Stage of change of 6 health-related behaviors among patients with type 2 diabetes

Effectiveness of a Diabetes Oral Nursing Program Including a Modified Diabetes Oral Health Assessment Tool for Nurses (M-DiOHAT©) : A 12-Month Follow-Up Intervention Study

PURPOSE

This study aimed to evaluate the effectiveness of a diabetes oral nursing intervention program for individuals with diabetes.

METHODS

Fifty-six participants with diabetes underwent a diabetes oral nursing intervention program. The program's effect was evaluated through questionnaires and small interviews. The modified diabetes oral health assessment tool (M-DiOHAT©) was used to assess and educate four factors;oral conditions, behaviors, perceptions and knowledge about diabetes and periodontal disease, and health information-sharing, among participants at baseline, 3, 6, and 12 months later. Primary outcomes included changes in the M-DiOHAT© total scores. Secondary outcomes included scores on the motivation stage of changes in oral health behaviors' scales, dental visits, number of present teeth, hemoglobin A1c (HbA1c), and participants' comments.

RESULTS

The M-DiOHAT© total score and the motivation stage score significantly improved with the narrative comment of "being motivated to practice oral health behaviors" between the baseline and 12 months later. Eight participants visited the dentist, whereas no differences were observed in the number of present teeth or HbA1c.

CONCLUSIONS

This program improved participants' M-DiOHAT© total score, motivation stage score, and dental visits. These results suggest the program improved oral health perceptions and behaviors among individuals with diabetes. J. Med. Invest. 69 : 86-96, February, 2022.

Multiple Unhealthy Behaviors Share Equivalent Profiles of Readiness for Change in Patients with Type 2 Diabetes

Few studies have considered more than one behavior, despite the tendency towards multiple behaviors, and there are none that have focused on a Latino population. We determined the concurrence of four unhealthy behaviors related to glycemic control and identified common cognitive factors at advanced stages of readiness for change in patients with type 2 diabetes treated in primary care. A cross-sectional study was carried out during August–December 2018 in northeastern Mexico. We consecutively included patients between 20 and 70 years who were without medical contraindication, physical impediment against exercise, pregnancy and edentulism, among other selection criteria (n = 407). Stages of behavior were measured according to the Transtheoretical Model. Pros, cons, self-efficacy, susceptibility, and severity data were collected by interview. Statistical analysis consisted of descriptive statistics and multiple logistic regression. A total of 36.7% exhibited more than one unhealthy behavior in precontemplation or contemplation (no interest or some interest in changing consumption of refined sugars and saturated fats, exercise, or oral hygiene behavior). Cons (p < 0.05) and self-efficacy (p < 0.001) were common to all four unhealthy behaviors, independent of potential confounders. Studies like ours facilitate the recognition of individuals with multiple unhealthy behaviors who share equivalent profiles of readiness for change before implementing public health programs.

Associations between self-management behavior and sociodemographic and disease-related characteristics in elderly people with type 2 diabetes - New results from the population-based KORA studies in Germany

AIMS

Self-management behavior (SMB) is an important aspect in the management of diabetes. This study aimed to identify sociodemographic and disease-related factors associated with good SMB in people with type 2 diabetes (T2D).

METHODS

We used data from 479 people with T2D aged 65 or older from the population-based KORA (Cooperative Health Research in the Area of Augsburg) Health Survey 2016 in Southern Germany. We estimated Poisson and logistic regression models testing the cross-sectional relationship between individual or disease-related characteristics and an established SMB sum index comprising six SMB dimensions stratified according to insulin treatment status.

RESULTS

Mean age in the sample was 75 and mean diabetes duration was 13 years. The overall level of SMB was low. Higher SMB index scores were associated with higher age, treatment with insulin, participation in a diabetes education program, and, for people with insulin treatment, with a BMI below 30 kg/m². Single item analyses generally supported these findings.

CONCLUSIONS

SMB in people with T2D needs to be improved with efficient interventions. Targeting obese individuals and those at an early stage of the disease with low-barrier, regular education or self-management programs may be a preferred strategy.

Readiness for weight change and its association with diet knowledge and skills, diet decision making and diet and exercise barriers in patients with type 2 diabetes

AIMS

this study aimed to investigate stages of weight change in type 2 diabetics and its associations with diet knowledge and skills, diet decision making, diet and exercise barriers.

MATERIALS AND METHODS

This was a cross-sectional study of 1139 patients with type 2 diabetes aged>18 years in East Azerbaijan, Iran. Data were collected using the Personal Diabetes Questionnaire (PDQ) and were analyzed using SPSS software (version 22) and descriptive statistics, Chi-square and one-way ANOVA tests.

RESULTS

48.1% of the patients were in the pre-contemplation stage. 7.5%, 14.6% and 29.8% of patients were in the stages of contemplation, preparation and action, respectively. Patients with a higher score in diet knowledge and skills and diet decision making were more likely to be involved in the action stage of weight loss process, while those who had more eating problems and exercise barriers were less likely to be involved in the action stage of weight loss.

CONCLUSION

The results of this study showed that a substantial percentage of patients are at the pre-contemplation stage, so proper measures are needed to inform patients about the consequences of obesity and overweight. It is also necessary to focus on people with poor incomes and education status and those living in rural areas. Improve diet knowledge and skills and diet decision making and the reduction of barriers to exercise can help patients to take action to lose weight.

Readiness for diet change and its association with diet knowledge and skills, diet decision making and diet barriers in type 2 diabetic patients

AIMS

to investigate stages of change for dietary in type 2 diabetics and its associations with diet knowledge and skills, diet decision making and diet barriers.

MATERIALS AND METHODS

This was a cross-sectional study which was conducted on 1139 diabetics aged>18 years in East Azerbaijan, Iran. Data were collected through a Personal Diabetes Questionnaire (PDQ) and analyzed through SPSS version 22 software using descriptive statistics, Chi-square and one-way ANOVA tests. Tukey's HSD post hoc tests were applied to illustrate ANOVA findings.

RESULTS

59.3% of patients do not follow a diet plan to control their blood glucose. 44.7%, 5.5%, 13%, and 36.8% of patients, respectively, were in the stages of pre-contemplation, contemplation, preparation and action. Patients who had shorter disease duration and those whose current treatment was lifestyle change were more likely within the action stage. Also, patients who had a higher score in diet knowledge and skills and diet decision making and those who had a lower score in diet barriers were more likely in the action stage of change.

CONCLUSION

Based on the results of this study, a considerable proportion of diabetic patients were in the pre-contemplation stage. Diet knowledge and skills, diet decision making and diet barriers were factors contributing to diet readiness to change. Therefore, taking necessary measures to increase diet knowledge, skills and diet decision-making and a reduction in diet barriers can help people with type 2 diabetes to change diet.

Phone-based motivational interviewing to increase self-efficacy in individuals with phenylketonuria

OBJECTIVE

To measure change in patient activation and self-efficacy in individuals with phenylketonuria (PKU) before and after a 6-month phone-based motivational interviewing (MI) intervention and determine the feasibility of implementing dietary counseling for PKU using an MI approach.

METHODS

Participants (n = 31) included preadolescents (7-12 years), adolescents (13-17 years), and adults (18-35 years) with early-treated PKU. Participants completed online questionnaires assessing self-reported stage of change (SOC), patient activation, and self-efficacy for PKU self-management behaviors. The intervention included monthly phone-based dietary counseling using MI during which participants set monthly goals.

RESULTS

Patient activation and self-efficacy were significantly different by age group (both p < 0.01) with higher scores in older participants. Self-efficacy significantly increased from baseline to month 6 among adolescents and adults (7.4 ± 1.9 and 8.6 ± 1.3, respectively, p = 0.002). Preadolescents did not have a significant change in self-efficacy (p = 0.79). There was no increase in patient activation for preadolescents or adolescents/adults (p = 0.19 and p = 0.24, respectively). Indicators of learning problems were not significantly associated with self-efficacy (p = 0.33) or patient activation (p = 0.83).

CONCLUSION

These results demonstrate the feasibility of implementing phone-based dietary counseling for PKU using MI. This study also supports further investigation of MI as an intervention approach to improving self-efficacy and self-management behaviors in adolescents and adults with PKU.

Higher Motivation for Weight Loss in African American than Caucasian Rural Patients with Hypertension and/or Diabetes

OBJECTIVE

To examine the relationship between race/ethnicity and motivation for weight loss and motivation for exercise among patients with chronic disease.

DESIGN

Cross-sectional.

SETTING

Our study took place within a network of federally qualified health centers (FQHCs) in the rural southern United States.

PATIENTS OR PARTICIPANTS

463 active FQHC patients with diabetes and/or hypertension identifying as African American, White Hispanic, or non-Hispanic White participated in our study.

MAIN OUTCOME MEASURES

Primary outcomes were assessed using standardized measures of motivation for a) weight loss; and b) hypertension per the Transtheoretical Model.

RESULTS

Multivariate logistic regression revealed that, when controlling for age, sex, education status, employment status, poverty, comorbidity, and weight status, there were no significant differences in motivation for exercise among the different racial/ethnic groups (P=.361). However, when controlling for the same factors, there was a significant difference in motivation for weight loss, with African American participants more than twice as likely as non-Hispanic White participants to be motivated to lose weight (ORADJ = 2.430, P=.002).

CONCLUSIONS

Our study suggests that, among rural patients with obesity-related chronic disease, there is a significant variation in motivation to lose weight between racial/ethnic groups. This underscores the importance of culturally tailoring interventions and in considering motivation for change when promoting weight loss behaviors. Additional implications for intervention development and delivery are discussed.

Stages of change for physical activity and dietary habits in persons with type 2 diabetes included in a mobile health intervention: the Norwegian study in RENEWING HEALTH

OBJECTIVE

The aim of this study was to investigate stages of change for physical activity and dietary habits using baseline data from persons with type 2 diabetes included in a mobile health intervention. We examined the associations between stages of change for physical activity change and dietary change, and between stages of change for each behavior and individual characteristics, health-related quality of life, self-management, depressive symptoms, and lifestyle.

RESEARCH DESIGN AND METHODS

We examined 151 persons with type 2 diabetes with an glycated hemoglobin (HbA1c) level ≥7.1%, aged ≥18 years at baseline of a randomized controlled trial, before testing a mobile app with or without health counseling. Stages of change were dichotomized into 'pre-action' and 'action'. Self-management was measured using the Health Education Impact Questionnaire (heiQ) where a higher score reflects increased self-management, and health-related quality of life was measured with the Short-Form-36 (SF-36). Logistic regression modeling was performed.

RESULTS

The median HbA1c level was 7.9% (7.1-12.4), 90% were overweight or obese, and 20% had ≥3 comorbidities. 58% were in the preaction stage for physical activity change and 79% in the preaction stage for dietary change. Higher scores of self-management were associated with an increased chance of being in the action stage for both dietary change and physical activity change. Higher body mass index was associated with an 8% reduced chance of being in the action stage for physical activity change (OR 0.92, 95% CI 0.86 to 0.99).

CONCLUSIONS

Being in the action stage was associated with higher scores of self-management, crucial for type 2 diabetes. Over half of the participants were in the preaction stage for physical activity and dietary change, and many had a high disease burden with comorbidities and overweight.

TRIAL REGISTRATION NUMBER

NCT01315756.

Diet self-management and readiness to change in underserved adults with type 2 diabetes

AIM

Dietary assessment in diabetes may be enhanced by considering patient-centered perspectives and barriers to change within IDF guidelines. Consideration of readiness to change (RTC) diet in underserved samples may guide future interventions in high risk populations. This study assesses the utility of a rapid assessment of RTC diet in a medically underserved sample.

METHOD

Participants were 253 Black (43.7%) and White (55.1%) American adults with type 2 diabetes [M age=57.93 (11.52); 60.5% female; 19% below the US poverty threshold]. Participants were recruited at medical clinics and completed validated self-report measures assessing diabetes knowledge, self-efficacy and dietary behaviors and barriers by RTC.

RESULTS

Stage-based comparisons identified significant differences in diabetes and dietary domains: participants in the Action stage endorsed fewer behavioral dietary barriers (p<.001), more frequent dietary problem-solving (p<.001), and greater diabetes self-efficacy (p<.001) than participants in the Contemplation and Preparation stages. Women were more likely to be in the Preparation stage and beyond (p<.05).

CONCLUSIONS

Findings highlight the clinical utility of a brief measure of RTC in understanding patient perspectives toward dietary behaviors in a medically underserved sample. The impact of gender on RTC diet warrants further exploration.

Introducing a new measure for assessing self-efficacy in response to air pollution hazards for pregnant women

A self-efficacy instrument should be condition-specific. There are several instruments for measuring self-efficacy, but none are air pollution-specific. This study aimed to develop a self-efficacy measure for assessing pregnant women's responses to air pollution hazards. A random sample of pregnant women aged between 18 and 35 years attending three prenatal care centers were entered into the study. Prenatal care centers randomly selected from a list of centers located in different geographical regions of Tehran, Iran. After careful consideration and performing content and face validity, a 4-item measure was developed and participants completed the questionnaire. Reliability was estimated using internal consistency and validity was assessed by performing confirmatory factor analysis (CFA) and known group comparison. In all 200 eligible pregnant women were studied. The mean age of participants was 26.9 (SD = 4.8) years and it was 27.9 (SD = 9.1) weeks for gestational age. The findings showed almost perfect results for both content validity ratio (CVR = 1) and content validity index (CVI = 1). The confirmatory factor analysis indicated a good fit to the data, and known group comparison revealed satisfying results. Internal consistency as measured by the Cronbach's alpha coefficient was found to be 0.74. In general, the findings suggest that this new generated scale is a reliable and valid specific measure of self-efficacy in response to air pollution hazards for pregnant women. However, further studies are needed to establish stronger psychometric properties for the questionnaire.