Development and validation of the Chinese version of the Diabetes Management Self-efficacy Scale

Cultural issues and other factors that affect self-management of Type 2 Diabetes Mellitus (T2D) by Chinese immigrants in Australia

AIMS

To investigate the influence of cultural and other factors on diabetes self-management behaviors among Australian Chinese immigrants with T2D.

METHODS

A cross-sectional survey was conducted between June and October 2015. The questionnaire comprised several validated scales examining aspects of self-management practice including medication adherence, acculturation and demographics. Participants were recruited from the community and Diabetes Center of the Royal Prince Alfred Hospital (RPAH), Sydney, Australia.

RESULTS

Of the 139 participants, a majority were female, from mainland China, with high school level education and a mean age of 64 (SD±12) years. Participants were found to have poor self-management practices generally but moderate medication adherence. 13.7% of participants reported incorporating TCM into their diabetes treatment and 24% reported a cultural shame surrounding a diabetes diagnosis. Higher levels of acculturation predicted better medication adherence, whereas stronger beliefs in TCM predicted poorer medication adherence. Gender, education level and duration of diabetes were also predictors of diabetes self-management behaviors.

CONCLUSIONS

This study provided insight into cultural influences on diabetes self-management and medication taking among Chinese immigrants in Australia. Health care providers should take these into account in delivering culturally sensitive care and advice to achieve better health outcomes.

Management of type 2 diabetes in China: the Happy Life Club, a pragmatic cluster randomised controlled trial using health coaches

OBJECTIVE

To assess the effectiveness of a coach-led motivational interviewing (MI) intervention in improving glycaemic control, as well as clinical, psychosocial and self-care outcomes of individuals with type 2 diabetes mellitus (T2DM) compared with usual care.

DESIGN

Pragmatic cluster randomised controlled trial (RCT).

SETTING

Community Health Stations (CHSs) in Fengtai district, Beijing, China.

PARTICIPANTS

Of the 41 randomised CHSs (21 intervention and 20 control), 21 intervention CHSs (372 participants) and 18 control CHSs (296 participants) started participation.

INTERVENTION

Intervention participants received telephone and face-to-face MI health coaching in addition to usual care from their CHS. Control participants received usual care only. Medical fees were waived for both groups.

OUTCOME MEASURES

Outcomes were assessed at baseline, 6 and 12 months. Primary outcome measure was glycated haemoglobin (HbA1c). Secondary outcomes included a suite of anthropometric, blood pressure (BP), fasting blood, psychosocial and self-care measures.

RESULTS

At 12 months, no differential treatment effect was found for HbA1c (adjusted difference 0.02, 95% CI -0.40 to 0.44, p=0.929), with both treatment and control groups showing significant improvements. However, two secondary outcomes: psychological distress (adjusted difference -2.38, 95% CI -4.64 to -0.12, p=0.039) and systolic BP (adjusted difference -3.57, 95% CI -6.08 to -1.05, p=0.005) were robust outcomes consistent with significant differential treatment effects, as supported in sensitivity analyses. Interestingly, in addition to HbA1c, both groups displayed significant improvements in triglycerides, LDL cholesterol and HDL cholesterol.

CONCLUSIONS

In line with the current Chinese primary healthcare reform, this study is the first large-scale cluster RCT to be implemented within real-world CHSs in China, specifically addressing T2DM. Although a differential treatment effect was not observed for HbA1c, numerous outcomes (including HbA1c) improved in both groups, supporting the establishment of regular, free clinical health checks for people with T2DM in China.

TRIAL REGISTRATION NUMBER

ISRCTN01010526; Pre-results.

Psychometric evaluation of the Diabetes Symptom Checklist-Revised in patients with type 2 diabetes in Turkey

AIM

To evaluate the psychometric properties of the Diabetes Symptoms Checklist-Revised (DSC-R), as measures of diabetes-related symptoms, in patients with type 2 diabetes in Turkey.

METHODS

This research was carried out on 340 patients diagnosed with type 2 diabetes in the Department of Endocrinology and Metabolic Diseases of a university hospital in Turkey, between 25 January 2011 and 1 April 2011. Personal information forms developed by the researchers and the DSC-R were used as the data tools. All data were collected by authors during face-to-face interviews.

RESULTS

According to the results of the research, the patients had a mean ± standard deviation age 55.9 ± 7.54 years (range, 20-65) and included most patients who were female (64.1%), married (87.1%), housewives (50.3%), and had completed primary education (47.4%). Cronbach's alpha found reliability for the total scale to be 0.92 and subscale alpha coefficients ranged 0.76-0.85. Confirmatory factor analysis resulted in a six factor structure: (i) neurology; (ii) psychology/fatigue; (iii) cardiology; (iv) ophthalmology; (v) psychology/cognition; and (vi) hyperglycemia.

CONCLUSION

The Turkish version of the DSC-R was found to be a reliable and valid means to measure the level in effect on symptoms in patients with type 2 diabetes.

Validation of the Greek Version of the Diabetes Management Self-Efficacy Scale (GR-DMSES)

Introduction

Self-efficacy has been found to have a direct relation with self-care in diabetes. Several tools have been developed and used for evaluating self-efficacy of diabetic patients, the most widely used being the Diabetes Management Self-Efficacy Scale (DMSES). The aim of the present study was to translate, culturally adapt, and validate the Greek DMSES (GR-DMSES) in order for it to be used in the ATTICA pilot study of the SmartCare EU-funded project.

Methods

Using standard procedures, the original version of DMSES was translated and culturally adapted into Greek. Content validity was assessed by an expert panel with the calculation of a content validity index of the overall scale. Α convenient sample was recruited to complete the questionnaire. Psychometric testing of the produced instrument included internal consistency test (Cronbach’s alpha), construct validity (factor analysis), and stability (intraclass correlation coefficient).

Results

One hundred and sixteen patients, aged 36–86 years, with type 2 diabetes (T2D) participated in the study. There were no items excluded from the original scale after the content validity procedure. The coefficient Cronbach's alpha for the internal consistency was 0.93 and the intraclass correlation coefficient for the stability with a 5-week time interval was 0.87 (P < 0.001). Factor analysis yielded four factors related to diet, medical therapy, medication and feet check, and physical activity.

Conclusion

The findings supported that the GR-DMSES was reliable and valid in measuring self-efficacy related to diabetes self-management, thus providing a quick and easy-to-use tool for health professionals dealing with Greek adults with T2D.

Electronic supplementary material

The online version of this article (doi:10.1007/s12325-015-0278-1) contains supplementary material, which is available to authorized users.

Translational research for Diabetes Self-Management in Sri Lanka: A randomized controlled trial

AIMS

The study tested the hypothesis that a theory driven Diabetes Self-Management (DSM) intervention delivered by trained nurses would result in a clinically significant improvement in glycaemic control.

METHODS

Patients with an HbA1c >7.5% (58mmol/mol) and free of diabetes complications were enrolled into a randomized controlled trial (n=85). Intervention consisted of four sessions and monthly follow up for 6 months. Biochemical tests, and diet and physical activity assessments were done in both groups. Analysis of covariance was used to test the effectiveness of the intervention.

RESULTS

At 6 months, there was a significant difference (P=0.001) in HbA1c between the groups controlling for baseline values and other variables. Based on the primary outcome, 28% in the intervention group achieved the target value of 6.5% HbA1c, compared to 8% in the "usual care" group (P<0.001; η(2)=0.65). The reduction in total energy intake and increase in physical activity was significant in the intervention group between baseline and follow up.

CONCLUSIONS

The DSM intervention has resulted in a clinically significant impact on glycaemia, change in diet and physical activity, and has demonstrated the feasibility of using it within existing care arrangements in a developing country setting.

Measuring Self-Care in Persons With Type 2 Diabetes: A Systematic Review

This systematic review examines the characteristics and psychometric properties of the instruments used to assess self-care behaviors among persons with type 2 diabetes. Electronic databases were searched for relevant studies published in English within the past 20 years. Thirty different instruments were identified in 75 articles: 18 original instruments on type 2 diabetes mellitus self-care, 8 translated or revised version, and 4 not specific but relevant to diabetes. Twenty-one instruments were multidimensional and addressed multiple dimensions of self-care behavior. Nine were unidimensional: three focusing exclusively on medication taking, three on diet, one on physical activity, one on self-monitoring of blood glucose, and one on oral care. Most instruments (22 of 30) were developed during the last decade. Only 10 were repeated more than once. Nineteen of the 30 instruments reported both reliability and validity information but with varying degrees of rigor. In conclusion, most instruments used to measure self-care were relatively new and had been applied to only a limited number of studies with incomplete psychometric profiles. Rigorous psychometric testing, operational definition of self-care, and sufficient explanation of scoring need to be considered for further instrument development.

Validity and reliability of the Chinese version of the care transition measure

Background

The 15-item care transition measure (CTM-15) is a reliable and valid instrument assessing the quality of care transition from patients’ perspectives. The aim of this study was to evaluate the psychometric properties of the CTM-15 and the CTM-3 (a 3-item short version of the CTM-15) in Mainland China.

Methodology/Findings

This was a cross-sectional study with a convenience sample of 646 patients in a general tertiary-level hospital in Chengdu, China. The results indicated that the Cronbach’s α values of the Chinese version of the two measures were 0.90 and 0.56, and the test-retest reliability values were 0.91 and 0.87, respectively. Three factors were extracted for the CTM-15 in Chinese populations. The CTM-15 and the CTM-3 scores discriminated well between patients with and without re-hospitalization for their index condition. The CTM-15 and the CTM-3 had significant positive relationships with self-rated health status. The CTM-3 score was significantly related to the CTM-15 score, and the CTM-3 score accounted for 64.23% of the variance of the CTM-15 score.

Conclusions/Significance

This study has demonstrated the psychometric properties of the CTM-15 and the CTM-3 in Mainland China. Although the Cronbach’s α value of the CTM-3 is suboptimal, it has exhibited high test-retest reliability, convergent validity and criterion validity. Therefore, the CTM-3 can substitute the CTM-15 as a performance measurement tool when the sample size is large enough to compensate its suboptimal reliability or the reduced response burden is a concern.

Psychometric Properties of the Diabetes Management Self-Efficacy Scale in Korean Patients with Type 2 Diabetes

Objectives. The aims of this study were to perform a cultural translation of the DMSES and evaluate the psychometric properties of the translated scale in a Korean population with type 2 diabetics. Methods. This study was conducted in patients with diabetes recruited from university hospitals. The first stage of this study involved translating the DMSES into Korean using a forward- and backward-translation technique. The content validity was assessed by an expert group. In the second stage, the psychometric properties of the Korean version of the DMSES (K-DMSES) were evaluated. Results. The content validity of the K-DMSES was satisfactory. Sixteen-items clustered into four-subscales were extracted by exploratory factor analysis, and supported by confirmatory factor analysis. The construct validity of the K-DMSES with the Summary of Diabetes Self-Care Activities scale was satisfactory (r = 0.50, P<0.001). The Cronbach's alpha and intraclass correlation coefficient were 0.92 and 0.85 (P<0.001; 95% CI = 0.75-0.91), respectively, which indicate excellent internal consistency reliability and test-retest reliability. Conclusions. The K-DMSES is a brief instrument that has demonstrated good psychometric properties. It is therefore feasible to use in practice, and is ready for use in clinical research involving Korean patients with type 2 diabetes.

Improved self-management skills in Chinese diabetes patients through a comprehensive health literacy strategy: study protocol of a cluster randomized controlled trial

Background

Diabetes self-management often involves the interpretation and application of oral, written, or quantitative information. Numerous diabetes patients in China have limited health literacy, which likely leads to poorer clinical outcomes. This study is designed to examine the efficacy and cost-effectiveness of addressing health literacy to improve self-management skills and glycemic control in Chinese diabetes patients.

Methods/design

This is a cluster randomized controlled trial (RCT) conducted in 20 community healthcare sites in Shanghai, China. Overall, 800 diabetes patients will be randomized into intervention and control arms and will have a baseline hemoglobin A1c (HbA1c) assay and undergo a baseline survey which includes measures of health literacy and diabetes numeracy using revised Chinese versions of the Health Literacy Management Scale and Diabetes Numeracy Test Scale. During the 1-year period of intervention, while the control group will receive usual care, the intervention group will be supplemented with a comprehensive health literacy strategy which includes i) training healthcare providers in effective health communication skills that address issues related to low literacy, and ii) use of an interactive Diabetes Education Toolkit to improve patient understanding and behaviors. Assessments will be conducted at both patient and healthcare provider levels, and will take place upon admission and after 3, 6, 12, and 24 months of intervention. The primary outcome will be the improvement in HbA1c between Intervention group and Control group patients. Secondary outcomes at the patient level will include improvement in i) clinical outcomes (blood pressure, fasting lipids, body mass index, weight, smoking status), ii) patient reported self-management behaviors, and iii) patient-reported self-efficacy. Outcomes at the provider level will include: i) provider satisfaction and ii) intensity and type of care provided. The effects of the intervention will be examined in multivariable general linear models. Both cost-effectiveness and cost-utility analyses will be performed.

Discussion

The main strengths of this study are its large sample size and RCT design, involvement of both patients and healthcare providers, and the long term follow-up (24-months). This project will help to demonstrate the value of addressing health literacy and health communication to improve self-management and clinical outcomes among Chinese diabetes patients.

Trial registration

ISRCTN76130594, Registration date: Sept 22, 2014.

Electronic supplementary material

The online version of this article (doi:10.1186/1745-6215-15-498) contains supplementary material, which is available to authorized users.

Efficacy of structured education in patients with type 2 diabetes mellitus receiving insulin treatment

BACKGROUND

The aim of the present study was to assess the efficacy of structured education in insulin-treated type 2 diabetes mellitus (T2DM) patients.

METHODS

In a 16-week open-label randomized controlled study, 1511 T2DM patients with inadequate responses to two or more oral antidiabetic drugs (OADs) for >3 months (HbA1c >7.5%) were randomized (1:1) to either an education group (structured diabetes education plus insulin therapy) or a control group (usual care plus insulin therapy). Both groups discontinued previous OADs (except biguanides and α-glucosidase inhibitors) and started twice daily injections of 30% soluble-70% isophane recombinant insulin. The primary endpoint was the change in HbA1c from baseline. Efficacy and safety data were analyzed for within- and between-group differences.

RESULTS

Of the initial 1511 patients, 1289 completed the study (643 in the control group; 646 in the education group). At the end of the study, significant reductions in HbA1c versus baseline were evident in both groups, but the reduction was greater in the education group (2.16% vs. 2.08%; P < 0.05). A higher proportion of patients in the education group achieved target HbA1c levels <7% (43.81% vs. 36.86%; P < 0.05) and ≤6.5% (28.48% vs. 22.71%; P < 0.05). In addition, patients in the education group showed greater increments in scores and improvement in the Morisky Medication Adherence Scale (P < 0.05). The overall incidence of hypoglycemic events was similar in the two groups.

CONCLUSIONS

Structured education can promote the ability of patients to self-manage and their compliance with medications, thereby achieving better outcomes.

Comparing self-efficacy and self-care behaviours between outpatients with comorbid schizophrenia and type 2 diabetes and outpatients with only type 2 diabetes

People with schizophrenia show higher-than-normal rates of type 2 diabetes mellitus (T2DM); however, research on their understanding of diabetes self-efficacy and self-care behaviours is lacking. This study compared differences in scores of self-efficacy and self-care behaviours between outpatients with comorbid schizophrenia and T2DM and outpatients with T2DM alone. Data were collected using the Diabetes Management Self-Efficacy Scale and Summary of Diabetes Self-Care Activity questionnaire. In total, 105 outpatients with schizophrenia and T2DM and 106 outpatients with T2DM returned completed questionnaires. Results of this study revealed that outpatients with schizophrenia and T2DM had significantly lower total self-efficacy and self-care scores than outpatients with only T2DM. The stepwise regression analysis revealed that self-efficacy, the haemoglobin A1C level and current smoking were significant predictors of self-care behaviours in outpatients with comorbid schizophrenia and T2DM, which explained 33.20% of the variance. These findings help mental health professionals improve patient care through a better understanding of self-care behaviours among outpatients with comorbid schizophrenia and T2DM.

The reliability and validity of the diabetes care profile for Chinese populations

This study aimed to translate into Chinese the Diabetes Care Profile (DCP), a measure of psychosocial factors and diabetes treatment, and to test the reliability and validity of the instrument within a Chinese population. The English version of the DCP was translated into Chinese following the standard translation methodology with consideration to cultural adaptation. The questionnaire was administered to 313 people with type 2 diabetes in an urban community in Beijing, China. Cronbach's α coefficient was used to calculate reliabilities, which ranged from .55 to .86 on DCP subscales. Mean values on the DCP differed by diabetes treatment as expected and supports the construct validity of the DCP. The overall score on the DCP correlated well both with blood glucose levels and with a validated measure of a Chinese version of the Diabetes Specific Quality of Life scale, thus supporting the DCP's criterion validity. The DCP is an acceptable measure of the psychosocial factors related to diabetes and its treatment in a Chinese population with type 2 diabetes.

A novel telemonitoring device for improving diabetes control: protocol and results from a randomized clinical trial

BACKGROUND

Telemedicine is one approach to managing patients with chronic illness. Several telephone-based monitoring studies of diabetes patients have shown improved glycosylated hemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein (LDL) levels. The purpose of this study was to evaluate an investigational in-home telemetry device for improving glucose and BP control over 6 months for patients with type 2 diabetes. The device was used to transmit weekly blood glucose, weight, and BP readings to a diabetes care manager.

SUBJECTS AND METHODS

We conducted a two-arm, parallel-comparison, single-blind, randomized controlled trial among Kaiser Permanente Northern California members 18-75 years old with type 2 diabetes mellitus and entry HbA1c levels between 7.5% and 10.0%. Participants were randomly assigned to either the telemonitoring arm or the usual care arm.

RESULTS

We observed very small, nonsignificant changes in fructosamine (telemonitoring, -54.9 μmol; usual care, -59.4 μmol) and systolic BP (telemonitoring, -6.3 mm Hg; usual care, -3.2 mm Hg) from baseline to 6 weeks in both groups. At 6 months, we observed no significant intergroup differences in change from baseline for HbA1c, fructosamine, or self-efficacy. However, LDL cholesterol in the telemonitoring arm decreased more than in the usual care arm (-17.1 mg/dL versus -5.4 mg/dL; P=0.045).

CONCLUSIONS

Although HbA1c improved significantly over 6 months in both groups, the difference in improvement between the groups was not significant. This lack of significance may be due to the relatively healthy status of the volunteers in our study and to the high level of care provided by the care managers in the Santa Rosa, CA clinic. Further study in subgroups of less healthy diabetes patients is recommended.

Chinese version of the nursing students' perception of instructor caring (C-NSPIC): assessment of reliability and validity

BACKGROUND

The nursing students' perceptions of instructor caring (NSPIC) is an instrument to assess the influence of caring interactions between students and faculty on students' ability to care. However, the validity and reliability of the Chinese version has not yet been studied.

OBJECTIVES

The study aimed to assess the validity and reliability of the Chinese version of NSPIC (C-NSPIC).

DESIGN

This is a cross-sectional study.

SETTING

The study was performed in three Tertiary Grade A (top level in China) and teaching hospitals in Shanghai, China.

PARTICIPANTS

The participants of the study are nursing students during clinical practice.

METHODS

The English version of nursing students' perception of instructor caring scale was professionally translated into Chinese and a pilot test was undertaken to ensure the equivalence of meaning and cultural appropriateness. The content validity of the C-NSPIC was examined by a panel of eight experts, and test-retest was conducted to assess the item reliabilities of the scale. A convenience sampling method was used to recruit nursing students. A first sample (N=256) was recruited to explore the factorial structure of the C-NSPIC using exploratory factor analysis (EFA), and a validation sample (N=358) was recruited to confirm the findings from the EFA using confirmatory factor analysis (CFA). SPSS version 16.0 was used for the EFA and Amos 17.0 was used for the CFA.

RESULTS

The Cronbach's alpha coefficient of the C-NSPIC was 0.933. The test-retest reliability was satisfactory, with the ICC scores for each item ranging from 0.603 to 0.962. The overall content validity index was 0.96. Five factors (control versus flexibility, supportive learning climate, confidence through caring, appreciation of life meaning and respectful sharing) were identified in EFA, which was consistent with that of the original English version, and were confirmed by CFA.

CONCLUSION

The C-NSPIC can serve as a reliable and valid instrument for assessing the nursing students' perception of instructor caring in China, which may help to improve the nursing students' caring ability in China.

Protocol for a randomised blocked design study using telephone and text-messaging to support cardiac patients with diabetes: a cross cultural international collaborative project

BACKGROUND

The prevalence of type 2 diabetes is rising internationally. Patients with diabetes have a higher risk of cardiovascular events accounting for substantial premature morbidity and mortality, and health care expenditure. Given healthcare workforce limitations, there is a need to improve interventions that promote positive self-management behaviours that enable patients to manage their chronic conditions effectively, across different cultural contexts. Previous studies have evaluated the feasibility of including telephone and Short Message Service (SMS) follow up in chronic disease self-management programs, but only for single diseases or in one specific population. Therefore, the aim of this study is to evaluate the feasibility and short-term efficacy of incorporating telephone and text messaging to support the care of patients with diabetes and cardiac disease, in Australia and in Taiwan.

METHODS/DESIGN

A randomised controlled trial design will be used to evaluate a self-management program for people with diabetes and cardiac disease that incorporates the use of simple remote-access communication technologies. A sample size of 180 participants from Australia and Taiwan will be recruited and randomised in a one-to-one ratio to receive either the intervention in addition to usual care (intervention) or usual care alone (control). The intervention will consist of in-hospital education as well as follow up utilising personal telephone calls and SMS reminders. Primary short term outcomes of interest include self-care behaviours and self-efficacy assessed at baseline and four weeks.

DISCUSSION

If the results of this investigation substantiate the feasibility and efficacy of the telephone and SMS intervention for promoting self management among patients with diabetes and cardiac disease in Australia and Taiwan, it will support the external validity of the intervention. It is anticipated that empirical data from this investigation will provide valuable information to inform future international collaborations, while providing a platform for further enhancements of the program, which has potential to benefit patients internationally.

TRIAL REGISTRATION

ACTRN 12611001196932.

Effects of self-care, self-efficacy, social support on glycemic control in adults with type 2 diabetes

Background

A number of studies have examined the influence of self-efficacy, social support and patient-provider communication (PPC) on self-care and glycemic control. Relatively few studies have tested the pathways through which these constructs operate to improve glycemic control, however. We used structural equation modeling to examine a conceptual model that hypothesizes how self-efficacy, social support and patient-provider communication influence glycemic control through self-care behaviors in Chinese adults with type 2 diabetes.

Methods

We conducted a cross-sectional study of 222 Chinese adults with type 2 diabetes in one primary care center. We collected information on demographics, self-efficacy, social support, patient-provider communication (PPC) and diabetes self-care. Hemoglobin A1c (HbA1c) values were also obtained. Measured variable path analyses were used to determine the predicted pathways linking self-efficacy, social support and PPC to diabetes self-care and glycemic control.

Results

Diabetes self-care had a direct effect on glycemic control (β = −0.21, p = .007), No direct effect was observed for self-efficacy, social support or PPC on glycemic control. There were significant positive direct paths from self-efficacy (β = 0.32, p < .001), social support (β = 0.17, p = .009) and PPC (β = 0.14, p = .029) to diabetes self-care. All of them had an indirect effect on HbA1c (β =–0.06, β =–0.04, β =–0.03 respectively). Additionally, PPC was positively associated with social support (γ = 0.32, p < .001).

Conclusions

Having better provider-patient communication, having social support, and having higher self-efficacy was associated with performing diabetes self-care behaviors; and these behaviors were directly linked to glycemic control. So longitudinal studies are needed to explore the effect of self-efficacy, social support and PPC on changes in diabetes self-care behaviors and glycemic control.

Determinants of Self-Management Among Diabetic Patients

Diabetes self-management (DSM) is a complex behavior and various factors influence it. Despite continual recommendations to DSM, implementation of this behavior still remains a major health problem for diabetic patients. Identifying effective factors in DSM is useful to promote health in diabetic patients. The purpose of this study was to test the effects of individual and environmental factors on DSM. Path analysis was used to examine both one-way direct and indirect effects of 7 constructs and 3 demographic factors on DSM in this population (N = 396). Data were collected from a convenience sample of 104 (26.3%) males and 292 (73.7%) females with a median age 53 years. The final model provided a good fit to the data explaining 25% of the variance in DSM. Illness perception and provider–patient communication were the most effective factors in DSM. Knowledge and self-efficacy affected DSM indirectly via illness perception. The results of this study showed that effective DSM interventions should be designed to change illness perception and patient–provider communication, especially in patients with low duration of diabetes and low level of education.

Validation of an information-motivation-behavioral skills model of self-care among Chinese adults with type 2 diabetes

BACKGROUND

Self-care is a crucial component of diabetes management. But comprehensive behavior change frameworks are needed to provide guidance for the design, implementation, and evaluation of diabetes self-care programs in diverse populations. We tested the Information-Motivation-Behavioral Skills (IMB) model in a sample of Chinese adults with Type 2 diabetes.

METHODS

A cross-sectional study of 222 Chinese adults with type 2 diabetes was conducted in a primary care center. We collected information on demographics, provider-patient communication (knowledge), social support (motivation), self-efficacy (behavioral skills), and diabetes self-care (behavior). The values of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were also obtained. Measured variable path analyses were used to the IMB framework.

RESULTS

Provider-patient communication (β = 0.12, p = .037), and social support (β = 0.19, p = .007) and self-efficacy (β = 0.41, p < .001) were independent, direct predictors of diabetes self-care behavior. Diabetes self-care behaviors had a direct effect on TC/HDL-C (β = -0.31, p < .001) and LDL-C/HDL-C (β = -0.30, p < .001).

CONCLUSIONS

Consistent with the IMB model, having better provider-patient communication, having social support, and having higher self-efficacy was associated with performing diabetes self-care behaviors; and these behaviors were directly linked to lipid control. The findings indicate that diabetes education programs should including strategies enhancing patients' knowledge, motivation and behavioral skills to effect behavior change.

Self-efficacy, self-care behavior, anxiety, and depression in Taiwanese with type 2 diabetes: A cross-sectional survey

The relationships between self-efficacy, self-care behavior, anxiety, and depression for Taiwanese individuals with type 2 diabetes were determined in this study. Depression and anxiety are common symptoms that can contribute toward adverse medical outcomes. A descriptive, cross-sectional, correlational design was used. The sample comprised 201 patients with type 2 diabetes from diabetes outpatient clinics at three teaching hospitals in Taiwan. The results of this study revealed that people with diabetes who had received diabetes health education, regularly made clinical visits, underwent treatment, and did not smoke demonstrated a high self-efficacy score (P < 0.05). Self-efficacy among people with diabetes positively correlated with illness duration (P < 0.05), treatment (P < 0.01), and self-care behavior (P < 0.01). Self-efficacy among people with diabetes negatively correlated with anxiety and depression (P < 0.01). Self-efficacy can be a predictor of anxiety and depression (P < 0.01). This study revealed that enhancing self-efficacy levels might reduce anxiety and depression. Self-efficacy-enhancing programs should be held regularly in clinical practices. Conducting psychological research on diabetes drives policy and healthcare system change.

Effectiveness of a self-efficacy program for persons with diabetes: a randomized controlled trial

The aim of this study was to examine the effects of a self-efficacy program for persons with type 2 diabetes in Taiwan. A randomized controlled trial was designed (n = 145), with 72 participants in the intervention group and 73 in the control group. The participants were pretested to establish a baseline and then post-tests were undertaken 3 and 6 months after the baseline data were collected. The participants in the intervention group received the standard diabetes education program and an additional self-efficacy program. The scores for efficacy expectations, outcome expectations, and self-care activities had significantly increased in the intervention group at the 3 and 6 month follow-ups, when compared to those of the control group. A smaller proportion of the participants in the intervention group had been hospitalized or had visited an emergency room than in the control group at the 6 month follow-up. This study revealed that a self-efficacy program for diabetes was acceptable and effective in the short term in the self-management of persons with type 2 diabetes.

The Happy Life Club™ study protocol: a cluster randomised controlled trial of a type 2 diabetes health coach intervention

BACKGROUND

The Happy Life Club™ is an intervention that utilises health coaches trained in behavioural change and motivational interviewing techniques to assist with the management of type 2 diabetes mellitus (T2DM) in primary care settings in China. Health coaches will support participants to improve modifiable risk factors and adhere to effective self-management treatments associated with T2DM.

METHODS/DESIGN

A cluster randomised controlled trial involving 22 Community Health Centres (CHCs) in Fengtai District of Beijing, China. CHCs will be randomised into a control or intervention group, facilitating recruitment of at least 1320 individual participants with T2DM into the study. Participants in the intervention group will receive a combination of both telephone and face-to-face health coaching over 18 months, in addition to usual care received by the control group. Health coaching will be performed by CHC doctors and nurses certified in coach-assisted chronic disease management. Outcomes will be assessed at baseline and again at 6, 12 and 18 months by means of a clinical health check and self-administered questionnaire. The primary outcome measure is HbA1c level. Secondary outcomes include metabolic, physiological and psychological variables.

DISCUSSION

This cluster RCT has been developed to suit the Chinese health care system and will contribute to the evidence base for the management of patients with T2DM. With a strong focus on self-management and health coach support, the study has the potential to be adapted to other chronic diseases, as well as other regions of China.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN01010526.