Problem solving in diabetes self-management and control: A systematic review of the literature

Purpose The purpose of this systematic review is to assess the published literature on problem solving and its associations with diabetes self-management and control, as the state of evidence exists. Data Sources PubMed, PsychINFO, and ERIC electronic databases were searched for the years 1990 to the present and for Englishlanguage articles, and reference lists from included studies were reviewed to capture additional studies. Study Selection Quantitative and qualitative studies that addressed problem solving as a process or strategy for diabetes selfmanagement were included. Fifty-two studies met the criteria for inclusion. Data Extraction Study design, sample characteristics, measures, and results were reviewed. Data Synthesis Thirty-six studies were quantitative; 16 were conceptual or qualitative. Studies were classified as addressing the problem-solving definition/framework, assessment, intervention, or health care professional issues. Conclusions Problem solving is a multidimensional construct encompassing verbal reasoning/rational problem solving, quantitative problem solving, and coping. Aspects of problem solving can be assessed using newly developed diabetesspecific problem-solving measures for children/adolescents and adults. Cross-sectional studies in adults, but not children/ adolescents, provide consistent evidence of associations between problem solving and A1C level. Only 25% of problem-solving intervention studies with children/ adolescents and 50% of interventions with adults reported improvement in A1C. Most intervention studies reported an improvement in behaviors, most commonly global adherence in children/adolescents and dietary behavior in adults. Methodological limitations (noninclusion of problem-solving measures, inadequate descriptions of problem-solving interventions, homogenous samples) need to be addressed in future research to clarify the effect of problem solving on diabetes outcomes, identify characteristics of effective interventions, and determine the utility across age and racial/ethnic groups.