Association between coping mechanisms and adherence to diabetes-related self-care activities: a cross-sectional study

Effects of Illness Perception and Coping Style on Self-Management in Peritoneal Dialysis Patients: A Cross-Sectional Study

Aim

Chronic disease self-management is critical to disease prognosis and patient quality of life. Several psychological factors influence this process of self-management. In this background, the present study investigated the impact of illness perceptions and coping style on self-management in people with peritoneal dialysis (PD).

Methods

The study is a cross-sectional study. From May 2022 to January 2023, a convenience sampling method was used to recruit 246 peritoneal dialysis patients. General information questionnaire, brief illness perception questionnaire, medical coping style modes questionnaire and the self-management scale for peritoneal dialysis patients were used in this study. We used SPSS 24.0 to analyze the data, and the statistical methods included descriptive analysis, single factor analysis, Pearson correlation analysis and multiple linear regression analysis.

Results

A total of 246 patients were included in this study (93.89% response rate). Cognitive representations and emotional representations were 30.40, 14.18, respectively. However, illness comprehensibility was 2.87. Illness perceptions were negative significantly correlated with self-management. With regard to coping style, our patients were more likely to adopt avoidance and resignation coping style. Confrontation and avoidance were positively related to self-management, while acceptance-resignation was negatively related.

Conclusion

Self-management of peritoneal dialysis patients needs to be improved. Age, female sex, monthly income, illness perceptions and coping style were independently associated with self-management.

Impact

These findings suggest that interventions that improve illness perceptions and coping style should be explored to ultimately improve their self-management. For example, patients can be provided with psychological counseling so that they can face the disease correctly, and we should pay attention to the positive role of social support.

Promoting Self-Management and Independent Living of Older Individuals with Chronic Diseases through Technology: A Study of Self-Reported Needs, Priorities, and Preferences

Background and Objectives: Older patients' needs are rarely examined beforehand, and thus, although technology-based tools can enhance self-management, acceptability rates are still low. This study aimed to examine and compare self-reported needs, priorities, and preferences of older patients with heart failure (HF), diabetes mellitus type II (DM2), and chronic obstructive pulmonary disease (COPD) toward technology use to enhance self-management. Materials and Methods: A convenience sample of 473 participants over 60 s (60.5% females), diagnosed with HF (n= 156), DM2 (n = 164), or COPD (n = 153) was recruited. They were administered a questionnaire about the usefulness of technology in general and in specific areas of disease management. Results: Most participants (84.7%) admitted that technology is needed for better disease management. This was equally recognized across the three groups both for the overall and specific areas of disease management (in order of priority: "Information", "Communication with Physicians and Caregivers", and "Quality of Life and Wellbeing"). Sociodemographic differences were found. Cell phones and PCs were the devices of preference. The four common features prioritized by all three groups were related to 'information about disease management' (i.e., monitoring symptoms, reminders for medication intake, management and prevention of complications), whereas the fifth one was related to 'communication with physicians and caregivers (i.e., in case of abnormal or critical signs). The top disease-specific feature was also monitoring systems (of respiratory rate or blood sugar or blood pressure, and oxygen), whereas other disease-specific features followed (i.e., maintaining normal weight for HF patients, adjusting insulin dose for DM2 patients, and training on breathing exercises for COPD patients). Conclusions: Older individuals in these three groups seem receptive to technology in disease management. mHealth tools, incorporating both common and disease-specific features and addressing different chronic patients, and also being personalized at the same time, could be cost-saving and useful adjuncts in routine clinical care to improve self-management.

Coping Behaviors and Incident Kidney Disease

Key Points

Adaptive coping behaviors are associated with lower odds of incident CKD. Coping behaviors could represent a target to prevent CKD.

Background

How someone copes may alter the trajectory of their kidney function. We aimed to evaluate whether coping behaviors were associated with incident CKD or rapid kidney function decline.

Methods

We used data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study (Baltimore, MD) for this longitudinal analysis. Adaptive and maladaptive coping behavioral constructs were measured using the Brief COPE Inventory at visit 1. We used multiple logistic regression to assess the odds of incident CKD and rapid kidney function decline per point increase in coping scales and adjusted for baseline demographics and clinical variables.

Results

Of 1935 participants, mean age was 48 years, 44% were male, 56% were Black persons, and baseline mean (SD) eGFR was 91 (16) ml/min per 1.73 m2. After a median of 8.2 years, 113 participants developed incident CKD and 341 had rapid kidney function decline. Compared with those who reported they usually did not use adaptive coping behaviors at all (such as emotional support), those with the highest use of adaptive coping had lower odds of incident CKD. Every 1-unit increase in adaptive coping corresponded with a 2% lower adjusted odds of incident CKD (odds ratio, 0.98; 95% confidence interval, 0.95 to 0.99). There was no association between maladaptive coping behaviors and incident CKD. Coping behaviors were not associated with rapid kidney function decline.

Conclusions

Adaptive coping behaviors were associated with lower odds of incident CKD and could represent a target to facilitate CKD prevention. The role of medical care in this association is an area worthy of further investigation.

Daily living activities' performance by male diabetics with sexual dysfunction in South Africa

BACKGROUND

Sexual dysfunction (SD) is a common complication among men living with diabetes (MLWD), which adds to stresses induced by medical condition. Effect of stress on their daily living activities has been only poorly described.

AIM

This study aimed to explore the behaviour and challenges of MLWD experiencing SD in respect of daily living activities.

SETTING

Five clinics in Senwabarwana in Limpopo province.

METHODS

Qualitative approach and phenomenological exploratory design were adopted to collect data from 15 male participants selected from five clinics using purposive homogeneous sampling. One-on-one interviews were conducted using voice recorders, and field notes were taken of non-verbal cues. Unstructured interview guide with principal question enabled instructive probing to be conducted. Data were analysed using eight steps of Tesch's inductive, descriptive and open coding technique.

RESULTS

Participants reported stressful experiences, difficulty coping with diabetes and its accompanying complication of SD that led to fear of losing their wives. They indicated that as a result of stress and difficulty in coping with the condition, they were engaged in less physical activity than before their diagnosis.

CONCLUSION

Sexual dysfunction is prevalent among male diabetics and often feel stressed and worried about losing their wives. They struggle to cope with conditions to the point where they are less capable of performing tasks than they were before diagnosis. These outcomes are critical issues that should be addressed in any diabetes treatment strategy.Contribution: Support-based collaboration of healthcare providers with spouses and revision of South African diabetes management strategy to incorporate healthy coping strategies are recommended.

The relationship between self-care, spiritual well-being and coping strategies in patients with type 2 diabetes mellitus

Background

Diabetes is one of the most common diseases in the world. The most important underlying cause of death in diabetic patients is the lack of self-care and management. However, there is little known about the influence of coping strategies and spiritual well-being (SWB) on self-care in diabetic patients.

Aims

This study aimed to investigate the relationship between self-care activities with coping strategies and spiritual well-being (SWB) in patients with type 2 diabetes mellitus (T2DM).

Methods

In this descriptive-analytical study, we selected 236 patients with T2DM referred to the diabetes hospital clinics in the southwest of Iran. Inclusion criteria were patients diagnosed with T2DM, with the age group ranging 20-80 years, literate, not suffering from severe and debilitating complications of diabetes and lacking acute psychological illness. Exclusion criteria included refusing to complete questionnaires and cognitive or emotional impairment. Instruments include the demographic questionnaire, Summary of Diabetes Self-Care Activities, Lazarus and Folkman's Coping Strategies Questionnaire and the Spiritual Well-Being Scale (SWBS; developed by Paloutzian and Ellison). To examine the relationship between variables, the Pearson correlation and multiple stepwise regression analysis were used.

Results

The findings of this study on 236 patients with T2DM (53.25 ± 10.91) including 76 (32.2%) males and 160 (67.8%) females showed the majority of participants were female, the age group was between 41 and 60 years (68.22%), had a Diploma (63.98%), were insured (63.55%) and had a moderate economic situation (55.93%). There was a direct and significant correlation between self-care activities and coping strategies (r = 0.163, p < 0.05), and only a problem-focused coping strategy was considered as a predictor variable of self-care (p < 0.01). There was a direct and significant correlation between self-care and SWB (r = 0.385, p < 0.01).

Conclusion

The results of this study showed that there is a significant relationship between self-care and the problem-focused dimension of coping strategies and SWB in patients with T2DM.

A longitudinal study of positive mental health and coping among Indigenous adults with type 2 diabetes

OBJECTIVE

Indigenous Peoples and scholars call for strengths-based approaches to research inclusive of Indigenous resiliency and positive outcomes. The purpose of this study was to examine positive mental health for Indigenous adults with type 2 diabetes and to determine if positive mental health is linked to community connectedness (a coping resource) and active coping (a coping response).

METHODS

Participants (N  = 194 at baseline) were randomly selected from clinical records, at least 18 years old with a type 2 diabetes diagnosis, and self-identified as American Indian.

RESULTS

Latent growth curve models revealed that average positive mental health was predicted to decrease over the four waves of the study, although not for participants with above-average active coping at baseline. Community connectedness at baseline was associated with higher initial levels of positive mental health. Within-person change in active coping and community connectedness were both associated with increases in positive mental health.

CONCLUSION

This study aligns with previous research demonstrating that coping can influence health outcomes, and furthers the stress process literature by showing that active coping and community connectedness can impact positive mental health for Indigenous adults with Type 2 Diabetes.

The effects of message framing on self-management behavior among people with type 2 diabetes: A randomized controlled trial

BACKGROUND

Message framing describes how information is communicated and demonstrated to influence its effect on future attitudes and behaviors. Message content can be structured as 'gain-framed', emphasizing the benefits of engagement as recommended, whereas 'loss-framed' describes the negative consequences of not engaging as recommended. However, the impact of message framing on behavior change in people with chronic diseases like diabetes is not well understood.

OBJECTIVE

Analyze the impact of message framing in diabetes education on self-management in people with type 2 diabetes, and identify potential moderating effects of patient activation on message framing.

DESIGN

A three-arm randomized controlled trial was performed.

SETTING(S)

Participants were recruited from inpatients in the endocrine and metabolic unit of a university-affiliated hospital in Changchun.

PARTICIPANTS

A total of 84 adults with type 2 diabetes were equally randomized into gain-, loss-, or no-message framing groups and received a 12-week intervention.

METHODS

Both the message framing groups received 30 video messages. One group of participants received the gain-framed messages emphasizing desirable outcomes from effective diabetes self-care. The other group of participants received the loss-framed messages emphasizing the undesirable consequences of ineffective diabetes self-care. The control group received 30 videos about diabetes self-care without message framing. Self-management behavior, self-efficacy, patient activation, diabetes knowledge, attitudes, and quality of life were measured at baseline and 12 weeks.

RESULTS

Compared with the control group, participants who watched either gain or loss-framed messages had significant increases in self-management behavior and quality of life after the intervention. The scores of self-efficacy, patient activation, knowledge, and attitudes of the loss-framing group were considerably higher than the control group. Further analysis revealed an interaction between patient activation and message framing (P = 0.002), with gain and loss message framing interventions more effective in increasing self-management behaviors in people with type 2 diabetes who had a higher and lower activation level, respectively.

CONCLUSIONS

Using message framing in diabetes education is a promising strategy to build and foster self-management behavior. It also suggests that appropriate message framing be chosen to enhance self-management behavior based on the level of patient activation.

REGISTRATION NUMBER

ChiCTR2100045772.

Coping strategies and their association with diabetes specific distress, depression and diabetes self-care among people living with diabetes in Zambia

OBJECTIVES

Utilising coping strategies to reduce and manage the intensity of negative and distressing emotions caused by diabetes is essential. However, little is known about the use of coping strategies among people living with diabetes in Sub-Saharan African countries like Zambia. This study investigates coping strategies used by people with diabetes in Zambia and how these are associated with diabetes-specific emotional distress, depression and diabetes self-care.

METHODS

Cross-sectional data from 157 people with diabetes aged between 12 and 68 years were collected. Of the 157, 59% were people with type 1 diabetes and 37% with type 2 diabetes. About 4% had missing information in their record but had either type 1 or type 2 diabetes. Coping styles were measured using the Brief Version of the Coping Orientation to Problems Experienced (Brief COPE), diabetes specific-distress using the Problem Areas in Diabetes, depression using the Major Depression Inventory and self-care using the Diabetes Self-Care scale.

RESULTS

Data showed that adaptive coping strategies such as religious coping, acceptance among others, were the most frequently used coping strategies among Zambian individuals with diabetes. Maladaptive coping strategies e.g., self-blame and self-distraction were related to increased diabetes specific-distress and depression. Emotional support was related to better diabetes self-care, while self-blame was related to poor diabetes self-care.

CONCLUSION

There is need to help individuals with diabetes identify adaptive strategies that work best for them in order to improve their quality of life.

Type 2 diabetes self-management: spirituality, coping and responsibility

Background

In England, although The National Institute of Health and Care Excellence recommends that patients’ religious beliefs should be incorporated into individual healthcare plans, these components are often neglected in diabetes management care plans. A literature review identified a paucity of research regarding how the spirituality of British people may influence their approach to their self-management of type 2 diabetes (T2D).

Aims

To explore how the spirituality of a small group of adults with T2D, living in England, influenced their coping strategies and self-management of diet and exercise.

Methods

Biographic Narrative Interpretive Method of two interviews per participant and thematic analysis for data interrogation ( n = 8). Data as glycated haemoglobin, living situation, age, length of time since T2D diagnosis, body mass index and diabetic medicines contextualised the interview data.

Results

Participants’ spirituality, health beliefs, coping and sense of responsibility for T2D self-management overlapped in complex layers. Three themes were generated: (a) spirituality influences expectations in life; (b) beliefs influence coping styles of diabetes self-management; and (c) responsibility influences diabetes self-management. A model was created to assist nurses in addressing these components.

Conclusion

Nurses should consider how patients’ self-management of T2D may be influenced by their spirituality, health beliefs, coping and sense of responsibility.

Adesão ao autocuidado de pessoas com Diabetes Mellitus na Atenção Primária: estudo de método misto

Resumo Objetivo elaborar um modelo interpretativo sobre a adesão ao autocuidado de pessoas com Diabetes Mellitus na Atenção Primária à Saúde. Método estudo de método misto realizado em quatro Unidades Básicas de Saúde. O estudo quantitativo transversal foi composto por 329 participantes, elegeram-se variáveis sociodemográficas e clínicas e o questionário de atividades de autocuidado. No estudo qualitativo, com 31 participantes, utilizou-se a vertente construtivista da Teoria Fundamentada nos Dados. Os dados foram analisados utilizando-se a estatística descritiva e a codificação inicial e focalizada. Resultados a maioria dos participantes é do sexo feminino, casada, com um a cinco anos de estudo, aposentada e com renda de um a três salários-mínimos. Obteve-se baixa adesão à alimentação saudável, à atividade física e ao monitoramento glicêmico. A adesão desejável foi relacionada ao uso de medicamentos e cuidados com os pés. Na etapa qualitativa, obteve-se como fenômeno: Enfrentando a complexidade do tratamento do Diabetes Mellitus e buscando o autocuidado. Este foi sustentado por duas categorias: Encontrando as dificuldades para seguir o tratamento e Valorizando os aspectos facilitadores do tratamento que deram subsídios para a elaboração do modelo. Conclusões e implicações para a prática foi elaborado um modelo interpretativo cujos elementos demonstram a complexidade do fenômeno e contribuem para a adesão ao autocuidado nessa população.

The Effect of Traumatic Experiences of North Korean Adolescent Refugees upon Their Negative Health Perception: Focusing on Multiple Moderating Effect of Problem-Focused versus Social Support-Focused Coping Strategies

The health problems of North Korean (NK) refugees living a new life after surviving the dangers of life and death traumas is an issue that must be taken very seriously. Adolescent refugees may be particularly vulnerable to adverse physical and mental health issues because of major physical, cognitive, and psychosocial developmental changes during adolescence. This study examines the positive roles two active coping strategies—problem-focused coping and social support-focused coping—can play in NK refugee adolescents’ health self-awareness. The analysis found that “social support-focused coping” alleviates the negative relationship between traumatic experience and health perception, acting as a protective factor. Contrary to our prediction, the protective effect of adopting “problem-focused coping” in this study was not verified. The findings suggest that providing interventions for developing appropriate coping strategies help them live healthier, both physically and mentally, in South Korean society.

The Relationship of Psychological Factors and Asthma Control to Health-Related Quality of Life

BACKGROUND

Psychological variables (anxiety, depression, and coping strategies) and asthma control (assessed from the patient's perspective or from the physician's perspective) affect health-related quality of life (HRQoL) in asthmatic patients. However, no study has simultaneously evaluated these variables to understand the independent contribution of each one of these factors to HRQoL.

OBJECTIVE

To determine the impact of anxiety, depression, coping strategies, and asthma control on HRQoL, and to compare the impact of asthma control on HRQoL when it is established by the physician versus when it is considered by the patient.

METHODS

A total of 373 asthmatics completed the Hospital Anxiety and Depression Scale, Coping Orientations to Problems Experienced Inventory, 36-Item Short-Form Health Survey, and St. George Respiratory Questionnaire. Asthma control was measured by the patient with Asthma Control Test and by the physician with the classification asthma control of Global Initiative for Asthma. Demographic and clinical characteristics were also collected.

RESULTS

Anxiety, depression, and poor patient-rated asthma control status were associated with worse HRQoL in all dimensions (except Mental Health for asthma control). Physician-rated asthma control was related to worse HRQoL in physical generic and specific dimensions. Among coping strategies, only avoidant coping impacted HRQoL in a few dimensions.

CONCLUSIONS

Anxiety, depression, and asthma control (especially patient-rated asthma control) were important independent predictors of asthma HRQoL, and all of them should therefore be considered in interventions to improve HRQoL in asthmatic patients.

Validation and cross-cultural adaptation of the depression Patient's Health Questionnaire - 9 in the Romanian population of patients with Type 2 Diabetes Mellitus

Purpose: To validate and to evaluate the performance in depression screening of the Patient's Health Questionnaire - 9 (PHQ-9) for Romanian patients with Type 2 Diabetes Mellitus (T2DM). Patients and methods: In a consecutive-case, population-based, non-interventional study design 107 hospitalized patients with T2DM were enrolled. The PHQ-9 was evaluated in regard to its acceptability, ceiling and floor effect, reproducibility, and test-retest performance. Its validity was tested by comparing it to the Beck depression scale, which is a validated tool for this patient population. Results: The PHQ-9 questionnaire had an excellent acceptability, having no non-responders for any of its questions and a median completion time of 3 mins and 12 s, a good reliability with a Cronbach's α=0.897 [0.865-0.924] 95%CI, a good test-retest performance (Spearman's rho =0.972; p<0.001 between two administrations of the test) without any ceiling or floor effect observed for the total score. At the same time, the score demonstrated a good validity when compared to a more complex and previously validated instrument like the Beck depression scale (Spearman's rho =0.777; p<0.001). The limits of agreement (Bland-Altmann analysis) between the two measurements are 2.6 to -2.5 points. Conclusion: The PHQ-9 is a valid, useful instrument for depression screening in Romanian patients with T2DM.

A Mobile App to Improve Self-Management of Individuals With Type 2 Diabetes: Qualitative Realist Evaluation

BACKGROUND

The increasing use of Web-based solutions for health prevention and promotion presents opportunities to improve self-management and adherence to guideline-based therapy for individuals with type 2 diabetes (T2DM). Despite promising preliminary evidence, many users stop using Web-based solutions due to the burden of data entry, hidden costs, loss of interest, and a lack of comprehensive features. Evaluations tend to focus on effectiveness or impact and fail to evaluate the nuanced variables that may interact to contribute to outcome success (or failure).

OBJECTIVE

This study aimed to evaluate a Web-based solution for improving self-management in T2DM to identify key combinations of contextual variables and mechanisms of action that explain for whom the solution worked best and in what circumstances.

METHODS

A qualitative realist evaluation was conducted with one-on-one, semistructured telephonic interviews completed at baseline, and again toward the end of the intervention period (3 months). Topics included participants' experiences of using the Web-based solution, barriers and facilitators of self-management, and barriers and facilitators to effective use. Transcripts were analyzed using thematic analysis strategies, after which the key themes were used to develop statements of the relationships between the key contextual factors, mechanisms of action, and impact on the primary outcome (glycated hemoglobin, HbA_1c).

RESULTS

Twenty-six interviews (14 baseline, 12 follow-up) were completed with 16 participants with T2DM, and the following 3 key groups emerged: the easiest fit, the best fit, and those who failed to activate. Self-efficacy and willingness to engage with the solution facilitated improvement in HbA_1c, whereas competing priorities and psychosocial issues created barriers to engagement. Individuals with high baseline self-efficacy who were motivated, took ownership for their actions, and prioritized diabetes management were early and eager adopters of the app and recorded improvements in HbA_1c over the intervention period. Individuals with moderate baseline self-efficacy and no competing priorities, who identified gaps in understanding of how their actions influence their health, were slow to adopt use but recorded the greatest improvements in HbA_1c. The final group had low baseline self-efficacy and identified a range of psychosocial issues and competing priorities. These participants were uncertain of the benefits of using a Web-based solution to support self-management, ultimately resulting in minimal engagement and no improvement in HbA_1c.

CONCLUSIONS

Self-efficacy, competing priorities, previous behavior change, and beliefs about Web-based solutions interact to determine engagement and impact on the clinical outcomes. Considering the balance of these patient characteristics is likely to help health care providers identify individuals who are apt to benefit from a Web-based solution to support self-management of T2DM. Web-based solutions could be modified to incorporate the existing screening measures to identify individuals who are at risk of suboptimal adherence to inform the provision of additional support(s) as needed.