Perceived resource support for chronic illnesses among diabetics in north-western China

Examining the Relationship Between Social Support, Self-Efficacy, Diabetes Self-Management, and Quality of Life Among Rural Individuals With Type 2 Diabetes in Eastern China: Path Analytical Approach

BACKGROUND

Patients with type 2 diabetes (T2D) in rural China frequently exhibit inadequate diabetes self-management (DSM) and a reduced quality of life (QoL). Social support and self-efficacy are known to influence DSM and QoL. However, the pathways through which social support and self-efficacy impact DSM and QoL among patients with T2D in rural China has yet to be fully elucidated.

OBJECTIVE

This study offers a foundation for developing policies in rural chronic disease management, thereby, contributing to the improvement of T2D prevention and control in China and other transitional countries.

METHODS

This study used a cross-sectional design, collecting data from a survey conducted between May and July 2021 on DSM and QoL among rural patients diagnosed with T2D in 2 townships in East China. All patients with T2D were enrolled through cluster sampling from the township health center database, and a questionnaire survey was administered by investigators. Structural equation modeling and multiple regression analyses were used to explore the pathways through which social support influences DSM and QoL, as well as the mediating role of self-efficacy.

RESULTS

It was found that the DSM score (mean 37.42, SD 7.70) was less than half of the maximum theoretical score. The QoL score (mean 48.92, SD 8.88) accounted for 36% of the maximum theoretical score. Social support directly and positively affected the DSM and QoL of Chinese rural patients with T2D (P<.01); an increase of 1 unit in social support was associated with a direct increment of 0.339 units in DSM and 0.397 units in QoL. Self-efficacy played a positive mediating role (P<.01), further increasing DSM and QoL by 0.147 and 0.159 units, respectively. The mediating effect of self-efficacy accounted for 30.2% and 28.6% of the total effect of social support on DSM and QoL. Furthermore, the family and friend dimension of social support, along with the symptom and disease management dimensions of self-efficacy, were significantly associated with DSM or QoL (P<.01).

CONCLUSIONS

The study confirmed the direct and indirect influences of social support on DSM and QoL and elucidated the mediating effect of self-efficacy among rural patients with T2D in eastern China. Interventions should be developed to enhance both social support and self-efficacy, creating a positive cycle of mutual reinforcement to improve DSM and QoL among this group.

Influence of chronic illness resources on self-management and the mediating effect of patient activation among patients with coronary heart disease

Aim

The aim of this study was to explore the relationship between chronic illness resources, patient activation and self‐management behaviour among middle‐aged and older patients with CHD.

Design

A cross‐sectional, descriptive correlational study was performed.

Methods

A convenience sample of 296 participants were recruited in Tianjin, China. Data were collected by using the Chronic Illness Resource Survey (CIRS), Patient Activation Measure (PAM) and Coronary Artery Disease Self‐Management Scale (CSMS). Descriptive statistics and Pearson's correlation analysis were used to data analysis. Linear regression analysis was performed to explore the mediating role of patient activation.

Results

The results showed that chronic illness resources and patient activation were significantly and positively correlated with self‐management behaviours (p < .01). Patient activation had a partial intermediary between chronic illness resources and self‐management behaviours, and the mediation effect was 0.230. Patient activation mediated the relationship between chronic illness resources and self‐management. In order to improving the self‐management behaviours, medical staff need to pay attention to the importance of chronic illness resources and patient activation.

Influencing factors of resource utilisation in haemodialysis patients-Based on socioecological pyramid model

Aims and objectives

To describe the current situation and analyse influencing factors of resource utilisation in maintenance haemodialysis patients.

Background

The self‐management level of patients undergoing maintenance haemodialysis in China is low. The applicability of the Chronic Illness Resources Survey in Chinese maintenance haemodialysis patients has been validated, and this survey can be used to assess the utilisation of self‐management support resources among haemodialysis patients. Determining the influencing factors of resource utilisation can help improve the self‐management behaviour of haemodialysis patients and control the progression of the disease.

Design

A descriptive study design was chosen.

Methods

A convenience sample of 314 patients undergoing haemodialysis was recruited from dialysis centres in three hospitals in western Xinjiang from June 2018–April 2019. SPSS19.0 software was used to describe the current situation of resource utilisation. Moreover, t test, analysis of variance and multivariate linear regression were applied to explore the influencing factors of patients’ resource utilisation. Standards for observational studies STROBE Statement checklist‐v4 were chosen on reporting the study process.

Results

The average score of the total resource utilisation was 2.95 ± 0.51. The average item score of seven dimensions from high to low was 3.46 for medical staff, 3.32 for personal, 3.22 for family and friends, 3.16 for work‐related, 3.12 for media policy, 2.55 for neighbourhood/community and 2.23 for organisation. Multiple linear regression showed that there have six main factors, which explained 65.4% of the variance of haemodialysis patients’ resource utilisation.

Conclusions

The personal, family and friends, work and media and policy subscales were rated the highest, with support from neighbourhood/community and organisation rated the lowest. In general, participants perceived moderate levels of support. Government and healthcare team should pay more attention on haemodialysis patients who had low level of education, poor economic conditions and poor mental condition.

Relevance to clinical practice

ESRD has caused a burden on healthcare expenditure and has become a critical public health problem worldwide. Self‐management is particularly important for dialysis patients which have attracted extensive interest. In the future research, we can use this questionnaire to evaluate the related resources of disease management of dialysis patients, encourage patients to make full use of the resources around them and focus on those patients with low education and monthly income level and bad mental state.

A cross-sectional study of readiness for discharge, chronic illness resources and postdischarge outcomes in patients with diabetic foot ulcer

Aim

To investigate the correlation of readiness for hospital discharge, the chronic illness resources, and postdischarge outcomes of diabetic foot ulcer patients, which can be help for discharged patient rehabilitation.

Design

A cross‐sectional study.

Methods

One hundred and seventy‐nine patients were recruited from the Endocrinology units of two tertiary hospitals between November 2018–September 2019, in Guangdong, China. The methods used were Readiness for Hospital Discharge Scale, The Chronic Illness Resources Survey and one‐on‐one telephone interviews.

Results

Pearson correlation coefficients indicated moderate correlation between the readiness for discharge and resource availability for chronic illnesses (r = .446, p < .001). Multiple linear regression analysis showed that Chronic Illness Resources Survey, self‐care ability, methods of wound treatments after discharge, and living alone were the main predictors of readiness for hospital discharge among diabetic foot ulcer patients (F = 12.272, p < .001, R² = .621, Rad2 = .571). The study was limited by location, patient's recall bias and lack of BADL scale, which can be further improved in subsequent studies by developing multi‐centre clinical study and adopting more objective assessment tools.

Cross-cultural adaptation of the Chronic Illness Resources Survey in Japanese patients with diabetes

AIM

The Chronic Illness Resources Survey (CIRS) is a tool for assessing multiple levels of resources for self-management in people with chronic illnesses. This study aimed to examine the reliability and validity of the Japanese version of the CIRS (CIRS-J) among patients with diabetes.

METHODS

This study included 102 Japanese patients with diabetes. Patients completed the CIRS-J on two occasions with additional measurements, including the multidimensional scale of perceived social support (MSPSS), the summary of diabetes self-care activities (SDSCA), and the perceived health competence scale (PHCS). The construct validity, internal consistency reliability, and test-retest reliability were evaluated.

RESULTS

Factor analysis resulted in six factors. The Cronbach's α coefficient was 0.82, indicating a high internal consistency. The intraclass correlation coefficient was 0.87, indicating that the CIRS-J is stable over time. The CIRS-J showed a positive moderate association with MSPSS, SDSCA, and PHCS, with a correlation coefficient value ranging from .34 to .44.

CONCLUSION

This study showed preliminary support for the reliability and validity of the CIRS-J. The availability of this instrument will help identify the spectrum of resources available for Japanese people with diabetes in both research and practical settings.