Diabetes self-management and its associated factors among patients with diabetes in central Vietnam: A cross-sectional study

"Obviously, Nothing's Gonna Happen in Five Minutes": How Adolescents and Young Adults Infrastructure Resources to Learn Type 1 Diabetes Management

Learning personalized self-management routines is pivotal for people with type 1 diabetes (T1D), particularly early in diagnosis. Context-aware technologies, such as hybrid closed-loop (HCL) insulin pumps, are important tools for diabetes self-management. However, clinicians have observed that practices using these technologies involve significant individual differences. We conducted interviews with 20 adolescents and young adults who use HCL insulin pump systems for managing T1D, and we found that these individuals leverage both technological and non-technological means to maintain situational awareness about their condition. We discuss how these practices serve to infrastructure their self-management routines, including medical treatment, diet, and glucose measurement-monitoring routines. Our study provides insights into adolescents' and young adults' lived experiences of using HCL systems and related technology to manage diabetes, and contributes to a more nuanced understanding of how the HCI community can support the contextualized management of diabetes through technology design.

Adaptation and measurement invariance of the 13-item version of Patient Activation Measure across Japanese young adult cancer survivors during and after treatment: A cross-sectional observational study

The 13-item version of the Patient Activation Measure (PAM-13) is a frequently used measure that gauges the level of self-management in an individual. However, its applicability across Japanese young adult (YA) cancer survivors during and after their treatment remains unclear. This study confirmed the psychometric properties and measurement invariance of the Japanese version of PAM-13 across them during and after treatment. We used cross-sectional observational data collected through an online survey from 500 survivors in January 2022. We determined feasibility, internal consistency, concurrent validity against physical fatigue and depression, and known-groups validity regarding educational level. Structural validity was also found using Rasch analysis for survivors both during and after treatment. Furthermore, measurement invariance of the PAM-13 was examined using multiple-group structural equation modeling. Rasch fit statistics were acceptable for the unidimensional structure of PAM-13. It was found to be internally consistent for survivors during (McDonald's omega: 0.88, item-total correlations: 0.48-0.62) and after treatment (McDonald's omega: 0.90, item-total correlations: 0.32-0.72). The PAM-13 was concurrently valid with physical fatigue (Pearson's product-moment correlation coefficients: -0.25 and -0.18 for survivors during and after treatment, respectively) and depression (Pearson's product-moment correlation coefficients: -0.20 and -0.19 for survivors during and after treatment, respectively). Known-groups validity showed that survivors after treatment with a higher educational level reported a higher patient activation score than those with a lower educational level (p = 0.001); however, there was no difference due to the education level between survivors during treatment. The configural and metric invariance of the PAM-13 were confirmed, but scalar invariance was rejected. It was found that the PAM-13 is applicable for Japanese YA cancer survivors during and after treatment. However, given the lack of scalar invariance in the PAM-13, the scores of particular items between YA cancer survivors during and after treatment should be interpreted with caution.

The mediating effect of self-efficacy on the relationship between diabetes self-management ability and patient activation in older adults with type 2 diabetes

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.

Rasch and Confirmatory Factor Analyses of the Arabic Version of the Diabetes Self-Management Scale (DSMS): An Intercultural Approach

The current study was designed to validate the Arabic version of the Diabetes Self-Management Scale (DSMS) using Rasch and confirmatory factor analyses. This included person and item fit, separation, and reliability; rating scale functionality to evidence substantive validity; unidimensional structure to evidence structural validity; and item technical quality to evidence content validity. The study was conducted between September 2021 and March 2022. Utilizing AMOS-based confirmatory factor analysis (CFA), the study also assured the dimensionality of the DSMS. The participants were 103 diabetic patients in Saudi Arabia with a mean age of 44.72 years (standard deviation = 17.35). The analysis was performed using a trichotomous rating scale, and only one item exhibited a misfit (DSMS14). The item difficulty range was -1.0 to +1.0 logits, while the person's ability range was -3.0 to +3.0 logits. The first construct proved one Rasch dimension, which was explained and further analyzed using AMOS-CFA for the one-factor model. The DSMS was shown to be beneficial as a screening instrument for patient-reported diabetes self-management, despite several flaws that need to be addressed to improve the scale further.

Mediation Effect of Self-Efficacy Between Health Beliefs and Glycated Haemoglobin Levels in Elderly Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

PURPOSE

To explore the mediating effect of self-efficacy in the relationship between glycated haemoglobin (HbA1c) levels and health beliefs in community elderly patients with type 2 diabetes.

PATIENTS AND METHODS

From January to March 2022, convenience sampling was adopted to investigate 200 elderly patients with type 2 diabetes in a community in Yangzhou, China. Data were collected using the Health Beliefs Questionnaire, Self-efficacy for Diabetes, and Medication Compliance Questionnaire. Laboratory parameters included HbA1c, fasting blood glucose, postprandial blood glucose, total cholesterol, triglyceride, high-density-lipoprotein cholesterol, and low-density-lipoprotein cholesterol levels. Correlation, linear regression, and mediation analyses were performed using SPSS 27.0.

RESULTS

HbA1c levels were higher in men (women vs men: 6.80% [6.08%, 7.73%] vs.7.30% [6.30%, 9.18%]) and employed (employed vs not employed vs retired: 7.60% [6.90%, 10.45%] vs 5.85% [5.40%, 6.95%] vs 7.10% [6.20%, 8.20%]) and low self-efficacy (low vs high: 13.1% [6.55%, 13.85%] vs 6.8% [6.10%, 7.70%]). HbA1c levels were negatively associated with health beliefs (r = -0.246) and self-efficacy (r = -0.240; p<0.01). Linear regression showed that perceived susceptibility, severity, benefit, and barriers, cues to action, and self-efficacy explained 50% of the variance in HbA1c levels after adjusting for sex and current work status. The mediation effect of self-efficacy was partial between health beliefs and HbA1c levels and accounted for 24.65% of the total effect (p < 0.001).

CONCLUSION

Health beliefs influenced the improvement of self-efficacy in older patients with type 2 diabetes mellitus, which in turn could improve HbA1c control. Self-efficacy plays a partial mediating role between health beliefs and Hba1c levels in elderly patients with type 2 diabetes.