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Villaécija J, Luque B, Castillo-Mayén R, Farhane-Medina NZ, Tabernero C. Influence of Family Social Support and Diabetes Self-Efficacy on the Emotional Wellbeing of Children and Adolescents with Type 1 Diabetes: A Longitudinal Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1196. [PMID: 37508693 PMCID: PMC10377974 DOI: 10.3390/children10071196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
Type 1 diabetes (T1D) is a chronic disease that is usually diagnosed in childhood, underscoring the importance of early disease control for overall wellbeing. Our aim was to design an explanatory model of subjective emotional wellbeing in children and adolescents with T1D. A longitudinal study was conducted at the Reina Sofia University Hospital in Cordoba (Spain). A total of 151 patients (mean age = 14.50, SD = 2.67; 41.1% girls) participated at T1, while 97 participated at T2 (mean age = 14.93, SD = 2.56; 39.2% girls). Participants completed a self-report questionnaire. Descriptive, reliability, correlation, path, and mediation analyses were performed. The explanatory model showed excellent fit indices [χ2 (10) = 8.62, p = 0.57, RMSEA = 0.00, 95% [0.00, 0.10], CFI = 1.00, GFI = 0.98, AGFI = 0.93, and TLI = 1.01]. The results showed significant and positive relationships between family social support and subjective emotional wellbeing and improved self-care skills. Self-efficacy presented a mediating role between family social support and subjective emotional wellbeing. Given that self-efficacy is a self-regulatory mechanism and a determinant of health, it is argued that future psychoeducational interventions could aim to improve self-efficacy to manage chronic diseases, to achieve greater emotional wellbeing in children and adolescents with T1D.
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Affiliation(s)
- Joaquín Villaécija
- Department of Psychology, University of Cordoba, 14071 Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Bárbara Luque
- Department of Psychology, University of Cordoba, 14071 Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Rosario Castillo-Mayén
- Department of Psychology, University of Cordoba, 14071 Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Naima Z Farhane-Medina
- Department of Psychology, University of Cordoba, 14071 Cordoba, Spain
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
| | - Carmen Tabernero
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Cordoba, Spain
- Instituto de Neurociencias de Castilla y León (INCYL), University of Salamanca, 37007 Salamanca, Spain
- Department of Social Psychology and Anthropology, University of Salamanca, 37005 Salamanca, Spain
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Zhang A, Wang J, Wan X, Guo Z, Zhang Z, Zhao S, Bai S, Miao Y, Zhang J. The mediating effect of self-efficacy on the relationship between diabetes self-management ability and patient activation in older adults with type 2 diabetes. Geriatr Nurs 2023; 51:136-142. [PMID: 36940508 DOI: 10.1016/j.gerinurse.2023.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the level of diabetes self-management ability in older patients with type 2 diabetes and analyse its relationship with patient activation. Besides, the mediating effect of self-efficacy on the relationship between the two was assessed in the study. METHODS Using a cross-sectional design, 200 elderly patients with type 2 diabetes were recruited from the community of Yangzhou, China. The Patient Activation Measure (PAM), The Self-efficacy for Diabetes (SED), and The Summary of Diabetes Self-Care Activities Measure (SDSCA) were used in the questionnaires. Data analysis was performed using SPSS 27.0 and PROCESS macro. RESULTS Pearson correlation analysis revealed a significant positive correlation (p< 0.01) between diabetes self-management ability and patient activation (r=0.312) and self-efficacy (r=0.367). Self-efficacy partially mediated the effect between patient activation and self-management ability in older patients with type 2 diabetes, and the mediating effect accounted for 49.33% of the total effect (p< 0.001). CONCLUSIONS Older patients with type 2 diabetes in the community have a moderate level of self-management ability. Patient activation can improve patients' self-management ability through self-efficacy.
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Affiliation(s)
- Anqi Zhang
- The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225003, Jiangsu, China; School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Jinsong Wang
- The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou 225003, Jiangsu, China; School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China; Yangzhou Commission of Health, Yangzhou 225012, Jiangsu, China.
| | - Xiaojuan Wan
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Zihe Guo
- Yangzhou Commission of Health, Yangzhou 225012, Jiangsu, China
| | - Ziyi Zhang
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Shuhan Zhao
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Shuo Bai
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Yamin Miao
- School of Nursing and Public Health, Yangzhou University, Yangzhou 225009, Jiangsu, China
| | - Jing Zhang
- Yangzhou Commission of Health, Yangzhou 225012, Jiangsu, China
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Irwin A, Igudesman D, Crandell J, Kichler JC, Kahkoska AR, Burger K, Zaharieva DP, Addala A, Mayer-Davis EJ. Mindfulness, disordered eating, and impulsivity in relation to glycemia among adolescents with type 1 diabetes and suboptimal glycemia from the Flexible Lifestyles Empowering Change (FLEX) intervention trial. Pediatr Diabetes 2022; 23:516-526. [PMID: 35297136 PMCID: PMC9268578 DOI: 10.1111/pedi.13334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the relationship between mindfulness and glycemia among adolescents with type 1 diabetes (T1D) with suboptimal glycemia, and evaluate the potential mediation by ingestive behaviors, including disordered eating, and impulsivity. RESEARCH DESIGN AND METHODS We used linear mixed models for hemoglobin A1c (HbA1c) and linear regression for continuous glucose monitoring (CGM) to study the relationship of mindfulness [Child and Adolescent Mindfulness Measure (CAMM)] and glycemia in adolescents with T1D from the 18-month Flexible Lifestyles Empowering Change (FLEX) trial. We tested for mediation of the mindfulness-glycemia relationship by ingestive behaviors, including disordered eating (Diabetes Eating Problem Survey-Revised), restrained eating, and emotional eating (Dutch Eating Behavior Questionnaire); and impulsivity (total, attentional, and motor, Barrett Impulsiveness Scale). RESULTS At baseline, participants (n = 152) had a mean age of 14.9 ± 1.1 years and HbA1c of 9.4 ± 1.2% [79 ± 13 mmol/mol]. The majority of adolescents were non-Hispanic white (83.6%), 50.7% were female, and 73.0% used insulin pumps. From adjusted mixed models, a 5-point increase in mindfulness scores was associated with a -0.19% (95%CI -0.29, -0.08, p = 0.0006) reduction in HbA1c. We did not find statistically significant associations between mindfulness and CGM metrics. Mediation of the relationship between mindfulness and HbA1c by ingestive behaviors and impulsivity was not found to be statistically significant. CONCLUSIONS Among adolescents with T1D and suboptimal glycemia, increased mindfulness was associated with lower HbA1c levels. Future studies may consider mindfulness-based interventions as a component of treatment for improving glycemia among adolescents with T1D, though more data are needed to assess feasibility and efficacy.
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Affiliation(s)
- Ashley Irwin
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Daria Igudesman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Jamie Crandell
- Department of Biostatistics and School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | | | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Kyle Burger
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Dessi P. Zaharieva
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, CA 94305
| | - Ananta Addala
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, CA 94305
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
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van Herpen-Meeuwissen LJM, van Onzenoort HAW, van den Bemt PMLA, Maat B, van den Bemt BJF. The Effect of Self-Administration of Medication During Hospitalization on Patient's Self-Efficacy and Medication Adherence After Discharge. Patient Prefer Adherence 2022; 16:2683-2693. [PMID: 36196066 PMCID: PMC9527028 DOI: 10.2147/ppa.s375295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The effect of self-administration of medication (SAM), in which capable hospitalized patients administer medication themselves on medication self-efficacy is inconclusive. The aim of this study was to evaluate the effect of SAM on medication self-efficacy, adherence and patient satisfaction. PATIENTS AND METHODS A prospective pre-post intervention study on the orthopedic ward of the Sint Maartenskliniek (Nijmegen) was conducted from January 2020 to July 2021. All adults admitted to this ward were eligible for participation. The primary outcome was the level of medication self-efficacy measured by the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) one week after discharge. Secondary outcomes were SEAMS-score three months after hospitalization, medication adherence measured by the Medication Adherence Rating Scale (MARS) one week and three months after hospitalization and patient satisfaction expressed on a five-point Likert scale in patients who experienced SAM. The differences in median SEAMS-scores and non-adherence pre- versus post-implementation of SAM were statistically analyzed. Patients' agreement regarding satisfaction with SAM was calculated as proportion per Likert scale answer. RESULTS Of the 197 patients participating in the study, 96 were included pre- and 101 post-implementation of SAM. Median SEAMS-scores one week after discharge were 35 [IQR 31-38] and 34 [IQR 30-36] pre- and post-intervention respectively (p = 0.08). There was no difference in the proportion of non-adherent patients at one week and three months after discharge pre- and post-intervention, 52.4%, 53.2%, 57.9% and 64.4% respectively. Of the patients that experienced SAM 32% agreed and 49% strongly agreed that they would like to self-manage medication again during a future hospitalization. CONCLUSION In this orthopedic population with high medication self-efficacy scores at discharge, SAM did not affect patients' medication self-efficacy nor medication adherence after hospitalization. Most patients preferred SAM. Additional studies should focus on the effect of SAM in other patient populations.
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Affiliation(s)
- Loes J M van Herpen-Meeuwissen
- Department of Pharmacy, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Pharmacy, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
- Correspondence: Loes JM van Herpen-Meeuwissen, Department of Pharmacy, Radboud University Medical Centre, PO Box 9101, Nijmegen, the Netherlands, Tel +31 624 3617744, Email
| | - Hein A W van Onzenoort
- Department of Pharmacy, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Patricia M L A van den Bemt
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Barbara Maat
- Department of Pharmacy, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
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