Contribution of barriers to dietary intake in female patients with type 2 diabetes

2018 ◽  
Vol 48 (3) ◽  
pp. 510-519 ◽  
Author(s):  
Reza Mahdavi ◽  
Faranak Halali ◽  
Mohammad Asghari Jafarabadi ◽  
Majid Mobasseri
Keyword(s):  
Type 2 Diabetes ◽  
Dietary Intake ◽  
Energy Intake ◽  
Diabetes Management ◽  
Dietary Adherence ◽  
Dietary Recommendations ◽  
Content Type ◽  
Female Patients ◽  
The Mean

Purpose Dietary adherence may potentially affect dietary intake. Besides, type 2 diabetes and obesity are closely inter-related. This paper aims to investigate the associations between barriers to dietary adherence and dietary intake among overweight/obese female patients with type 2 diabetes. Design/methodology/approach In this cross-sectional study, 122 female patients with type 2 diabetes from Tabriz, Iran were recruited. All of them had received dietary recommendations from either a nutritionist or a physician. Weight, height and waist circumference were measured using standard methods. A 24-h dietary recall and food records assessed energy and macronutrient intake. Findings The mean BMI of the participants was 32.2 ± 4.3 kg/m2, and the mean daily total energy intake was 1909.5 (218.7) kcal. To assess the associations between barriers to dietary adherence and dietary intake, analysis of variance was used. Analysis revealed significant positive associations between energy intake and the barrier factors situational barriers/difficulty resisting temptation [B (SE) = 42.11 (20.50), p = 0.042], difficulty with meals and snacks plan [B (SE) = 36.13 (12.78), p = 0.005] and small portion sizes [B (SE) = 25.35 (13.58), p = 0.029]. Originality/value Diet has a key role in type 2 diabetes management. The results highlight the need for the barriers to be addressed in nutritional programs targeted for patients with type 2 diabetes. Thereby, level of adherence to the recommended program, eating habits and diabetes management could improve.

scholarly journals Dietary Macronutrient Intakes and Mortality among Patients with Type 2 Diabetes

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1665 ◽  
Author(s):  
Cheng-Chieh Lin ◽  
Chiu-Shong Liu ◽  
Chia-Ing Li ◽  
Chih-Hsueh Lin ◽  
Wen-Yuan Lin ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Dietary Intake ◽  
Total Energy ◽  
Energy Intake ◽  
Total Energy Intake ◽  
Diabetic Patients ◽  
Fat Intake ◽  
Food Diary ◽  
Cvd Mortality

The best macronutrient percentages of dietary intake supporting longevity remains unclear. The strength of association between dietary intake and mortality in patients with type 2 diabetes (T2DM) should be quantified as a basis for dietary recommendations. Our study cohort consisted of 15,289 type 2 diabetic patients aged 30 years and older in Taiwan during 2001–2014 and was followed up through 2016. Percentages of macronutrient intakes were calculated as dietary energy intake contributed by carbohydrate, protein, and fat, divided by the total energy intake using a 24 h food diary recall approach. Cox proportional hazard models were applied to examine the temporal relation of macronutrient intakes with all-cause and cause-specific mortality. The average follow-up time was 7.4 years, during which 2784 adults with T2DM died. After multivariable adjustment, people with fourth and fifth quintiles of total energy, second and third quintiles of carbohydrate, and fourth quintiles of protein intakes were likely to have lower risks of all-cause and expanded cardiovascular disease (CVD) mortality. People with fifth quintiles of total energy intake were likely to have decreased non-expanded CVD mortality. We found a significant interaction between gender and fat intake on all-cause and expanded CVD mortality. Fat intake was associated with all-cause, expanded and non-expanded CVD mortality among males with T2DM. Total energy, carbohydrate, and protein intakes were associated with lower risks of all-cause and expanded CVD mortality, with minimal risks observed at ≥1673 Kcal total energy, 43–52% carbohydrate intake, and 15–16% protein intake among people with T2DM.

scholarly journals Time-Restricted Eating as a Nutrition Strategy for Individuals with Type 2 Diabetes: A Feasibility Study

Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3228 ◽  
Author(s):  
Evelyn B. Parr ◽  
Brooke L. Devlin ◽  
Karen H. C. Lim ◽  
Laura N. Z. Moresi ◽  
Claudia Geils ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Dietary Intake ◽  
Energy Intake ◽  
Well Being ◽  
Cognitive Outcomes ◽  
Daily Energy Intake ◽  
Psychological Well Being ◽  
Daily Energy

Individuals with type 2 diabetes (T2D) require a long-term dietary strategy for blood glucose management and may benefit from time-restricted eating (TRE, where the duration between the first and last energy intake is restricted to 8–10 h/day). We aimed to determine the feasibility of TRE for individuals with T2D. Participants with T2D (HbA1c >6.5 to <9%, eating window >12 h/day) were recruited to a pre-post, non-randomised intervention consisting of a 2-week Habitual period to establish baseline dietary intake, followed by a 4-weeks TRE intervention during which they were instructed to limit all eating occasions to between 10:00 and 19:00 h on as many days of each week as possible. Recruitment, retention, acceptability, and safety were recorded throughout the study as indicators of feasibility. Dietary intake, glycaemic control, psychological well-being, acceptability, cognitive outcomes, and physiological measures were explored as secondary outcomes. From 594 interested persons, and 27 eligible individuals, 24 participants enrolled and 19 participants (mean ± SD; age: 50 ± 9 years, BMI: 34 ± 5 kg/m2, HbA1c: 7.6 ± 1.1%) completed the 6-week study. Overall daily dietary intake did not change between Habitual (~8400 kJ/d; 35% carbohydrate, 20% protein, 41% fat, 1% alcohol) and TRE periods (~8500 kJ/d; 35% carbohydrate, 19% protein, 42% fat, 1% alcohol). Compliance to the 9 h TRE period was 72 ± 24% of 28 days (i.e., ~5 days/week), with varied adherence (range: 4–100%). Comparisons of adherent vs. non-adherent TRE days showed that adherence to the 9-h TRE window reduced daily energy intake through lower absolute carbohydrate and alcohol intakes. Overall, TRE did not significantly improve measures of glycaemic control (HbA1c −0.2 ± 0.4%; p = 0.053) or reduce body mass. TRE did not impair or improve psychological well-being, with variable effects on cognitive function. Participants described hunger, daily stressors, and emotions as the main barriers to adherence. We demonstrate that 4-weeks of TRE is feasible and achievable for these individuals with T2D to adhere to for at least 5 days/week. The degree of adherence to TRE strongly influenced daily energy intake. Future trials may benefit from supporting participants to incorporate TRE in regular daily life and to overcome barriers to adherence.

scholarly journals Motivational Interviewing to Improve Self-efficacy in Type 2 Diabetes Management

2020 ◽  
Author(s):  
Masumeh Hemmati Maslakpak ◽  
Naser Parizad ◽  
Amir Ghahremani ◽  
Vahid Alinejad
Keyword(s):  
Type 2 Diabetes ◽  
Motivational Interviewing ◽  
Self Efficacy ◽  
Diabetes Management ◽  
Intervention Group ◽  
Significant Difference ◽  
Before And After ◽  
Quasi Experimental ◽  
The Mean

Abstract Background Self-efficacy predicts adherence to treatment in patients with diabetes. Motivational interviewing could be a promising intervention to increase the patients’ motivation to follow therapeutic recommendations. The present study aimed to assess the effects of motivational interviewing on self-efficacy in type 2 diabetes management. Methods This quasi-experimental study with a pretest-posttest design was conducted on 60 patients with type 2 diabetes, who were members of the Bukan Diabetes Association in Iran. The patients were selected using a random number table and were randomly allocated into intervention (n = 30) and control (n = 30) groups. Five motivational interviewing sessions (30–45 minutes) were held for the intervention group (two sessions per week). Data were collected using a demographic questionnaire and the diabetes management self-efficacy scale (DMSES). Data were analyzed with SPSS software version 14.0 using descriptive and inferential statistics. Results Sixty patients entered the analysis. A significant difference was observed in the mean score of diabetes management self-efficacy between the two groups before and after the intervention (P = 0.014). The mean score of self-efficacy in diabetes management was increased significantly in the intervention group after MI (P = 0.001). Conclusions Motivational interviewing improved self-efficacy in diabetes management. Thus, this approach is recommended to be used in patients with type 2 diabetes in order to increase their self-efficacy.

scholarly journals Managing with Learning Disability and Diabetes: OK-Diabetes – a case-finding study and feasibility randomised controlled trial

2018 ◽  
Vol 22 (26) ◽  
pp. 1-328 ◽  
Author(s):  
Allan House ◽  
Louise Bryant ◽  
Amy M Russell ◽  
Alexandra Wright-Hughes ◽  
Liz Graham ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Observational Study ◽  
Learning Disability ◽  
Diabetes Management ◽  
Controlled Trial ◽  
Self Management ◽  
Feasibility Randomised Controlled Trial ◽  
The Mean ◽  
Randomised Controlled

BackgroundObesity and type 2 diabetes are common in adults with a learning disability. It is not known if the principles of self-management can be applied in this population.ObjectivesTo develop and evaluate a case-finding method and undertake an observational study of adults with a learning disability and type 2 diabetes, to develop a standardised supported self-management (SSM) intervention and measure of adherence and to undertake a feasibility randomised controlled trial (RCT) of SSM versus treatment as usual (TAU).DesignObservational study and an individually randomised feasibility RCT.SettingThree cities in West Yorkshire, UK.ParticipantsIn the observational study: adults aged > 18 years with a mild or moderate learning disability, who have type 2 diabetes that is not being treated with insulin and who are living in the community. Participants had mental capacity to consent to research and to the intervention. In the RCT participants had glycated haemoglobin (HbA1c) levels of > 6.5% (48 mmol/mol), a body mass index (BMI) of > 25 kg/m2or self-reported physical activity below national guideline levels.InterventionsStandardised SSM. TAU supported by an easy-read booklet.Main outcome measures(1) The number of eligible participants identified and sources of referral; (2) current living and support arrangements; (3) current health state, including level of HbA1c, BMI and waist circumference, blood pressure and lipids; (4) mood, preferences for change; (5) recruitment and retention in RCT; (6) implementation and adherence to the intervention; (7) completeness of data collection and values for candidate primary outcomes; and (8) qualitative data on participant experience of the research process and intervention.ResultsIn the observational study we identified 147 eligible consenting participants. The mean age was 54.4 years. In total, 130 out of 147 (88%) named a key supporter, with 113 supporters (77%) being involved in diabetes management. The mean HbA1clevel was 54.5 mmol/mol [standard deviation (SD) 14.8 mmol/mol; 7.1%, SD 1.4%]. The BMI of 65% of participants was > 30 kg/m2and of 21% was > 40 kg/m2. Many participants reported low mood, dissatisfaction with lifestyle and diabetes management and an interest in change. Non-response rates were high (45/147, 31%) for medical data requested from the primary care team. In the RCT, 82 participants were randomised. The mean baseline HbA1clevel was 56 mmol/mol (SD 16.5 mmol/mol; 7.3%, SD 1.5%) and the mean BMI was 34 kg/m2(SD 7.6 kg/m2). All SSM sessions were completed by 35 out of 41 participants. The adherence measure was obtained in 37 out of 41 participants. The follow-up HbA1clevel and BMI was obtained for 75 out of 82 (91%) and 77 out of 82 (94%) participants, respectively. Most participants reported a positive experience of the intervention. A low response rate and difficulty understanding the EuroQol-5 Dimensions were challenges in obtaining data for an economic analysis.LimitationsWe recruited from only 60% of eligible general practices, and 90% of participants were on a general practice learning disability register, which meant that we did not recruit many participants from the wider population with milder learning disability.ConclusionsA definitive RCT is feasible and would need to recruit 194 participants per arm. The main barrier is the resource-intensive nature of recruitment. Future research is needed into the effectiveness of obesity treatments in this population, particularly estimating the longer-term outcomes that are important for health benefit. Research is also needed into improving ways of assessing quality of life in adults with a learning disability.Trial registrationCurrent Controlled Trials ISRCTN41897033.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 22, No. 26. See the NIHR Journals Library website for further project information.

scholarly journals Abbreviated Dietary Self-Monitoring for Type 2 Diabetes Management: A Mixed-Methods Feasibility Study (Preprint)

2021 ◽  
Author(s):  
Kelli Marie Richardson ◽  
Gloria Cota Aguirre ◽  
Rick Weiss ◽  
Ali Cinar ◽  
Yue Liao ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Mixed Methods ◽  
Diabetes Management ◽  
Lifestyle Changes ◽  
Diabetes Knowledge ◽  
Specific Knowledge ◽  
Self Monitoring ◽  
Glucose Levels ◽  
The Mean

BACKGROUND Type 2 diabetes mellitus (T2D) can be managed through diet and lifestyle changes. The American Dietetics Association acknowledges that knowing what and when to eat is the most challenging aspect of diabetes management. While current recommendations for self-monitoring of diet and glucose levels aim to improve glycemic control among people with T2D, tracking all intake is burdensome and unsustainable. Equally effective, but lower burden, dietary self-monitoring approaches should be explored. OBJECTIVE To examine the feasibility of abbreviated dietary self-monitoring in T2D where only carbohydrate-containing foods are recorded into a diet tracker. METHODS We used a mixed methods approach to quantitatively and qualitatively assess general and diet-related diabetes knowledge and the acceptability of reporting only carbohydrate-containing foods in N=30 men and women with T2D. RESULTS The mean Diabetes Knowledge Test score was 83.9±14.2%. Only 6 of 30 (20%) participants correctly categorized 5 commonly-consumed carbohydrate-containing and 5 non-carbohydrate containing foods. The mean perceived difficulty of reporting only carbohydrate-containing foods was 5.3 on a 10-point scale. Approximately half of the participants (53.3%, n=16) preferred to record all foods. A lack of knowledge about carbohydrate-containing foods was the primary cited barrier to acceptability (40%, n=12). CONCLUSIONS Abbreviated dietary self-monitoring, where only carbohydrate-containing foods are reported, is likely not feasible due to limited carbohydrate-specific knowledge and a preference of the majority to report all foods. Other approaches to reduce the burden of dietary self-monitoring for people with T2D that do not rely on food specific knowledge could be more feasible.

scholarly journals Real-World Clinical Experience on the Usage of High-Dose Metformin (1500-2500 mg/day) in Type 2 Diabetes Management

2021 ◽  
Vol 14 ◽  
pp. 117955142110305
Author(s):  
Ashok Kumar Das ◽  
Sanjiv Shah ◽  
Santosh Kumar Singh ◽  
Archana Juneja ◽  
Niroj Kumar Mishra ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Real World ◽  
Diabetes Management ◽  
Clinical Effectiveness ◽  
High Dose ◽  
Global Evaluation ◽  
The Mean ◽  
High Doses ◽  
Hba1c Levels

Background: To evaluate the clinical characteristics, treatment patterns, and clinical effectiveness and safety of high doses of metformin (1500-2500 mg/day) in Indian adults with type 2 diabetes mellitus (T2DM). Materials and methods: A retrospective, multicentric (n = 241), real-world study included patients with T2DM (aged >18 years) receiving high doses of metformin. Details were retrieved from patient’s medical records. Results: Out of 5695 patients, 62.7% were men with median age was 50.0 years. Hypertension (67.5%) and dyslipidemia (48.7%) were the prevalent comorbidities. Doses of 2000 mg (57.4%) and 1500 mg (29.1%) were the most commonly used doses of metformin and median duration of high-dose metformin therapy was 24.0 months. Metformin twice daily was the most frequently used dosage pattern (94.2%). Up-titration of doses was done in 96.8% of patients. The mean HbA1c levels were significantly decreased post-treatment (mean change: 1.08%; P < .001). The target glycemic control was achieved in 91.2% patients. A total of 83.0% had decreased weight. Adverse events were reported in 156 patients. Physician global evaluation of efficacy and tolerability showed majority of patients on a good to excellent scale (98.2% and 97.7%). Conclusion: Clinical effectiveness and safety of a high-dose metformin was demonstrated through significant improvement in HbA1c levels and weight reduction.

scholarly journals Dietary intake of carbohydrates and risk of type 2 diabetes: the European Prospective Investigation into Cancer-Norfolk study

2013 ◽  
Vol 111 (2) ◽  
pp. 342-352 ◽  
Author(s):  
Sara Ahmadi-Abhari ◽  
Robert N. Luben ◽  
Natasha Powell ◽  
Amit Bhaniani ◽  
Rajiv Chowdhury ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Dietary Intake ◽  
Energy Intake ◽  
Cox Proportional Hazards ◽  
Diabetes Risk ◽  
Dietary Intakes ◽  
Residual Method ◽  
Nutrient Density ◽  
Incident Cases

In the present study, we investigated the association between dietary intake of carbohydrates and the risk of type 2 diabetes. Incident cases of diabetes (n 749) were identified and compared with a randomly selected subcohort of 3496 participants aged 40–79 years. For dietary assessment, we used 7 d food diaries administered at baseline. We carried out modified Cox proportional hazards regression analyses and compared results obtained from the different methods of adjustment for total energy intake. Dietary intakes of total carbohydrates, starch, sucrose, lactose or maltose were not significantly related to diabetes risk after adjustment for confounders. However, in the residual method for energy adjustment, intakes of fructose and glucose were inversely related to diabetes risk. The multivariable-adjusted hazard ratios (HR) of diabetes comparing the extreme quintiles of intake were 0·79 (95 % CI 0·59, 1·07; P for trend = 0·03) for glucose and 0·62 (95 % CI 0·46, 0·83; P for trend = 0·01) for fructose. In the nutrient density method, only fructose was inversely related to diabetes risk (HR 0·65, 95 % CI 0·48, 0·88). The replacement of 5 % energy intake from SFA with an isoenergetic amount of fructose was associated with a 30 % lower diabetes risk (HR 0·69, 95 % CI 0·50, 0·96). Results of the standard and energy partition methods were similar to those of the residual method. These prospective findings suggest that the intakes of starch and sucrose are not associated, but that those of fructose and glucose are inversely associated with diabetes risk. Whether the inverse associations with fructose and glucose reflect the effect of substitution of these carbohydrate subtypes with other nutrients (i.e. SFA), their net higher intake or other nutrients associated with their intake remains to be established through further investigation.

A Randomized Trial About Glycemic Index and Glycemic Load Improves Outcomes Among Adults With Type 2 Diabetes

2008 ◽  
Vol 36 (3) ◽  
pp. 615-626 ◽  
Author(s):  
Carla K. Miller ◽  
Melissa Gutschall
Keyword(s):  
Type 2 Diabetes ◽  
Dietary Intake ◽  
Glycemic Index ◽  
Self Efficacy ◽  
Diabetes Management ◽  
Glycemic Load ◽  
Self Regulation ◽  
Glucose Monitoring ◽  
Outcome Expectations

Glycemic index (GI) represents the postprandial glucose response of carbohydrate foods, and glycemic load (GL) represents the quantity and quality of carbohydrate consumed. A diet lower in GI and GL may improve diabetes management. A 9-week intervention regarding GI and GL was evaluated among adults in the age range of 40-70 years who had had type 2 diabetes ≥1 year ( n = 103). Randomized pre—post test design with immediate and delayed treatment groups was employed. Dietary intake, knowledge, outcome expectations, self-efficacy, and empowerment regarding GI and GL and glucose monitoring were assessed. Four components were identified for outcome expectations using principal components analysis (dietary barrier, glycemic control, family support, and glucose monitoring), and two components were identified for self-efficacy (GI and self-regulation). Significant improvements in GI, knowledge, empowerment, self-efficacy, and outcome expectations (all p < .05) were observed except for glucose monitoring expectations. Only self-regulation efficacy significantly declined ( p < .05) at the follow-up assessment in the immediate group. Nutrition education regarding GI and GL can improve dietary intake, knowledge, outcome and efficacy expectations, and empowerment for diabetes management.

Examining the Effects of Mindful Eating Training on Adherence to a Carbohydrate-Restricted Diet in Patients With Type 2 Diabetes (the DELISH Study): Protocol for a Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Ashley E Mason ◽  
Laura Saslow ◽  
Patricia J Moran ◽  
Sarah Kim ◽  
Hiba Abousleiman ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Group Intervention ◽  
Controlled Trial ◽  
Dietary Adherence ◽  
Mindful Eating ◽  
Dietary Recommendations ◽  
Diet Patterns ◽  
The Impact

BACKGROUND Diet patterns have a profound influence on glycemic control for individuals with type 2 diabetes mellitus (T2DM), and craving-related eating is an important obstacle to dietary adherence. A growing body of research suggests that carbohydrate-restricted (CR) diets can improve glycemic control and reduce medication dependence in T2DM. However, limited data speak to the effects of long-term adherence to CR diets. Mindful eating training has been shown to reduce craving-related eating in overweight populations but has yet to be examined as a behavioral support for dietary adherence in T2DM. This trial examines behavioral mechanisms, particularly craving-related eating, through which mindful eating training might improve adherence to CR dietary recommendations in T2DM. This will clarify the importance of focusing on craving-related eating in the optimization of dietary adherence interventions. OBJECTIVE The aim of this trial is to determine whether providing training in mindful eating increases adherence to a CR dietary recommendation in T2DM. METHODS We are randomizing 60 participants to receive a CR diet with or without mindful eating training (12-week group intervention) and are following participants for 12 weeks after intervention completion. We hypothesize that participants who receive mindful eating training (relative to those who do not) will demonstrate greater adherence to the CR diet. RESULTS Our primary outcome is change in craving-related eating, as assessed using an ecological momentary assessment mobile phone–based platform. Secondary behavioral pathway outcomes include changes in stress-related eating, impulsivity, glycemic control, weight change, dietary adherence, and resumption of dietary adherence after dietary nonadherence. CONCLUSIONS This theory-driven trial will shed light on the impact of mindfulness training on mechanisms that may impact dietary adherence in T2DM. CLINICALTRIAL ClinicalTrials.gov NCT03207711; https://clinicaltrials.gov/ct2/show/NCT03207711 (Archived by WebCite at http://www.webcitation.org/73pXscwaU)  INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11002

Exploring illness beliefs about diabetes among individuals with type 2 diabetes

2014 ◽  
Vol 8 (4) ◽  
pp. 392-413 ◽  
Author(s):  
Rema Lakshmi ◽  
Palanisamy Ganesan ◽  
Ranjit Mohan Anjana ◽  
Muthuswamy Balasubramanyam ◽  
Viswanathan Mohan
Keyword(s):  
Type 2 Diabetes ◽  
Diabetes Management ◽  
Self Regulation ◽  
Research Work ◽  
Illness Beliefs ◽  
Content Type ◽  
Indian Context ◽  
Regulation Model ◽  
Patient Centric

Purpose – The purpose of this paper is to explore illness beliefs among adults with type 2 diabetes (T2DM), studied in a clinical setting in the Indian context. Diabetes management lies primarily in the hands of the patient, which signifies the need for understanding the various dimensions of individuals’ illness beliefs. While past research from abroad has stressed the need for understanding the patient’s perspective in effective illness management, the lack of studies in the Indian context calls for further research in this area. Design/methodology/approach – Drawing on the Self-Regulation Model (Leventhal et al., 1980), semi-structured interviews were carried out to understand the beliefs about diabetes among individuals diagnosed to have T2DM. In total, 70 individuals with T2DM were included, taking into account the disease duration, urban-rural, age and gender distinctions. The data were analyzed using content analysis method. Findings – The results of the analysis revealed numerous sub-themes related to the perceived consequences of diabetes, control or cure issues, timeline and emotional issues as experienced by the subjects. Research limitations/implications – Carrying out a triangulated research with the various stakeholders, namely, diabetologists, general practitioners and other support staff like dieticians could add more value to this exploratory study. Originality/value – There is a dearth of research work that explores the illness beliefs that patients’ hold about diabetes, as discussed in the Indian context. It is expected that the insight provided by the study can help the government bodies, healthcare organizations and practitioners design and develop interventions from a patient-centric view. Additionally, such a patient-centric approach will enable individuals to achieve their treatment goals.

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