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

Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study

AIMS

To describe self-care as defined by the Middle Range Theory of Self-Care of Chronic Illness and to identify clinical and socio-demographic determinants in a T2DM population.

METHODS

A multicentre observational cross-sectional study was conducted involving 540 adults with a confirmed diagnosis of T2DM from six outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management, and confidence dimensions. For each separate scale, scores were standardized 0-100 with higher SCODI scores indicating better self-care; a score ≥ 70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension.

RESULTS

Self-care maintenance (median = 81.3) and self-care confidence (median = 79.5) were adequate in most of the subjects. Self-care monitoring was adequate in only half of the sample (median = 70.6). Self-care management was poor (median = 59.4). Lower self-care maintenance was associated with lower self-care confidence (p < 0.001). Lower self-care monitoring was associated with being male (p < 0.001), having lower self-care confidence (p < 001), and having diabetes for < 10 years (p < 0.001). Lower self-care management was associated with being male (p = 0.002), being older (p = 0.005), having a low income (p = 0.030), being employed (p = 0.008), having missed diabetes education in the last year (p = 0.002), and lower self-care confidence (p < 0.0001). Lower self-care confidence was associated with having diabetes for < 10 years (p = 0.008), and having at least one comorbid condition (p = 0.006).

CONCLUSIONS

Determinants of self-care maintenance, monitoring, management and confidence include both clinical and socio-demographic variables. Modifiable determinants such as self-care confidence and diabetes self-care management education could be used to tailor interventions to improve diabetes self-care.

A randomized controlled study to evaluate the effect of pharmacist-led educational intervention on glycemic control, self-care activities and disease knowledge among type 2 diabetes patients: A consort compliant study protocol

BACKGROUND

Diabetes self-care activities, like, healthy diet, regular exercise, self-monitoring of blood glucose, and rational use of medicines are considered to play a vital role in establishing euglycemia. Health literacy among type 2 diabetes mellitus (T2DM) patients in Pakistan is very low, which is the most likely cause for poor clinical outcomes. This study is designed to investigate the impact of pharmacist-led educational intervention on glycemic control, self-care activities and disease knowledge among T2DM patients in Pakistan.

METHODS

In this randomized controlled trail, effectiveness of a 6-month pharmacist-led educational intervention will be examined on glycemic control, diabetes self-care activities and disease knowledge of 80 adult T2DM patients (age >30 years) with poorly controlled T2DM (HbA1c> 7%), after randomizing them into intervention and control groups, at diabetes care clinic of Capital Hospital Islamabad, Pakistan.

RESULTS

The primary outcome is change in patients' HbA1c, whereas, changes in self-care activities and patients' disease knowledge are the secondary outcomes. After baseline assessment of their self-care activities and disease knowledge by using validated Urdu versions of Diabetes Self-management Questionnaire (DSMQ) and Diabetes Knowledge Questionnaire (DKQ), respectively, interventional group patients will be supplemented with a face-to-face pharmacist-led educational intervention, whereas, the control group will receive usual care. Intervention arm patients will be educated successively at their first follow-up visit (12th week) and telephonically after every 4 weeks. All assessments will be made at baseline and end of trail for both intervention and control groups. Multivariate general linear model will be applied to analyze the effects of the intervention.

CONCLUSION

Glycemic control in T2DM patients requires optimum self-care activities. This study is an attempt to improve self-care behaviors among poorly controlled T2DM patients who are at higher risk of diabetes-associated late complications.

Association of diabetes-related self-care activities with glycemic control of patients with type 2 diabetes in Pakistan

OBJECTIVE

Association of various self-care activities on glycemic control of people with diabetes (PWD) in Pakistan is yet to be explored. The current study aimed to evaluate the association of various diabetes-related self-care activities with glycated hemoglobin (HbA1c) levels and to examine the predictive relationship of patients' demographic variables with their self-care activities.

PATIENTS AND METHODS

A cross-sectional study was conducted on adult PWD (N=218) who were diagnosed with type 2 diabetes mellitus of at least 1 year duration. Self-care activities were examined by using the Urdu version of Diabetes Self-management Questionnaire. Linear regression analysis was conducted to examine the significant predictors for diabetes-related self-care activities and glycemic control.

RESULTS

Mean age of the patients was 50.77±13.3 years. Poor glycemic control (HbA1c $7%) was observed in majority of the patients (83%). Linear regression analysis revealed that glucose management (β=-0.44; 95% CI -0.438, -0.209; P<0.001) was the strongest predictor for low levels of patients' HbA1c, followed by dietary control (β=-0.19; 95% CI -0.248, -0.018; P=0.024) and physical activity (β=-0.17; 95% CI -0.165, -0.023; P=0.010), respectively. Linear regression analysis showed that use of oral hypoglycemic agents only (β=-0.218; 95% CI -0.956, -0.200; P=0.003) and higher education level (β=0.204; 95% CI 0.138, 0.777; P=0.005) were significant predictors for higher scores of patients' self-care activities.

CONCLUSION

The findings support that PWD having better self-reported self-care activities achieve better glycemic control. Patients' self-care activities should be monitored on a regular basis, especially for those who are at risk of poor glycemic control.

Treatment Adherence and Its Associated Factors in Patients with Type 2 Diabetes: Results from the Rio de Janeiro Type 2 Diabetes Cohort Study

OBJECTIVES

To investigate treatment adherence in patients with type 2 diabetes and to evaluate its associated factors.

METHODS

The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire was used to assess treatment adherence. Good adherence was defined as ≥5 days a week in each SDSCA item. Pain, emotional, and physical domains of the SF-36 quality of life questionnaire and the Canadian Occupational Performance Measure (COPM) were also evaluated. Multivariable logistic regressions explored the independent correlates of good general adherence and of specific items of the SDSCA (diet, exercise, and medications).

RESULTS

Good adherence was 93.5% for medication use, 59.3% for foot care, 56.1% for blood glucose monitoring, 29.2% for diet, and 22.5% for exercise. Patients with general good adherence had lower BMI, better serum lipid profile, higher values of functional capacity, emotional and pain domains of SF-36, better occupational performance, and lower prevalence of pain or limitation in the upper and lower limbs than patients with worse adherence. The variables associated with good adherence were younger age, lower BMI, presence of macrovascular complications, better occupational performance and emotional domain of SF-36, and higher HDL cholesterol levels. The presence of pain/limitation in the upper limbs was associated with worse adherence. Good medication adherence was associated with longer diabetes duration, lower BMI, and lower HbA_1c levels. Higher values of pain and emotional domains of the SF-36 and lower BMI were related to better exercise and diet adherence, while the presence of peripheral neuropathy and joint pain/limitation were associated with worse exercise adherence.

CONCLUSIONS

Emotional and physical performances are important determinants of good diabetic treatment adherence. Good adherence has beneficial impact on BMI, lipid, and glycemic control.

Development and psychometric testing of a theory-based tool to measure self-care in diabetes patients: the Self-Care of Diabetes Inventory

BACKGROUND

Self-care is essential for patients with diabetes mellitus. Both clinicians and researchers must be able to assess the quality of that self-care. Available tools have various limitations and none are theoretically based. The aims of this study were to develop and to test the psychometric properties of a new instrument based on the middle range-theory of self-care of chronic illness: the Self-Care of Diabetes Inventory (SCODI).

METHODS

Forty SCODI items (5 point Likert type scale) were developed based on clinical recommendations and grouped into 4 dimensions: self-care maintenance, self-care monitoring, self-care management and self-care confidence based on the theory. Content validity was assessed by a multidisciplinary panel of experts. A multi-centre cross-sectional study was conducted in a consecutive sample of 200 type 1 and type 2 diabetes patients. Dimensionality was evaluated by exploratory factor analyses. Multidimensional model based reliability was estimated for each scale. Multiple regression models estimating associations between SCODI scores and glycated haemoglobin (HbA1c), body mass index, and diabetes complications, were used for construct validity.

RESULTS

Content validity ratio was 100%. A multidimensional structure emerged for the 4 scales. Multidimensional model-based reliabilities were between 0.81 (maintenance) and 0.89 (confidence). Significant associations were found between self-care maintenance and HbA1c (p = 0.02) and between self-care monitoring and diabetes complications (p = 0.04). Self-care management was associated with BMI (p = 0.004) and diabetes complications (p = 0.03). Self-care confidence was a significant predictor of self-care maintenance, monitoring and management (all p < 0.0001).

CONCLUSION

The SCODI is a valid and reliable theoretically-grounded tool to measure self-care in type 1 and type 2 DM patients.

Psychometric properties of the Diabetes Self-Management Questionnaire (DSMQ) in Urdu

Background

Numerous study tools on diabetes self-care have been introduced; however, most existing tools do not show expectable and meaningful correlations with patients’ glycaemic control. The Diabetes Self-Management Questionnaire (DSMQ) was designed to appraise self-care activities which can predict glycaemic control outcomes. However, this tool has not been validated in Pakistan. Therefore, the aim of this study was to translate and examine the psychometric properties of the Urdu version of DSMQ among type 2 diabetes patients.

Method

Standard forward-backward translation was used to translate the DSMQ into Urdu language. A convenience sample of 130 patients with type 2 diabetes was collected to assess the Urdu version’s psychometric properties. Reliability was assessed by Cronbach’s coefficient α and validity was assessed using confirmatory factor analysis and criterion-related correlations.

Results

High internal consistency was found for all DSMQ scales (Sum scale: α = 0.96, Glucose Management: 0.91; Dietary Control: 0.88; Physical Activity: 0.89; Health-Care Use: 0.73). The DSMQ subscales showed significant correlations with HbA1c (Glucose Management: −0.75; Dietary Control: −0.76; Physical Activity: −0.71; Health-Care Use: −0.64; Sum Scale: −0.78; all p < 0.001). However, when associations with HbA1c were assessed in one multiple linear regression model, only Glucose Management and Dietary Control were significantly associated with lower HbA1c values (Beta = −0.42, p = 0.004 and Beta = −0.30, p = 0.028, respectively), while Physical Activity and Health-Care Use were not (p > 0.05). Adequate fit to the data was achieved for single factor model after successively modelling all significant correlations between the items’ error terms, with Chi² = 106.6, df = 84, p = 0.049; TLI = 0.98, CFI = 0.99 and RMSEA = 0.05 (90% CI 0.01–0.07). Whereas a comparatively lower fit indices to data were observed in case of four factor model.

Conclusion

The findings support the Urdu version of the DSMQ as a reliable and valid instrument for assessing self-care activities associated with glycaemic control in type 2 diabetes patients.

Electronic supplementary material

The online version of this article (10.1186/s12955-017-0776-8) contains supplementary material, which is available to authorized users.

[Wearables to support self-management of older adults with chronic diseases : A qualitative study from the perspectives of patients and physicians]

BACKGROUND

The use of wearable devices (WD) is discussed as an option to support elderly chronically ill people. These technologies lack essential research regarding the improvement of self-management. This study aimes to identify perspectives, expectations and their underlying background of patients and physicians with respect to the usage of WDs to enhance self-management.

METHODS

In this study a total of 14 patients and physicians were surveyed using a semi-structured questionnaire design. The data were analyzed by qualitative content analysis.

RESULTS

The participants have in general a positive attitude towards the use of WDs with respect to memory function, self-control, sense of security, documentation of vital parameters and communication about the disease, as well as suitability for everyday use; however, in many cases participants are concerned about the usage of WDs for a variety of reasons. They perceive the device as unnecessary or they lack technological self-confidence and felt controlled as well as data protection concerns. Participant responses show prerequisites which should be met for the usage of a WD requiring an individual needs assessment.

CONCLUSION

The results show a potential of WDs to improve self-management. The usage of WD could have a positive effect on the course of the disease; however, personality and environmental factors should be taken into account to individually adjust and support the usage of WDs. Furthermore, the application of WDs should be integrated into a structured training program accompanied by healthcare professionals. For this purpose, funding and time-oriented framework conditions should be established.

Instruments to assess self-care among healthy children: A systematic review of measurement properties

AIM

To identify, critically appraise and summarize the measurement properties of instruments to assess self-care in healthy children.

BACKGROUND

Assessing self-care is a proper consideration for nursing practice and nursing research. No systematic review summarizes instruments of measurement validated in healthy children.

DESIGN

Psychometric review in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) panel.

DATA SOURCES

MEDLINE, CINAHL, PsycINFO, Web of Science and Open Grey were searched from their inception to December 2016.

REVIEW METHODS

Validation studies with a healthy child population were included. Search was not restricted by language. Two reviewers independently assessed the methodological quality of included studies using the COSMIN checklist.

RESULTS

Eleven studies were included in the review assessing the measurement properties of ten instruments. There was a maximum of two studies per instrument. None of the studies evaluated the properties of test-retest reliability, measurement error, criterion validity and responsiveness. Internal consistency and structural validity were rated as "excellent" or "good" in four studies. Four studies were rated as "excellent" in content validity. Cross-cultural validity was rated as "poor" in the two studies (three instruments) which cultural adaptation was carried out.

CONCLUSION

The evidence available does not allow firm conclusions about the instruments identified in terms of reliability and validity. Future research should focus on generate evidence about a wider range of measurement properties of these instruments using a rigorous methodology, as well as instrument testing on different countries and child population.

Construction and validation of the Self-care Assessment Instrument for patients with type 2 diabetes mellitus

Objective:

to construct and validate the contents of the Self-care Assessment instrument for patients with type 2 diabetes mellitus.

Method:

methodological study, based on Orem's General Theory of Nursing. The empirical categories and the items of the instrument were elucidated through a focus group. The content validation process was performed by seven specialists and the semantic analysis by 14 patients. The Content Validity Indices of the items, ≥0.78, and of the scale, ≥0.90, were considered excellent.

Results:

the instrument contains 131 items in six dimensions corresponding to the health deviation self-care requisites. Regarding the maintenance, a Content Validity Index of 0.98 was obtained for the full set of items, and, regarding the relevance, Content Validity Indices ≥0.80 were obtained for the majority of the assessed psychometric criteria.

Conclusion:

the instrument showed evidence of content validity.

Vietnamese Version of Diabetes Self-Management Instrument: Development and Psychometric Testing

Self-management plays a vital role in diabetes management for adults with type 2 diabetes (T2DM). While there are many people with T2DM in Vietnam, clinical understanding of diabetes self-management (DSM) in this context is limited due to the lack of a valid measurement instrument. Translation and back-translation processes were used to translate the Diabetes Self-Management Instrument (DSMI) into Vietnamese. Then, translation equivalence, face validity, construct validity, and internal consistency were assessed in a sample of 198 Vietnamese adults with T2DM. The Cronbach's alpha of the V-DSMI was .92, with a number of significant inter-item correlations. The Vietnamese version of the Diabetes Self-Management Instrument (V-DSMI) retained the meaning of the original English version, and the language of the V-DSMI was clearly understandable to adults with T2DM in Vietnam. Confirmatory factor analysis supported the goodness of fit between the data and the previously identified factor structure. These results indicated that the V-DSMI is acceptable for use with Vietnamese adults with T2DM in further practice and research. However, future studies would be beneficial to determine the test-retest reliability and criterion validity of the V-DSMI. © 2016 Wiley Periodicals, Inc.