The interaction of locus of control, self-efficacy, and outcome expectancy in relation to HbA1c in medically underserved individuals with type 2 diabetes

Patient-physician alliance and patient's sense of self-efficacy are negatively associated with resistance to treatment among patients with type 2 diabetes

AIMS

Resistance to treatment is prevalent among patients diagnosed with chronic conditions, including type 2 diabetes (T2DM). The current study aimed to examine the relationship between patient characteristics, patient-physician relationship, and resistance to treatment in T2DM.

METHODS

A sample of 120 T2DM patients were recruited by means of non-randomized sampling and through a public post on Facebook. Participants were asked to fill-in several questionnaires online: Rotter's Locus of Control questionnaire (short version); the General Self-efficacy (GSE) questionnaire; the Working Alliance Inventory - Short Revised (WAI-SR) - evaluating patient-physician relationship; and, finally, the Resistance to Treatment Questionnaire (RTQ) - which meant to capture the intensity of resistance to treatment and served as the dependent variable in this study.

RESULTS

Interestingly, better patient-physician relationship and higher sense of self-efficacy among patients were found to negatively associate with patient's resistance to treatment (r = -.53, p < .001, and, r = -.26, p < .01, respectively). Patient-physician relationship explained 22% of the variance of resistance to treatment, and self-efficacy explained 6% of the variance.

CONCLUSIONS

Stronger patient-doctor relationship and higher sense of self-efficacy are shown to robustly associate with lower resistance to treatment among patients with T2DM. Current findings may instructor educate physicians as to the importance of the alliance with these chronic patients.

Effect of personality on blood glucose control in patients with type 1 diabetes

OBJECTIVE

The diagnosis of type 1 diabetes mellitus (DM1) has a major impact on young people and their families. Psychosocial factors, patient motivation, participation and acceptance of the disease are essential to achieve good blood glucose control. Our aims were to analyse personality traits and how they are related to blood glucose control in patients with DM1.

METHODS

Sixty-two patients with DM1 over 18 years of age, with at least one-year disease duration and absence of advanced chronic complications were studied. Clinical, biological and personality parameters were measured. The Millon Index of Personality Styles was administered for personality assessment.

RESULTS

Significant correlations between different personality variables and glycated haemoglobin (HbA1c) values were found. Individuals with poor blood glucose control had significantly higher scores on the Feeling-guided (53.6±25.7 vs 36.2±26.8, p=0.021), Innovation-seeking (36.7±24.1 vs 21.9±21.4, p=0.025), Dissenting (41.1±24.4 vs 15.6±16.6, p=0.001), Submissive (41.5±25.1 vs 28.3±14.7, p=0.038) and Dissatisfied (37.5±27.5 vs 19.5±20.2, p=0.015) scales. This psychological profile is characterised by greater focus on emotions and personal values (feeling-guided), the tendency to reject conventional ideas (innovation-seeking), an aversion to complying with norms and a preference for autonomy (unconventional/dissenting), labile self-confidence (submissive/yielding) and expressed disagreement with others (dissatisfied/complaining). Factor analysis based on the main components of the variance yielded four factors. Factor characterised as related to rebelliousness or independent judgement and action was correlated with poor blood glucose control (r=0.402, p<0.05).

CONCLUSION

The rebellious or non-conformist personality type is closely associated with poor blood glucose control in patients with DM1.

The paradox: guilt as an antidote to helplessness among oncologists

PURPOSE

Oncologists are exposed to suffering, loss, and death, and as a result may experience guilt. The study examined two competing hypotheses regarding the relation between locus of control (LOC) and guilt among oncologists and the mediating role of helplessness.

METHOD

Eighty-three oncologists answered a demographic questionnaire; the Levenson's "Internal, Powerful Others, and Chance" scale; the Guilt Inventory; and the Learned Helplessness Scale.

RESULTS

Oncologists reported moderate levels of guilt, high levels of internal LOC, and low levels of external LOC and helplessness. The results indicate a significant negative relationship between internal LOC and guilt and a significant positive relationship between external LOC (powerful others) and guilt, both mediated by helplessness. It seems that oncologists with external LOC feel helplessness and this metamorphoses into guilt, due to its potentially protective role against feelings of helplessness.

CONCLUSIONS

Oncologists are at risk for guilt. Whereas an internal LOC plays an important role as a resilience factor in terms of helplessness, an external LOC is a risk factor for helplessness and guilt. A paradoxical association between guilt and helplessness was found. The implication of which is that guilt may be produced to avoid helplessness; in other words, guilt, however painful, might be preferable to feeling helpless. Interventions focusing on oncologists' coping with uncontrolled situations in their daily work, decreasing their sense of helplessness and guilt, should be implanted.

Cross-Sectional Study of Factors Influencing Perceived Threat and Stress among the Arab Minority in Israel during the COVID-19 Pandemic

This study aimed to examine the impact of the locus of control, coping strategies and loneliness on perceived threat and stress among the Arab minority in Israel during the first COVID-19 closure. This was a cross-sectional online study, with 486 participants who completed a questionnaire measuring the study variables during the period of 28-31 March 2020. Statistical analyses included t-tests and analyses of variance. Means, standard deviations and intercorrelations for the study variables were calculated. The results revealed a moderate-low level of stress and a moderate-high level of perceived threat. Higher stress was related to higher perceived threat, a greater external locus of control, lower problem-focused coping, higher emotion-focused coping and social support-seeking and higher loneliness. Perceived threat was positively related to both problem-focused coping and emotion-focused coping. The results show that the Arab population in Israel coped as a strong minority group. This study contributes to our understanding of how minority groups cope in the current epidemic and to the identification of effective strategies for reducing stress during this challenging period. The study's results may help devise intervention programs that foster more effective coping capabilities among this and other minority populations.

Self-efficacy in physical activity and glycemic control among older adults with diabetes in Jagir Subdistrict, Surabaya, Indonesia

Diabetes in older adults has shown an increase in prevalence, especially in urban areas of Indonesia. This study aimed to assess the relationship between self-efficacy in physical activity and glycemic control in older adults' population with diabetes mellitus in Indonesia. This research used cross sectional design that involved 52 adults with diabetes, aged between 55-90 years old who regularly attended the older adult's health post (Posyandu Lansia) at Jagir Sub-district, Surabaya. Those who had physical disabilities were excluded from the study. Questionnaires were used to measure the physical activity and two types of self-efficacy whilst the glycemic control was measured using HbA1c in basal condition. The relationship between the variables was tested using Pearson and partial correlation test. Results show that the level of physical activity was insufficient (216.4 ± 343.5 MET) with only 32.7% (N = 17) of the participants was categorized as being physically active. The mean of the HbA1c indicated poor glycaemic control (8.63 ± 2.34%) with majority of them (76.9%, N = 40) was in the poor glycaemic control group (HbA1c ≥ 6.5%). Their self-efficacy was at the average level (Against the barriers:52.65 ± 13.23; Engage in physical activity: 59.06 ± 26.2). The self-efficacy in performing the physical activity was found significantly related to the duration of physical activity (r = 0.278, p = 0.046). Other relationships, however, were not significant (p > 0.05). In conclusion, self-efficacy to engage in physical activity is paramount to increase the physical activity among the older adults. Nevertheless, further longitudinal research on self-efficacy in physical activity management is needed.

Investigating Treatment Adherence of British and Greek Patients With Type 2 Diabetes Mellitus

Abstract. Background: Treatment adherence is associated with a number of personal characteristics (e.g., self-esteem, self-efficacy, locus of control) and illness perceptions. However, there is a lack of studies for Type 2 Diabetes Mellitus (T2DM). Aims: The aim of this study was to compare adherence behavior of British and Greek people with T2DM and examine the association between personal characteristics, illness perceptions, and adherence. Method: This was a cross-cultural, cross-sectional study. Five hundred eighty participants completed questionnaires, 208 males (35.9%) and 372 females (64.1%) with a mean age of 49 years. Regression analyses and t-tests were used. Results: Personal characteristics and illness perceptions predicted adherence and British patients reported better exercise adherence while Greek patients reported better diet and medication adherence; both groups reported suboptimal adherence. Self-efficacy, Health Locus of Control (HLoC), and illness perceptions were the main adherence determinants. Limitations: The use of self-reports and the convenience sampling method are the main limitations of this study. Conclusion: The findings address a significant gap in research and can inform future adherence-enhancing interventions to promote the well-being of people with T2DM.

Effects of therapeutic education on self-efficacy, self-care activities and glycemic control of type 2 diabetic patients in a primary healthcare center in Lebanon

BACKGROUND

Diabetes type 2 is a chronic hyperglycemia, its control depends on the patient's Self-efficacy and self-care activities. Therapeutic Patient Education (TPE) enhances the patient involvement and engagement in managing chronic diseases effectively by improving the health outcomes. It helps the patients developing competencies of self-care, coping with diabetes and controlling glycaemia.

OBJECTIVE

The objectives of this study are to assess the effects of TPE in type 2 Diabetic patients in Lebanon on their glycemic control, Diabetes Management Self-Efficacy Scale (DMSES) and their self-care activities (Summary of Diabetes Self-Care Activities SDSCA).

MATERIALS AND METHODS

A total of 100 diabetic patients (50 experimental, 50 control) were recruited from a primary care center according to inclusion and exclusion criteria. The experimental group followed the TPE by a multidisciplinary team. Glycemic control, DMSES and SDSCA were measured at baseline and after three months. The experimental group (EG) was followed up by phone calls every two weeks after the TPE.

RESULTS

The results revealed that the experimental group showed significant improvement at the level of self-efficacy in managing their disease concerning general nutrition, specific nutrition, control of glycaemia, physical activity, weight control and medical control (α<0.01); the total score of DMSES had significantly increased from 5.02 to 8.28 in the EG (α<0.01) compared to the control group (CG) that has decreased from 4.91 to 4.85 (α<0.05). Moreover, regarding the SDSCA of the EG, the results highlighted that the activities related to general diet, specific diet, physical exercise, foot care, the measurement of glycaemia and the medication-taking had significantly improved (α<0.05), whereas the CG didn't improve his self-care activities (α>0.05). In addition, the glycemic control HbA1c had improved in the EG after the intervention compared to the CG.

CONCLUSION

The findings of this study demonstrated that Therapeutic Patient Education is efficient in contributing to better glycemic control, better DMSES and SDSCA. Health professionals are best suited to help diabetic patients improve their self-efficacy in managing diabetes, controlling glycemia and improving their self-care.

The association of illness perceptions and God locus of health control with self-care behaviours in patients with type 2 diabetes in Saudi Arabia

Objective: To investigate the associations between illness perceptions, God locus of health control (GLHC) beliefs, and self-care behaviours in Saudi patients with type 2 diabetes (T2D). Design: A cross-sectional study was conducted with 115 adults with T2D in a Saudi Arabian diabetes clinic. Illness perceptions, GLHC beliefs, and self-care behaviours were assessed using the Arabic versions of the Brief Illness Perception Questionnaire, God Locus of Health Control, and Summary of Diabetes Self-Care Activities. Logistic and linear regressions were conducted. Results: Greater perceptions of personal control (OR = 2.07, p = .045) and diet effectiveness (OR =   2.73, p = .037) were associated with higher odds of adhering to general diet. Greater perceptions of diet effectiveness (β = 0.27, p = .034) and better understanding of T2D (β = 0.54, p < .001) were significant independent predictors of fruit and vegetables intake and exercise respectively. Patients with lower GLHC beliefs (OR =  4.40, p = .004) had higher odds of adhering to foot care than those with higher GLHC beliefs. Illness perceptions and GLHC beliefs did not predict adherence to a low-fat diet, self-monitoring of blood glucose, or not smoking. Conclusion: Greater perceptions of personal control, coherence, diet effectiveness, and lower GLHC beliefs were associated with higher adherence to self-care behaviours in Saudi patients with T2D. Interventions designed to promote self-care behaviours in Saudi patients with T2D could focus on addressing these perceptions.

Diabetes conversation map - a novel tool for diabetes management self-efficacy among type 2 diabetes patients in Pakistan: a randomized controlled trial

BACKGROUND

This study aimed to measure the effect of diabetes education using the novel method of "diabetes conversation map (DCM)" as compared to routine counselling (RC) on diabetes management self-efficacy (DMSE) among patients living with type 2 diabetes in Karachi, Pakistan.

METHODS

A parallel arm randomized controlled trial among patients with type 2 diabetes aged 30-60 years, with HbA1c > 7%, diagnosed for at least 5 yrs., was conducted at the national institute of diabetes and endocrinology in Karachi, Pakistan. A total 123 type 2 diabetes patients were randomized into DCM (n = 62) or RC (n = 61). Four weekly diabetes control sessions of 40 min each using the DCM or RC was provided. DMSE was measured using a validated Urdu language DMSE tool at baseline and after three months of the randomization. Change in DMSE and HbA1c levels within groups (pre-post) and between the groups after 3 months of enrollment was compared.

RESULTS

Baseline characteristics except HbA1c were similar between the two arms. After 3 months of enrollment, there was no change in the DMSE score in the RC arm however, significant increase in DMSE score was noted in the DCM arm (P = < 0.001). The average difference (95% confidence interval) in DMSE score between the DCM and RC arm was 33.7(27.3, 40.0; p = < 0.001) after 3 months of the enrollment. Difference in HbA1c within groups was not significant.

CONCLUSIONS

DCM significantly improved DMSE among type 2 diabetes patients in a developing country setting like Pakistan. Healthcare workers caring for type 2 diabetes patients need to be trained on DCM to effectively utilize this novel tool for educating diabetes patients.

TRIAL REGISTRATION

This trial was prospectively registered. ClinicalTrials.gov Identifier: NCT03747471. Date of registration: Nov 20. 2018.

Illness Perceptions, HbA1c, And Adherence In Type 2 Diabetes In Saudi Arabia

PURPOSE

Little is known about predictors of adherence to diabetes medication in Saudi Arabia. This study aimed to investigate whether illness perceptions, beliefs about medicine, and God locus of health control beliefs were associated with adherence to medication and glycaemic control (HbA1c) in Saudi patients with type 2 diabetes (T2D).

PATIENTS AND METHODS

A convenience sample of 115 adults with T2D were recruited from a diabetes outpatient clinic. Validated self-reported measures of adherence to medication, illness perceptions, beliefs about medicine, and God locus of health control were administered. Patients' most recent HbA1c levels were extracted from medical records. Multivariable logistic and linear regressions were used to examine the association between illness perceptions, beliefs about medicine and adherence to medication and HbA1c.

RESULTS

More than two thirds of patients (69%) reported poor adherence to medication. All illness perceptions domains, beliefs about medicine, and God locus of health control beliefs were associated with adherence. Multivariable logistic regression revealed that older age (OR= 3.76, p= 0.023), worse consequences perceptions (OR= 0.21, p= 0.011), worse illness identity (OR= 0.23, p= 0.010), and greater illness coherence (OR= 3.24, p= 0.022) were independent predictors of adherence. Two thirds of patients (67%) had suboptimal HbA1c; and perceptions of a cyclical timeline and lower insulin effectiveness were associated with higher HbA1c. In multiple linear regression, perceptions of a cyclical timeline (β= 0.19, p= 0.040) were an independent significant predictor of HbA1c.

CONCLUSION

In Saudi Arabia, patients' perceptions of T2D, beliefs about medicine, and God locus of control beliefs are associated with adherence. These results inform the development of interventions based on the Common-Sense Model (CSM) to encourage improved adherence and glycaemic control among Saudi patients with T2D. Further research with larger and more diverse samples is warranted to expand the generalizability of these findings.

Validation of the shortened Perceived Medical Condition Self-Management Scale in patients with chronic disease

Self-efficacy, or perceived competence, has been identified as an important factor in self-management behaviors and health outcomes in patients with chronic disease. Measures of self-management self-efficacy are currently available for multiple forms of chronic disease. One established measure is the 8-item Perceived Medical Condition Self-Management Scale (PMCSMS). This study investigated the use of the PMCSMS in samples of patients with a chronic disease to develop an abbreviated version of the scale that could be more readily used in clinical contexts or in large population health cohort studies. The PMCSMS was administered as either a generic scale or as a disease-specific scale. The results of analyses using item response theory and classical test theory methods indicated that using 4 items of the scale resulted in similar internal consistency (α = .70-0.90) and temporal stability (test-retest r = .75 after 2 to 4 weeks) to the 8-item PMCSMS (r = .81 after 2 to 4 weeks). The 4 items selected had the greatest discriminability among participants (α parameters = 2.49-3.47). Scores from both versions also demonstrated similar correlations with related constructs such as health literacy (r = .13-0.29 vs. 0.14-0.27), self-rated health (r = .17-0.48 vs. 0.26-0.50), social support (r = .21-0.32 vs. 0.25-0.34), and medication adherence (r = .20-0.24 vs. 0.20-0.25). The results of this study indicate that 4-item PMCSMS scores are equally valid but more efficient, and have the potential to be beneficial for both research and clinical applications. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Analysing mHealth usage logs in RCTs: Explaining participants' interactions with type 2 diabetes self-management tools

Background

The Introduction of mobile health (mHealth) devices to health intervention studies challenges us as researchers to adapt how we analyse the impact of these technologies. For interventions involving chronic illness self-management, we must consider changes in behaviour in addition to changes in health. Fortunately, these mHealth technologies can record participants’ interactions via usage-logs during research interventions.

Objective

The objective of this paper is to demonstrate the potential of analysing mHealth usage-logs by presenting an in-depth analysis as a preliminary study for using behavioural theories to contextualize the user-recorded results of mHealth intervention studies. We use the logs collected by persons with type 2 diabetes during a randomized controlled trial (RCT) as a use-case.

Methods

The Few Touch Application was tested in a year-long intervention, which allowed participants to register and review their blood glucose, diet and physical activity, goals, and access general disease information. Usage-logs, i.e. logged interactions with the mHealth devices, were collected from participants (n = 101) in the intervention groups. HbA1c was collected (baseline, 4- and 12-months). Usage logs were categorized into registrations or navigations.

Results

There were n = 29 non-mHealth users, n = 11 short-term users and n = 61 long-term users. Non-mHealth users increased (+0.33%) while Long-term users reduced their HbA1c (-0.86%), which was significantly different (P = .021). Long-term users significantly decreased their usage over the year (P < .001). K-means clustering revealed two clusters: one dominated by diet/exercise interactions (n = 16), and one dominated by BG interactions and navigations in general (n = 40). The only significant difference between these two clusters was that the first cluster spent more time on the goals functionalities than the second (P < .001).

Conclusion

By comparing participants based upon their usage-logs, we were able to discern differences in HbA1c as well as usage patterns. This approach demonstrates the potential of analysing usage-logs to better understand how participants engage during mHealth intervention studies.

An Analysis of Race-related Attitudes and Beliefs in Black Cancer Patients: Implications for Health Care Disparities

This research concerned relationships among Black cancer patients' health care attitudes and behaviors (e.g., adherence, decisional control preferences,) and their race-related attitudes and beliefs shaped by (a) general life experiences (i.e., perceived discrimination, racial identity) and (b) experiences interacting with health care systems (i.e., physician mistrust, suspicion about medical care). Perceived discrimination, racial identity, and medical suspicion correlated weakly with one another; mistrust and suspicion correlated only moderately. Race-related attitudes and beliefs were associated with health care attitudes and behavior, but patterns of association varied. Physician mistrust and medical suspicion each independently correlated with adherence and decisional control preferences, but discrimination only correlated with control preferences. Associations among patients' different racial attitudes/beliefs are more complex than previously assumed. Interventions that target patient attitudes/beliefs and health care disparities might be more productive if they focus on mistrust or suspicion specific to health care providers/systems and their correlates identified in this study.

Clinical Application of Patient-Centered Diabetes Care for People With Serious Mental Illness

IN BRIEF Patients with serious mental illness (SMI) have markedly higher mortality rates than those without SMI. A large portion of this disparity is explained by higher rates of diabetes and cardiovascular illness, highlighting the need for people with diabetes and SMI to have access to the highest quality diabetes care. This article applies principles of patient-centered diabetes care to those with SMI, exploring a novel approach to diabetes care embedded within a community mental health setting.

Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence

Background

Current health policies emphasize the need for an equitable doctor-patient relationship, and this requires a certain level of patient empowerment. However, a systematic review of the empirical evidence on how empowerment affects medication adherence—the extent to which patients follow the physician’s prescription of medication intake—is still missing. The goal of this systematic review is to sum up current state-of-the-art knowledge concerning the relationship between patient empowerment and medication adherence across medical conditions. As our conceptualization defines health locus of control and self-efficacy as being crucial components of empowerment, we explored the relationship between these two constructs and medication adherence.

Methods

Relevant studies were retrieved through a comprehensive search of Medline and PsychINFO databases (1967 to 2017). In total, 4903 publications were identified. After applying inclusion and exclusion criteria and quality assessment, 154 articles were deemed relevant. Peer-reviewed articles, written in English, addressing the relationship between empowerment (predictor) and medication adherence (outcome) were included.

Findings

High levels of self-efficacy and Internal Health Locus of Control are consistently found to promote medication adherence. External control dimensions were found to have mainly negative (Chance and God attributed control beliefs) or ambiguous (Powerful others attributed control beliefs) links to adherence, except for Doctor Health Locus of Control which had a positive association with medication adherence. To fully capture how health locus of control dimensions influence medication adherence, the interaction between the sub-dimensions and the attitudinal symmetry between the doctor and patient, regarding the patient’s control over the disease management, can provide promising new alternatives.

Discussion

The beneficial effect of patients’ high internal and concurrent physician-attributed control beliefs suggests that a so-called “joint empowerment” approach can be suitable in order to foster medication adherence, enabling us to address the question of control as a versatile component in the doctor-patient relationship.

The Impact of Health Locus of Control and Anxiety on Self-Monitored Blood Glucose Concentration in Women with Gestational Diabetes Mellitus

BACKGROUND

The purpose of this study was to evaluate the associations between health locus of control (HLC), anxiety, and glycemic control from the time of diagnosis of gestational diabetes (GDM) to the end of pregnancy.

METHODS

The study group comprised 165 women with GDM. Baseline HLC (∼27 weeks of gestation) was assessed by the Multidimensional HLC Scale. The level of anxiety was measured at baseline and follow-up (37 weeks of gestation) by the State-Trait Anxiety Inventory. Using questionnaires, we collected information about the level of fear related to measuring blood glucose several times per day, dietary regimen, and insulin therapy, as well as fear for the baby and its health, patient's own health, and having diabetes in the next pregnancy. Glycemic control was evaluated by self-monitored fasting and postprandial blood glucose levels.

RESULTS

Baseline state anxiety was significantly higher than trait anxiety. From baseline to follow-up, the state anxiety and percentage of women with increased fear for their infant's health, diabetic diet, self-monitoring of blood glucose, and insulin injection significantly decreased. In comparison to women with blood glucose in the low tertile, those with blood glucose in the high tertile had significantly higher scores in the chance HLC subscale and a similar level of state anxiety. Blood glucose was positively correlated with the chance HLC score.

CONCLUSIONS

Chance HLC beliefs seem to be associated with poorer glycemic outcomes in women with GDM. Our results suggest the need for further efforts to reduce the GDM-associated state anxiety.

Factors Influencing Diabetes Self-Management Among Medically Underserved Patients With Type II Diabetes

In this study, researchers compare and contrast issues regarding diabetes self-management between persons in good versus poor glycemic control. The sample comprises low-income racially diverse adults with diabetes from four mid-western community health centers; 44 patients participated in eight focus groups divided by control status (HbA1c of > 9 [uncontrolled] or < 7 [controlled]). Themes common to both groups included the impact of dietary restrictions on social interactions, food cravings, the impact of mental health on self-management, and the importance of formal and informal (friends and family) support. Those in the uncontrolled groups described fear about being able to control their diabetes, confusion about self-management, and difficulty managing their diabetes while caring for family members. Although those in the controlled groups acknowledged difficulties, they discussed resisting cravings, making improvements with small changes, positive feelings about their ability to control their diabetes, and enjoying new foods and exercise. Interventions should include mental health support, incorporate formal and informal patient support structures, and address literacy issues. Health care providers and intervention personnel should be very concrete about how to do self-management tasks and guide patients on how to alter their diabetes regimens for social and other important life events.

General self-efficacy and diabetes management self-efficacy of diabetic patients referred to diabetes clinic of Aq Qala, North of Iran

BACKGROUND

Self-efficacy is one of the factors involved in successful self-care of diabetic patients. The aim of this study was to evaluate general self-efficacy and diabetes management self-efficacy and to determine their association with glycemic control in diabetic individuals, referred to the diabetes clinic of Aq Qala city, North of Iran.

METHODS

In this cross-sectional study, 251 type 2 diabetes mellitus patients were enrolled using census method. Data collection tools consisted of Sherer General Self-Efficacy Scale (SGSES) and Diabetes Management Self-Efficacy Scale (DMSES) with minor demographic adjustments and hemoglobin A₁C test. Data were analyzed using descriptive statistics and analytical techniques include independent t-test, Spearman correlation coefficient and linear regression were applied for further data analysis.

RESULTS

The mean and standard deviation age of subjects was 56.17 ± 10.45 years. The mean level of HbA₁C of studied subject was 8.35 ± 2.02%. There was a negative correlation between age and general self-efficacy and diabetes self-efficacy while, there was a positive correlation between general self-efficacy and diabetes self-efficacy (P < 0.001). Results of the regression analysis showed that duration of the disease was the only variable which had a significant effect on the level of hemoglobin A1C (P < 0.001), so that for each year of having the disease, the level of hemoglobin A₁C increased by 0.084% (CI 95% = 0.048-0.121).

CONCLUSIONS

General self-efficacy and diabetes self-efficacy does not affect glycemic control in diabetic individuals. The duration of the disease is the only affecting variable on glycemic control by its worsening in diabetic individuals. Interventions are recommended to help glycemic control in individuals who are having this disease for longer periods. Moreover, further studies on the affecting factors on poor glycemic control of diabetic patients as well as the role of time variable, are recommended.

The Burden of Structured Self-Monitoring of Blood Glucose on Diabetes-Specific Quality of Life and Locus of Control in Patients with Noninsulin-Treated Type 2 Diabetes: The PRISMA Study

BACKGROUND

To evaluate whether structured self-monitoring of blood glucose (SMBG) is associated with changes in diabetes-specific quality of life (DSQoL) and locus of control (LOC) in patients with noninsulin-treated type 2 diabetes (T2DM).

STUDY DESIGN AND METHODS

In this analysis of the PRISMA (Prospective Randomized Trial on Intensive SMBG Management Added Value in Noninsulin-Treated T2DM Patients) Study psychosocial data, we evaluated the impact of 12 months of structured SMBG on the individual domains of DSQoL and LOC questionnaires, including the role of selected confounders.

RESULTS

The score for Satisfaction, Impact, and Worry domains (DSQoL) improved when compared with baseline, without significant differences between structured SMBG regimen (intervention group, n = 501) and active control group (n = 523). Scores for Internal, Chance, and Powerful Others domains (LOC) improved compared with baseline, with a significant between-group change in Chance (P = 0.0309). For DSQoL domain score, improvements were associated with higher number of SMBG measurements (P = 0.007), older age (P = 0.013), and male sex (P = 0.0133) for Satisfaction and with male sex (P < 0.0001) for Worry. Concerning LOC domain score, improvements were associated with longer diabetes duration (P = 0.0084) and younger age (P < 0.0001) for Chance and total number of SMBG measurements (P = 0.0036) for Internal, with the intervention group close to being significant (P = 0.06).

CONCLUSIONS

Our analysis demonstrates that in patients with noninsulin-treated T2DM, structured SMBG is not associated with a deterioration of quality of life and LOC, which is strongly predicted by demographics and diabetes-related variables. These findings should be considered when tailoring educational support to SMBG for these patients.

Modified social learning theory re-examined: correlates of self-management behaviors of persons with Type 2 diabetes

Modified social learning theory (MSLT) applied to health predicts that health behavior is a multiplicative function of health value and perceptions of control over health. The self-management behaviors of persons with Type 2 diabetes mellitus, internal diabetes locus of control (IDLC), diabetes self-efficacy (DSE), and health value (HV) were assessed with an index of diabetes self-care activities in 107 patients receiving insulin. Multiple regression analysis showed DSE as the only MSLT construct that correlated with the index of diabetes self-care behaviors (β = .21, p < .05). While the predicted three-way interaction of IDLC × DSE × HV was significant (∆R² = 4.5 %, p < .05) in the final step of the hierarchical model, the pattern of the findings only partially supported MSLT. Instead of finding that patients who were simultaneously high on all three predictors scored highest on the behavioral index, we found that patients who were low on all three constructs reported the least amount of diabetes self-care behavior. Implications for further modification of MSLT and its applications to clinical practice are discussed.

The interactive effects of patient control beliefs on adherence to fluid-intake restrictions in hemodialysis: Results from a randomized controlled trial

This study examined the interactive role of perceived control and preference for control on adherence in a sample of patients with chronic kidney disease. As part of a randomized controlled trial assessing adherence to fluid-intake restrictions, 119 hemodialysis patients completed measures of these constructs; results indicated that patients with high perceived control and high preference for control demonstrated the most favorable adherence. This suggests that patients who believe health-related outcomes are a function of one's own behaviors-and having the opportunity to exert control over aspects of treatment-may be most adherent to complex regimens in which self-management is key.

How information about the time requirements and legacy effects of treatments influence decision-making in patients with diabetes and hypertension

OBJECTIVE

When deciding about diabetes treatments, patients are typically uninformed about how much time is required before (time requirements), or for how long treatments change outcomes (legacy effects). However, patients may be motivated to adopt treatments with time-related treatment information. We explored whether this information alters a patients' likelihood of starting medications.

RESEARCH DESIGN AND METHODS

We conducted semistructured interviews with 60 adults with type 2 diabetes for <10 years and hypertension on oral medications. We measured change in likelihood of starting medications after receiving time requirement (diabetes, 10 years; hypertension, 3 years) and legacy effect (diabetes, 10 additional years; hypertension, none) information. Responses were analyzed for themes about time-related treatment information.

RESULTS

At baseline, 70% of participants reported being very likely to start a recommended medication. Nearly half (40%) were less likely to start a diabetes medication after being informed of time requirements; but after being informed of legacy effects, 32% reported being more likely. Fewer participants changed likelihoods of starting antihypertensives with time-related information. Many participants expressed that medications' benefits were important to them regardless of time-related information. Participants considered time requirements for diabetes medications too long and compared them to their life expectancy. Many participants were interested in legacy effects of diabetes medications because they looked forward to discontinuing medications, although some expressed doubt that benefits could persist after stopping medications.

CONCLUSIONS

While prolonged time requirements may dissuade patients from adopting treatments, the promise of legacy effects may motivate patients to commit to diabetes treatments.

Health locus of control in Indonesian women with breast cancer: a comparison with healthy women

The aims of this study were to assess whether Indonesian women with breast cancer havea higher external health locus of control (HLC) than healthy women, and to explore the association between HLC and symptoms of anxiety and depression. In this study, 120 consecutive women with breast cancer were recruited at the outpatient surgical oncology clinic at the Hasan Sadikin Hospital in Bandung. One hundred and twenty two healthy women were recruited from the Bandung area as controls. A standard demographic form, Form C of the Multidimensional Health Locus of Control, as well as the Hospital Anxiety and Depression Scale and patients' medical records were used. Data were analyzed using descriptive statistics, t-test, Pearson's correlation, MANOVA and multiple linear regressions. Women with breast cancer had higher scores on all external HLC subscales, i.e. chance, doctor, powerful others and God, and lower internal HLC compared to healthy women. High God LHC scores were associated with a high level of anxiety (β=0.21, p<0.05), whereas none of the HLC subscales were associated with depression. Our results suggest that women with breast cancer tend to have high external HLC, while healthy women tend to have high internal HLC. A strong belief in an external source of control, i.e. God, might be negatively associated with patient emotional adjustment. Further research is needed to give an insight into the direction of this association.

The influence of locus of control on self-rated health in context of chronic disease: a structural equation modeling approach in a cross sectional study

BACKGROUND

Self-rated health is a robust predictor of several health outcomes, such as functional ability, health care utilization, morbidity and mortality. The purpose of this study is to investigate and explore how health locus of control and disease burden relate to self-rated health among patients at risk for cardiovascular disease.

METHODS

In 2009, 414 Swedish patients who were using statins completed a questionnaire about their health, diseases and their views on the three-dimensional health locus of control scale. The scale determines which category of health locus of control - internal, chance or powerful others - a patient most identifies with. The data was analyzed using logistic regression and a structural equation modeling approach.

RESULTS

The analyses showed positive associations between internal health locus of control and self-rated health, and a negative association between health locus of control in chance and powerful others and self-rated health. High internal health locus of control was negatively associated with the cumulative burden of diseases, while health locus of control in chance and powerful others were positively associated with burden of diseases. In addition, age and education level had indirect associations with self-rated health through health locus of control.

CONCLUSIONS

This study suggests that self-rated health is positively correlated with internal locus of control and negatively associated with high locus of control in chance and powerful others in patients at high risk for cardiovascular disease. Furthermore, disease burden seems to be negatively associated with self-rated health.

Self-Management of Wellness and Illness in an Aging Population

In this chapter, we review the last 10 years of literature on self-management of illnesses (acute/episodic and chronic) and wellness (e.g., health promotion). We focus on health self-management in the context of an aging population, wherein middle-aged adults are more likely to be managing wellness activities and older adults are often managing both maintenance of health and chronic illnesses. The critical issues related to self-management of health are discussed, including those imposed by health care demands and those stemming from individual differences in general abilities (e.g., motor, perception, cognition) and socioemotional characteristics. The dynamic relationship between theory and practice is highlighted. Health care demands reflect the nature of the illness or wellness activity and include managing comorbidities, symptoms, and medications; engaging in health promotion activities (e.g., exercise, diet); the required use of health technologies; the need for health-related information; and coordination of the care network. Individual differences in motor, perceptual, and cognitive abilities, as well as in the severity and complexity of the illness and the consequent demands, also impact how a person self-manages health. Cognitive abilities, such as decision making, knowledge, literacy (i.e., general, health, and e-health literacy), and numeracy are particularly implicated in the process of managing one’s own health and are especially important in the context of an aging population; therefore we give these cognitive abilities special attention in this chapter. Socioemotional characteristics, and attitudes and beliefs about one’s health, impact an individual’s self-management of health as well, impacting his or her motivation and goal-setting behaviors. Moreover, we discuss literature on interventions that have been used to improve self-management of health, and we examine the potential for technology. We conclude with guidelines for technology design and instruction, and discuss emerging themes.

Placebo effects in children: a review

Of more than 155,000 PubMed citations found with the search term "placebo," only ~9,000 (5.8%) included the terms "children" or "adolescents." When all these papers were screened, only ~2,000 of them investigated the placebo effect per se, and of those, only ~50 (2.5%) discussed the placebo effect in children and adolescents. In this narrative review, we explore four aspects of the placebo response in children and adolescents: (i) the legal and ethical limitations and restrictions for the inclusion of children in clinical trials as well as in experimental (placebo) research that may explain the poor knowledge base; (ii) the question of whether or not the placebo effect is larger in children and adolescents as compared with adults; (iii) whether the mechanisms underlying the placebo effect are similar between children and adults; and (iv) whether mediators and moderators of the placebo effect are comparable between children and adults. We finally discuss some of the consequences from the current placebo research in adults that may affect both experimental and clinical research in children and adolescents.

Effects of emotional response on adherence to antihypertensive medication and blood pressure improvement

Background. Developing interventions to improve medication adherence may depend upon discovery of novel behavioral risk factors for nonadherence. Objective. Explore the effects of emotional response (ER) on adherence to antihypertensive medication and on systolic blood pressure (SBP) improvement. Design. We studied 101 adults with diabetes and hypertension. The primary outcome, 90-day “percentage of days covered” adherence score, was determined from pharmacy refill records. The secondary outcome was change in SBP over 90 days. ER was classified as positive, negative, or neutral. Results. Average adherence was 71.6% (SD 31.4%), and negative and positive ER were endorsed by 25% and 9% of subjects, respectively. Gender moderated the effect of positive or negative versus neutral ER on adherence (interaction P = 0.003); regardless of gender, negative and positive ER were associated with similarly high and low adherence, respectively, but males endorsing neutral ER had significantly higher adherence than their female counterparts (85.6% versus 57.1%, F value = 15.3, P = 0.0002). Adherence mediated ER's effect on SBP improvement: among participants with negative, but not positive or neutral, ER, increasing adherence and SBP improvement were correlated (Spearman's r = 0.49, P = 0.02). Conclusions. Negative, but not positive or neutral, ER predicted better medication adherence and a correlation between medication adherence and improvement in SBP.

Asthma medication adherence: the role of God and other health locus of control factors

BACKGROUND

Medication adherence is an important determinant of disease outcomes, yet medication use on average tends to be low among patients with chronic conditions, including asthma. Although several predictors of non-adherence have been assessed, more research is needed on patients' beliefs about God and how these relate to medication use.

OBJECTIVE

To examine the relationship between perceptions about "God's" role in health and other locus of control factors with inhaled corticosteroid (ICS) adherence among asthma patients.

METHODS

Participants were from a clinical trial to improve ICS adherence and were 5-56 years old, had a diagnosis of asthma, and were receiving ICS medication. Baseline adherence was estimated from electronic prescription and pharmacy fill records. Patients were considered to be adherent if ICS use was ≥80% of prescribed. A baseline survey with the Multidimensional Health Locus of Control scale was used to assess five sources (God, doctors, other people, chance, and internal).

RESULTS

Medication adherence was low (36%). Patients' who had a stronger belief that God determined asthma control were less likely to be adherent (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70-0.96). This relationship was stronger among African American (OR 0.68, 95% CI0.47-0.99) compared to white patients (OR 0.89, 95% CI 0.75-1.04), and among adults (OR 0.81, 95% CI 0.69-0.96) compared to children (OR 0.84, 95% CI 0.58-1.22).

CONCLUSION

Patients' belief in God's control of health appears to be a factor in asthma controller use, and therefore should be considered in physician-patient discussions concerning course of treatment.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00459368.

A concept analysis of self-efficacy among Chinese elderly with diabetes mellitus

AIM

This paper is a report of concept analysis of self-efficacy in elderly with diabetes in China.

METHODS

Literature was systematically retrieved from 2000 to 2011 using five databases: Cumulative Index to Nursing and Allied Health Literature, MEDLINE, OVID, PsycInfo, and Web of Science. The key words used in the search were self-efficacy, diabetes, type 2, aged, self-care, and China. The electronic search was supplemented by a manual search of current issues of periodicals and follow-up of other cited materials, where appropriate. A total of 45 articles were retrieved. After a careful review of the 45 articles most relevant to the topic, 31 articles remained. They were used to complete a concept analysis using Walker and Avant's technique.

RESULTS

Four defining attributes of self-efficacy were identified: (a) cognitive recognition of requisite specific techniques and skills required to undertake diabetes self-management, (b) perceived expectations of the outcomes of self-management, (c) confidence in the capability to perform self-management, and (d) sustained efforts in self-management of diabetes.

CONCLUSIONS

Self-efficacy has been an important determinant in self-management among elderly with diabetes. The application of self-efficacy should be incorporated into decision-making and problem-solving procedures when caring for older adults with diabetes.

Relationships among self-efficacy, social support, social problem solving, and self-management in a rural sample living with type 2 diabetes mellitus

Self-management behaviors are important for control of type 2 diabetes mellitus. Therefore, determining factors that promote effective self-management behaviors may be significant for improving the well-being of patients with type 2 diabetes mellitus. This study examined relationships among self-efficacy, social support, social problem solving, and diabetes self-management behaviors. Further, this study evaluated whether social support and social problem solving were mediators of the relationship between self-efficacy and diabetes self-management behaviors in those living with type 2 diabetes mellitus. Using a cross-sectional, descriptive correlational design, data from a convenience sample of 152 rural people living with type 2 diabetes mellitus were examined. Findings indicated that self-efficacy was a strong predictor of diabetes self-management. The effect of social support on diabetes self-management differed among men and women in the sample. Social support and social problem solving were significantly associated with diabetes self-management in men. Neither social support nor social problem solving were mediators of the relationship between self-efficacy and diabetes self-management in this sample. These findings suggest that nurses need to consider implementing interventions to improve patients' self-efficacy and potentially influence diabetes self-management.

Locus of control beliefs mediate the relationship between religious functioning and psychological health

Theistic and spiritually based beliefs and behaviors have been demonstrated to consistently predict physical and mental health, although the psychological processes underlying these relationships are unclear. This study investigated associative relationships and pathways of mediation between religious functioning, locus of control (LOC) and health. The sample consisted of 122 Christians (79 women, 43 men) who were predominately Catholic, ranging in age from 18 to 80 (M = 45.47, SD = 15.0). Participants were recruited from churches in the Western suburbs of Melbourne, Australia, and completed a questionnaire package measuring (1) psychological and physical health, (2) the religious variables of awareness of God, instability and impression management, and (3) God, internal and external LOC domains. Results indicated that awareness of God and internal LOC were associated with better health, whereas external LOC and instability were associated with poorer health. God LOC and impression management were not significantly associated with health. Sobel tests were used to analyse mediation hypotheses. Internal LOC was found to mediate the relationship between awareness of God and better psychological health, and external LOC was found to mediate the relationship between instability and poorer psychological health. These findings are of considerable clinical significance.

Effect of perceived control on quality of life in indigent adults with type 2 diabetes

PURPOSE

To examine the relationship between perceived control of diabetes and physical and mental health components of quality of life in indigent adults with diabetes.

METHODS

The primary variables, perceived control of diabetes and quality of life, were evaluated among188 patients from a low-income clinic located at an academic medical center. Over a 12-month period, consenting subjects completed the surveys to assess perceived control of diabetes and health-related quality of life. Sociodemographic factors (age, gender, race/ethnicity, income, education, employment, marital status, and insurance status) were collected as well as clinical factors like comorbid conditions and use of insulin therapy. Multiple linear regression models were used to assess the independent association of perceived control on quality of life.

RESULTS

The sample largely comprised middle-aged women with diabetes, a majority being black; nearly two-thirds had at least a high school education and almost three-quarters were unemployed. Mean quality of life scores were generally below national population means. Correlation results indicated a positive relationship between perceived control and both physical and mental quality of life. Regression results supported the positive association between perceived control and quality of life, even when controlling for sociodemographics and comorbidity in the final model.

CONCLUSION

Increasing perceived control, perhaps by a combination of education and skills building (ie, self-efficacy), will result in higher perceived quality of life (QOL) among disadvantaged populations with diabetes.

Facilitators and Barriers to Self-management of Type 2 Diabetes Among Urban African American Adults

Purpose

The purpose of this study was to identify facilitators and barriers to self-management of type 2 diabetes mellitus (T2DM) among urban African American adults.

Methods

Thirty-eight African American adults with T2DM were recruited from 1 of 3 health care agencies in a midsized city in the southeastern United States. Qualitative data were obtained using focus groups, wherein each participant engaged in a 60- to 90-minute audio-recorded session. Focus group data were transcribed and analyzed using Atlas ti 6 ® data analysis software. Demographic and medical history information was also collected.

Results

Factors relating to external locus of control primarily facilitated adherence to T2DM self-management behaviors. Support from family, peers, and health care providers positively influenced adherence behaviors by providing cues to action, direct assistance, reinforcement, and knowledge. Internal factors were primarily described as barriers to self-management behaviors and included fears associated with glucose monitoring, lack of self-control over dietary habits, memory failure, and perceived lack of personal control over diabetes.

Conclusions

African Americans perceived external factors as facilitators of their T2DM management behaviors and internal factors as barriers to self-management. Further research is necessary to design and test interventions that capitalize on the external facilitators while helping African Americans to overcome perceived barriers identified in this study.

Health locus of control theory in diabetes: a worthwhile approach in managing diabetic foot ulcers?

The current global epidemic of type two diabetes mellitus has led to an accompanying increase in both foot ulceration and amputations, which pose significant health problems to populations worldwide. If improved treatment options are to be offered, then we clearly need a better understanding of all aspects of this disease. To date the major focus of diabetes research has been on physical factors, which are undeniably important, but there has been little acknowledgement of the significant psychological effects that can influence health and delay wound healing. The 'health locus of control' (HLC) theory, a psychological theory concerning patients' perceptions of how much control they have over life events (both positive and negative) may well be of use in this patient group. It has been suggested that concordance with treatment is improved when patients have a high 'internal' HLC (as measured by a questionnaire), which aligns with the belief that they have greater control over their health. It has further been suggested that through the implementation of 'group-care' education programmes, patients' attitudes can change, with a shift towards higher 'internal' HLC values. Thus a new approach in patient management might be to implement such education programmes, in the hope of improving adherence to treatment regimens and, hence, patient outcomes. To date there has been little conclusive evidence of the application of this theory, and although various studies have been performed in diabetic populations, only one study has been conducted specifically regarding diabetic foot ulcers. Clearly more research is needed.