**11. Barriers to family-centered Care**

*Lifestyle and Epidemiology - The Double Burden of Poverty and Cardiovascular Diseases...*

**9. The type of support a family can give to diabetes patients**

outcomes have been associated with better income [31].

**10. The negative ways family can affect diabetes**

lifestyle modification and new way of doing things [33].

outcomes for better glycaemic outcomes.

**9.1 Supporting family**

a healthy lifestyle [3]. Adequate family support also helps in achieving good QoL [29], particularly when the family are knowledgeable with regard to diabetes care.

Living alone is linked with increasing depression, poor diabetes outcomes and increased mortality [30]. The family support and care for patients, with daily living activities which includes meal preparation and consumption, physical activity, collection of medication, bathing, distribution of household chores, bathing and clothing, and honoring of medical appointments. Families also help patients cope `with the diabetes and also may be required to financially support the patients so as to daily meet the activities of daily living. Quality of life and better glycaemic

Family communication needs to be improved during DSME, and also empower

Actions of family members in providing support to diabetes patients may be harmful and lead to poor diabetes outcomes [33], particularly when family members who are not trained about care, are not capacitated through DSME on self-care activities. Family culture, way of living and problem-solving skills may additionally contribute in harming the patients and resulting poor diabetes outcomes. The required diabetes self-management activities may be in conflict with the traditional family way of cooking and eating, which may prompt family to not accept the

Family members usually support the patients at home through food preparation and may compromise and sabotage patients through cooking and serving unhealthy meals, tempting patients to consume unhealthy food for the sake of peace at home [30]. Additionally, the family members may also discourage patients from regularly taking medications and its adherence, particularly when the patient relies on them for getting and taking medications and meals. Hence the need for family centred diabetes care to minimize the ways family can negatively impact on patients'

them with knowledge and skills essential in positively influence patient health behaviors and subsequently diabetes outcomes. Lack of diabetes care knowledge among family members, result in stress of not knowing how best to care for loved one in need of support, hence adoption of family centred diabetes care empowers family and minimizes the negative psychological impact. Exclusion of families during consultations may lead to families having misconceptions that patients know more about diabetes management than actually patients know, relying on the patients to report to them on how to best care for them [24], leading to inappropriate care. Educating families on diabetes care needs and why the changes are necessary can aid in easing the stress brought along by inadequate knowledge. The family may as well need to be educated on the coping skills. The effective family involvement in diabetes care may help the family accept the lifestyle modifications for the patients and family members' health considering that they are already at risk due to family history [29]. Additional information which should be provided to the family during consultation includes information about the disease, possible treatment alternatives and stress management skills, as well as helping them plan for the future [32].

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