Perception and utilization of social support in diabetic control

Family resilience and its predictors among patients with a first-ever stroke one month after stroke: a cross-sectional study

BACKGROUND

Understanding post-stroke family resilience would be helpful for healthcare professionals in planning interventions to facilitate family adaptation following stroke onset.

OBJECTIVE

To investigate the level of family resilience and its predictors among patients with the first stroke.

DESIGN

An explorative cross-sectional study.

METHODS

The study was conducted on 288 first stroke patients recruited from 7 tertiary hospitals in China between July 2020 and October 2020, and they were followed up one month after stroke. Data were collected using the Medical Coping Modes Questionnaire, Self-efficacy for Managing Chronic Disease 6-item Scale, shortened Chinese version of Family Resilience Assessment Scale, and the Social Support Rating Scale. The predictive variables of family resilience were investigated using hierarchical regression analyses.

RESULTS

A total of 255 patients finished the survey with a response rate of 88.5%. The mean score of family resilience was 96.19 (SD = 9.87), highest in the dimension of maintaining a positive outlook and lowest in utilizing social resources. Patient subjective support (β = 0.22, P = 0.004), social support utilization (β = 0.13, P = 0.027), self-efficacy for managing disease (β = 0.27, P < 0.001), marriage status (divorced vs married)(β=-0.18, P = 0.002), and caregivers' relationship with patients (siblings vs spouse)(β=-0.18, P = 0.002) were predictors of family resilience.

CONCLUSION

Family resilience was low among stroke patients one month after the onset. Special attention should be paid to families of patients who were divorced, cared for by siblings, or have low social support or self-efficacy in managing stroke. Further research on family-based interventions may focus on increasing patient social support and promoting their self-efficacy in managing stroke.

Analyzing Online Social Support Within the Type 1 Diabetes Community

Social support has been linked with many health outcomes, ranging from heart disease to depression. Although its importance has been recognized, less is known about how individuals with chronic illnesses may use social media to provide and seek social support. This chapter's focus is on the way in which people with Type 1 diabetes (T1D) use social media to provide and solicit social support. A mixed-methods approach is utilized. First, posts from two social media platforms were qualitatively content analyzed. Second, the data were quantitatively analyzed to provide a finer-grained understanding of the messages. The results show informational support as the most prevalent on both sites, although there are some differences in content and use. This chapter's implications highlight the importance of social media as a conduit for social support among caregivers and individuals affected by T1D.

Predictors of Empowerment in Individuals With Type 2 Diabetes Mellitus

Introduction: Type 2 diabetes is a chronic, progressive disease that has reached pandemic proportions. In Turkey, the frequency of diabetes in individuals aged 20 years or older has been reported to be 13.7% compared with the worldwide prevalence of 8.5%. Empowerment has been correlated with improvement in diabetic self-management capabilities and glycemic control. The purpose of this study was to examine predictors of “empowerment” in individuals with type 2 diabetes from Turkey. Method: This was a secondary analysis with a cross-sectional correlation design using stepwise linear regression to evaluate previously collected data from 220 type 2 diabetic individuals in Turkey from January through July 2014. Demographic and Disease-Related Information Form, Diabetes Empowerment Scale, and Multidimensional Scale of Perceived Social Support were used to collect the research data. Results: Being educated about diabetes (β = .22, p < .001), high school (β = .16, p = .007), university (β = .12, p = .046), age (β = −.18, p = .003), social support (β = .15, p = .027), employment status (β = .13, p = .045), and A1C (β = −.12, p = .046) were statistically significant predictors of empowerment of type 2 diabetic individuals, and these variables explained 30% of the common variance. Discussion: It is important for nurses to assess sources of social support and integrate the results of this assessment to ensure the empowerment of the patient during diabetes education. For the empowerment of diabetic individuals, attempts should be made to increase the diabetes literacy levels of diabetic individuals who have low level of education and who are in the older age group, and patients who can get employed could be directed to work life.

Association of Social Support and Medication Adherence in Chinese Patients with Type 2 Diabetes Mellitus

The prevalence of diabetes is steadily increasing in China. When diabetes is uncontrolled, it generates dire consequences for health and well-being. Numerous studies have shown that health outcomes were associated with social support and medication adherence. Previous study confirmed that social support was associated with medication adherence in patients with heart failure, HIV diseases, and first-episode psychosis. However, the relationship between social support and medication adherence in patients with type 2 diabetes mellitus (T2DM) is remains unclear. This study aims to examine whether social support is associated with medication adherence in patients with T2DM. This study was conducted in the First Affiliated Hospital of the General Hospital of the People’s Liberation Army (PLA). In Beijing, a systematic random sample of 412 patients with T2DM over 18 years was recruited at baseline, and demographic characteristics, clinical data and their assessment of social support were collected from medical records and self-reported questionnaires. 330 of these patients completed a self-report measure of medication adherence at the sixth month after baseline data collection. Regression analysis showed that social support presented a positive effect on medication adherence, additionally, support utilization and the subscale of social support exhibited a significantly strong influence on medication adherence in patients with T2DM. Although medication adherence was influenced by multiple factors, this finding confirmed that social support must be recognized as a core element in interventions aimed at improving in the management of patients with T2DM.

Glucose and Cardiac Risk Factor Control in Individuals With Type 2 Diabetes

Purpose

The purpose of this descriptive study was to describe attainment of glucose and coronary heart disease (CHD) risk factor goals and to identify factors that were associated with successful goal achievement.

Methods

A cross-sectional survey enrolled 110 subjects with type 2 diabetes undergoing screening for asymptomatic myocardial ischemia.

Results

Many participants had HbA1c levels ≥7% (45%), and 46% to 79% were not meeting goals for CHD risk reduction. Individual factors of age, gender, and anxiety; the illness-related factor of lipid-lowering therapy; and the family-related factor of living alone were independently associated with 1 of the 7 outcomes under study. Illness-related factors of a longer duration of diabetes were strongly associated with glucose and blood pressure control, insulin use with glucose control and waist circumference, and antihypertensive use with blood pressure, triglycerides, and body mass index. Family-related factors of higher income were significantly associated with poorer glucose control and higher body mass index, while higher levels of perceived support by family and friends were associated with a lower risk of not meeting lipid goals. However, individual factors, represented by several aspects of personal model beliefs (exercising regularly, testing glucose, and checking one’s feet) and physical activity, were consistently related to lipid and weight control.

Conclusions

A variety of factors were associated with control of blood glucose and CHD risk factors, suggesting that a one-size-fits-all approach to multiple risk factor reduction efforts may not result in goal attainment.

Social Support and Mortality Among Older Persons With Diabetes

PURPOSE

The purpose of this study was to examine the relationship between social support and mortality among older persons with diabetes and the pathways by which social support affects diabetes survival.

METHODS

Using data from the Longitudinal Study of Aging cohort 2 baseline (1994) and follow-up (1997-1998 and 1999-2000 surveys), the authors identified 1431 persons aged >or=70 years with diabetes, among whom 387 deaths occurred. Social support was measured by an index with regard to participants' connection with relatives, friends, neighbors, social events, church, and senior centers. Regression analysis was used to find the pathway, and survival analysis was used to find the relationship between social support and mortality.

RESULTS

Compared to people with a low level of social support, the risk of death is 41% lower among people with medium levels of support (hazards ratio = 0.59, 0.39-0.91) and 55% lower among those with the highest levels of support (hazards ratio = 0.45, 0.21-0.98). Eight of the 11 regression models demonstrated that the effect of social support on mortality was mediated by both physical and mental health status.

CONCLUSIONS

Social support is strongly associated with mortality. Based on findings from this study, social support should be considered an important target for intervention to reduce mortality risk among older adults with diabetes.

Social support and glycemic control in adult patients with type 2 diabetes mellitus

INTRODUCTION

The purpose of this study is to examine the prevalence of social support and its association with glycemic control in patients with type 2 diabetes mellitus (T2D) in an urban primary care center within an academic institution. Social support is important in the management of chronic diseases. However, its association with glycemic control has been controversial.

METHODS

This was part of a study examining religiosity in T2D patients. Nonsmoking patients with T2D for at least 3 years and aged 30 years and above were recruited. Social support was measured using The Social Support Survey-Medical Outcomes Study (SS), a self-administered questionnaire; the scores range from 19 to 95, and a high score indicates better social support. Glycemic control was measured using the 3 most recent glycosylated hemoglobin (HbA1c) levels within the past 3 years.

RESULTS

A total of 175 participants completed the SS survey (response rate 79.0%). The mean age was 62.7 (standard deviation [SD] = 10.8) years, and the mean duration of diabetes was 11.74 (SD = 6.7) years. The mean HbA1c level was 8.15 (SD = 1.44). The mean SS score was 68.1. The prevalence of high and low social support were 29.7% and 24.0 %, respectively. A significant correlation was found between SS score and number of social supporters (n = 167). No significant correlation was found between the self-reported number of social supporters or the SS score and the mean HbA1c level.

CONCLUSIONS

Social support was not associated with glycemic control in adult patients with T2D in this primary care setting.

Self-care activities and glycated haemoglobin in Iranian patients with type 2 diabetes: can coping styles and social support have a buffering role?

BACKGROUND

Diabetes self-care is a key element in the overall management of diabetes. However, the importance of psychosocial factors for successful disease management is under investigated. This study aimed at exploring the role of coping styles and social support in the relationship between self-care activities and glycated haemoglobin in patients with type 2 diabetes.

METHODS

One hundred adults (60% female, aged 40-70 years) with type 2 diabetes completed questionnaires assessing self-care activities, coping styles and social support. In addition, a blood test was performed to obtain glycated haemoglobin levels.

RESULTS

Result showed significant relationships of glycated haemoglobin with self-care activities, coping styles and social support. Regression analysis indicated that social support had a moderating role on the relationship between self-care activities and glycated haemoglobin, such that, at very high levels of social support the association, between Self-Care and HbA1c disappears.

CONCLUSIONS

Findings indicate that health care providers, within the context of the Iranian social and cultural situation, should pay more attention to psychosocial factors when addressing self-care activities. Delineation of the role of coping styles and social support might be useful for identifying patients in need of particular counselling and support for improving self-care activities and HbA1c levels.

Challenges and Lessons Learned in the Development and Implementation of a Couples-Focused Telephone Intervention for Adults with Type 2 Diabetes: The Diabetes Support Project

BACKGROUND: Type 2 diabetes (T2DM) studies report that marital/family support relates to glycemic control, adherence and quality-of-life. Yet, there are few reports of couples-focused interventions. PURPOSE: To describe the challenges faced and lessons learned in the implementation of a theoretically-based, couples intervention. METHODS: 350 couples (one partner has T2DM in poor glycemic control) are randomized to a couples intervention, individual intervention, or enhanced usual care. All contacts are by telephone, to increase reach. OUTCOMES: medical (e.g. glycemic control), psychosocial (e.g. diabetes distress), and behavioral (e.g. regimen adherence). Challenges in recruitment, assessment and intervention with couples are described, with suggestions about how to address them. RESULTS: Findings concerning the efficacy and cost-effectiveness of the couples intervention, its effect on partners, and possible mechanisms of demonstrated changes, are anticipated in 2013. CONCLUSIONS: Interventionists need specific skills to work with couples to promote communal coping and increase the likelihood of an efficacious couples intervention.

Levels of acculturation and effect on glycemic control in Mexicans and Mexican Americans with type 2 diabetes

BACKGROUND

Acculturation of Mexican Americans toward the predominant American culture has been shown to influence health outcomes. Little is known about the role of acculturation in diabetes control.

OBJECTIVE

To measure the association between acculturation and diabetes control in Mexicans and Mexican Americans with type 2 diabetes mellitus (T2DM).

DESIGN

Cross-sectional survey and chart review.

SETTING

Ambulatory family medicine clinics.

PATIENTS

Sixty-six Mexican and Mexican American adults with T2DM for ≥ 1 year. INSTRUMENT AND OUTCOMES: A survey tool was developed that included the General Acculturation Index developed by Balcazar et al to measure acculturation. Basic demographics, psychosocial factors, patient satisfaction, and patients' most recent hemoglobin A(1c) (HbA(1c)) levels were also obtained.

RESULTS

There was no significant correlation between acculturation score and HbA(1c) levels. On binary logistic regression, HbA(1c) levels were associated with patient satisfaction in having their questions answered (odds ratio [OR], 0.44; P < 0.05), interference of diabetes with daily life (OR, 1.4; P < 0.05), male gender (OR, 3.93; P < 0.01), and number of diabetes complications (OR, 1.81; P < 0.05). In the multivariate linear regression model, age (beta, -0.348; P < 0.05) and frequency of physician visits (beta, -0.403; P < 0.05) were the only variables significantly associated with glycemic control. Variables included in the model that were not associated with glycemic control include family history of diabetes and confidence in diabetes treatment efficacy.

CONCLUSIONS

Acculturation was not associated with glycemic control in this population. Family physicians should not assume that acculturation difficulties explain poor glycemic control in their Mexican American patients with T2DM.

Relationship styles and mortality in patients with diabetes

OBJECTIVE Prior research has shown that less social support is associated with increased mortality in individuals with chronic illnesses. We set out to determine whether lower propensity to seek support as indicated by relationship style, based on attachment theory, is associated with mortality in patients with diabetes. RESEARCH DESIGN AND METHODS A total of 3,535 nondepressed adult patients with type 1 and type 2 diabetes enrolled in a health maintenance organization in Washington State were surveyed at baseline and followed for 5 years. Relationship style was assessed at baseline. Patients with a greater propensity to seek support were classified as having an interactive relationship style and those less inclined to seek support as having an independent relationship style. We collected Washington State mortality data and used Cox proportional hazards models to estimate relative risk (RR) of death for relationship style groups. RESULTS The rate of death in the independent and interactive relationship style groups was 39 and 29 per 1,000 individuals, respectively. Unadjusted RR of death was 1.33 (95% CI 1.12-1.58), indicating an increased risk of death among individuals with an independent relationship style. After adjustment for demographic and clinical covariates, those with an independent relationship style still had a greater risk of death compared with those with an interactive relationship style (hazard ratio 1.20 [95% CI 1.01-1.43]). CONCLUSIONS In a large sample of adult patients with diabetes, a lower propensity to reach out to others is associated with higher mortality over 5 years. Further research is needed to examine possible mechanisms for this relationship and to develop appropriate interventions.

Ethnic and gender differences in psychosocial factors, glycemic control, and quality of life among adult type 2 diabetic patients

OBJECTIVE

To examine ethnic and gender differences in psychosocial factors, e.g., social support and acceptance of the disease, knowledge levels, perceived difficulty in adherence behaviors, and diabetes outcome (glycemic control and quality of life) in Type 2 diabetic patients.

METHODS

Data were collected via telephone interviews from 180 diabetic subjects (34% Hispanics, 27% Non-Hispanic whites, 18% African-Americans, and 20% Asian-Indians; 52% females) from 2 clinics. Hemoglobin A1c levels were obtained from patient charts.

RESULTS

Significant ethnic and gender differences existed in acceptance of the disease, in receiving social support, disease knowledge, perceived difficulty in self-management behaviors, glycemic control, and quality of life among Type 2 diabetic patients; differences were more pronounced by gender than by ethnicity. In general, social support and acceptance of the disease were high. However, perceived difficulty in self-management behaviors varied by racial/ethnic groups with self-monitoring of blood glucose perceived as most difficult by Hispanic respondents, dietary management was most difficult for non-Hispanic whites, while physical activity was the most difficult for African-Americans. Hispanic respondents had greatest severity of the disease (poorest metabolic control).

CONCLUSIONS

Ethnic and gender variations exist in social support, acceptance of diabetes, quality of life, and adherence behaviors. The outcomes of diabetes care can be improved if practitioners factor these differences in tailoring diabetes education and supportive care for individuals with Type 2 diabetes.

Predictors of quality of life among adults with type 2 diabetes mellitus

Using a path model, this study examined the relationships among psychosocial factors (social support and acceptance of diabetes), knowledge of the disease, perceived difficulty of self-care behaviors (SCBs), and disease outcome [quality of life (QoL)] among 180 adults with type 2 diabetes mellitus. In general, respondents exhibited high levels of acceptance. The hypothesis that higher levels of social support and acceptance lead to lower perceived difficulty with SCBs was supported. High levels of social support increased acceptance and reduced SCBs. Knowledge reduced SCBs but was not associated with QoL. In the path model, SCBs influenced QoL and mediated the relationship between social support, acceptance, and QoL.

Assessment of two culturally competent diabetes education methods: individual versus individual plus group education in Canadian Portuguese adults with type 2 diabetes

OBJECTIVE

To examine the impact of two culturally competent diabetes education methods, individual counselling and individual counselling in conjunction with group education, on nutrition adherence and glycemic control in Portuguese Canadian adults with type 2 diabetes over a three-month period.

DESIGN

The Diabetes Education Centre is located in the urban multicultural city of Toronto, Ontario, Canada. We used a three-month randomized controlled trial design. Eligible Portuguese-speaking adults with type 2 diabetes were randomly assigned to receive either diabetes education counselling only (control group) or counselling in conjunction with group education (intervention group). Of the 61 patients who completed the study, 36 were in the counselling only and 25 in the counselling with group education intervention. We used a per-protocol analysis to examine the efficacy of the two educational approaches on nutrition adherence and glycemic control; paired t-tests to compare results within groups and analysis of covariance (ACOVA) to compare outcomes between groups adjusting for baseline measures. The Theory of Planned Behaviour was used to describe the behavioural mechanisms that influenced nutrition adherence.

RESULTS

Attitudes, subjective norms, perceived behaviour control, and intentions towards nutrition adherence, self-reported nutrition adherence and glycemic control significantly improved in both groups, over the three-month study period. Yet, those receiving individual counselling with group education showed greater improvement in all measures with the exception of glycemic control, where no significant difference was found between the two groups at three months.

CONCLUSIONS

Our study findings provide preliminary evidence that culturally competent group education in conjunction with individual counselling may be more efficacious in shaping eating behaviours than individual counselling alone for Canadian Portuguese adults with type 2 diabetes. However, larger longitudinal studies are needed to determine the most efficacious education method to sustain long-term nutrition adherence and glycemic control.

Prospective study on influence of psychosocial factors on glycemic control in Japanese patients with type 2 diabetes

The authors prospectively assessed the causal relationship between psychosocial factors and glycemic control in 256 Japanese outpatients with Type 2 diabetes. Using structural-equation modeling, they first developed a causal model in which glycosylated hemoglobin (HbA(1c)) at 6 months after assessment was influenced by the baseline psychosocial factors. Then, the reliability of the causal model was investigated with measurement of HbA(1c) at 12 months after baseline. Self-efficacy directly reinforced adherence, and adherence had a direct association with future HbA(1c). Other psychosocial factors, including social support, diabetes-related distress, daily burden, and emotion-focused coping prospectively influenced HbA(1c) indirectly through self-efficacy.

Psychosocial predictors of relapse among diabetes patients: a 2-year follow-up after inpatient diabetes education

In a 2-year follow-up study of diabetes patients (N=309) who received 2 weeks of inpatient diabetes education, the authors investigate the relationship of several demographic, clinical, and psychosocial factors with relapse, defined as the worsening of glycemic control. The patients with no improvement in glycemic control after diabetes education were more likely to have higher scores on the depression subscale of the Profile of Mood States, compared to the patients with improvement. Kaplan-Meier survival analyses showed that patients who had no prior diabetes education, whose meals were prepared by their spouses, and who had less social support were more likely to relapse and relapsed within a significantly shorter period of time than those who had prior diabetes education, cooked for themselves, and had more social support.