranian older adults [7, 8]. This problem is especially relevant in the context of global population ageing [9]. Effective diabetes control requires long-term disease management, and evidence described in the article indicates that education and access to appropriate health information are important for disease control [10]. Successful management is strongly dependent on self-care behaviors [11, 12], including appropriate diet, adequate physical activity, medication adherence, blood glucose self-monitoring, and other daily care activities [13]. Because type 2 diabetes is progressive and may remain clinically silent while complications develop, older adults need accurate, accessible, and practical information that supports sustained self-care. However, limited evidence has explored how older people with diabetes themselves understand information therapy and how they perceive its role in self-care. This qualitative study therefore aimed to explain the understanding of older adults with type 2 diabetes regarding information therapy related to self-care.

Methods

This qualitative study used content analysis and was conducted in 2024 among 18 older adults with type 2 diabetes attending selected specialized diabetes centers in Hamadan, Iran. Participants were recruited purposively until content saturation, with maximum variation sought according to sex, educational level, marital status, employment status, and duration of diabetes. Eligibility required a diagnosis of type 2 diabetes by an internist or endocrinologist, disease duration longer than one year, age 60 years or older, ability to communicate verbally in Persian, independence in daily functioning, and ability to read and write. Exclusion criteria included other underlying diseases, psychological disorders, unwillingness to participate, or physical inability to answer the interview questions. Data were collected through individual, in-depth, semi-structured interviews guided by demographic questions and open-ended questions concerning dimensions of diabetes self-care and sources used to obtain self-care information. Interviews were conducted privately, lasted approximately 30-40 minutes depending on participant fatigue and cooperation, were audio-recorded with permission, and were accompanied by field notes. Interviewing continued until new interviews no longer added new information. Recordings were transcribed and entered into MAXQDA 2020. Researchers repeatedly reviewed the recordings and transcripts, extracted manifest and latent meanings, generated initial codes, merged similar codes, and organized them into subcategories, categories, and ultimately a higher-order theme. Trustworthiness was addressed using the Guba and Lincoln criteria of credibility, transferability, dependability, and confirmability [14]. Strategies included involvement of a trained interviewer, adequate engagement with the data, documentation of study procedures, simultaneous collection and analysis, external review of interview materials, and checking codes and categories with researchers familiar with qualitative analysis. The study was approved by the Ethics Committee of Islamic Azad University, Hamedan Branch (IR.IAU.H.REC.1403.010). Participants were informed about the study purpose, confidentiality, voluntary withdrawal, and recording of interviews, and written informed consent was obtained.

Results

The study included 18 older adults with type 2 diabetes, comprising 10 men and 8 women. Participants were 60-82 years old, and the duration of diabetes ranged from 2 to 40 years, providing variation in educational attainment, marital status, employment, and disease experience. Analysis of the 18 interviews initially produced 250 codes; after review and consolidation, 36 codes remained. These were organized into 13 subcategories, three categories, and one overarching theme: diabetes control and management. The first category, enhancing self-care behaviors, comprised four subcategories. Physical self-care included diet, physical activity, blood glucose assessment, medication use, foot care, eye care, and avoidance of tobacco. Psychological and emotional self-care included listening to relaxing music, spending time in nature, using relaxation techniques to control stress, and consulting a psychologist. Social self-care included communication with family members, friends, and peers and maintaining friendships and social interactions. Spiritual self-care included connection with God, prayer and supplication, Quran recitation, performing prayers, fasting, charitable activity, and participation in religious ceremonies. Participants described these behaviors as relevant to daily diabetes management, although views regarding spiritual practices were not uniform. The second category, increasing individual motivation to perform self-care behaviors, included increasing awareness, improving attitude, controlling the disease and its complications, reducing costs, and making better decisions. Participants perceived information therapy as a means of expanding knowledge, reducing negative attitudes toward diabetes, lowering anxiety and stress, supporting better control of complications, decreasing some material and non-material burdens and physician visits, and enabling more informed choices about care. The third category, access to information-therapy communication channels, comprised interpersonal sources, traditional media, digital media, and social networks. Physicians and health professionals, family members and relatives, and friends and peers represented interpersonal sources. Traditional media included radio, television, books, magazines, and newspapers; digital sources included the internet and specialized diabetes websites; and social networks included Eitaa, Telegram, WhatsApp, Instagram, and similar platforms. Many participants described the internet as the easiest and most accessible non-face-to-face source of information, while physicians and health professionals were also prominent and trusted information sources. Television health programming was another commonly described source. Perceptions of peer information were mixed: some participants valued experienced peers, whereas others preferred professional guidance because they were concerned about inaccurate advice. The overall organization of the qualitative findings is presented in Table 2.

Table 2. Concepts identified in the in-depth individual interviews: theme of diabetes control and management.

Conclusion

Older adults with type 2 diabetes perceived information therapy as a potentially useful approach for increasing motivation to perform self-care, strengthening self-care behaviors, and supporting diabetes control and management. Their accounts emphasized that effective information therapy is broader than delivery of biomedical facts; it includes physical, psychological, social, and spiritual dimensions of self-care and depends on access to multiple communication channels. The findings also indicate the importance of reliable professional guidance alongside accessible digital and traditional media. Because the study was qualitative, involved a small purposively selected sample, and was conducted in a limited setting, the findings are contextual rather than broadly generalizable. Nevertheless, they suggest that health professionals can consider information therapy as a structured educational approach for supporting self-care among older adults with type 2 diabetes.

Keywords: Aged, Content Analysis, Diabetes Mellitus Type 2, Information Therapy, Self Care

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