Relationships between locus of control and adherence to diabetes regimen in a sample of Iranians

Following Physician's Advice in Late Life: The Roles of Health Beliefs and Health Status

Objective

This study aims to explore the influence of health-related locus of control beliefs such as belief in the role of health professionals in influencing patient health, cognitive functioning, and multimorbidity on adherence to physician's recommendations among older adults.

Methods

A cross-sectional study involving older adults (N=684, age range = 71-100 years) living in Clearwater, Florida, reported their adherence to physician's recommendations, cognitive functioning, physical health, and health-related locus of control beliefs. Ordered Logistic regression was used.

Results

Older adults who believed that health professionals influence health and a person is likely to recover from illness because other people take good care of him/her had higher adherence to physician's recommendations. Older adults who believed that their own action affects their health had lower odds of reporting adherence by 27%. Additionally, those with cognitive impairment had lower odds of reporting adherence by 38%. Functional limitations, multimorbidity, and self-image of health were not associated with adherence.

Conclusion

This is one of the first studies to consider the influence of locus of control beliefs on adherence of physician's recommendations among community dwelling older adults. With the exception of one item "My good health is largely a matter of good fortune", generally individuals with external locus of control had higher adherence. Our findings also underscore the policy and clinical significance of different health-related beliefs held by older adults.

Psychosocial Facilitators and Barriers to Type 2 Diabetes Management in Adults: A Meta-Synthesis

BACKGROUND

Globally, the cases of type 2 diabetes are increasing, and this is largely attributed to lifestyle changes. Though diabetes is primarily a metabolic disease determined by biological factors, psychosocial aspects play a crucial role in its progression and management. However, the literature on psychosocial dimensions of diabetes management is minuscule and scattered.

OBJECTIVE

This synthesis sought to understand the psychosocial facilitators and barriers to type 2 diabetes management and coping among adults.

METHODS

We have adopted a meta-synthesis to review available qualitative studies using Pub- Med and Scopus databases. Based on inclusion criteria, we have chosen 24 studies published between 2010 and 2023. We have considered studies across countries, among which 63% of the studies included were from Western countries, and most have employed qualitative descriptive design. The selected studies were analyzed thematically using a deductive framework.

RESULTS

Six themes emerged as the psychosocial barriers and facilitators of managing and coping with type 2 diabetes: 1) cognitive-emotional factors, 2) faith, 3) constraints to behavioural change, 4) social constraints and support, 5) healthcare provider-patient relationship, and 6) awareness. Further, a conceptual framework was developed from the synthesis.

CONCLUSION

The patients' experiences evident from this synthesis signify the crucial role of psychosocial factors in diabetes management and coping. This evidence emphasizes the need for integrated care so that psychosocial aspects are addressed by healthcare providers and behavioural health professionals, which may lead to the promotion of facilitators and the minimization of barriers.

Coping and adaptation strategies among young persons living with type 1 diabetes and their caregivers: textual and photovoice analyses

BACKGROUND

Management of type 1 diabetes (T1D) is complex and demanding. It requires patients and their caregivers, particularly those in low-resource settings to adopt productive coping strategies to achieve ideal glycaemic control. Coping and adaptation strategies have far-reaching implications on their behavioural and health outcomes. Yet, it is uncertain how young people living with T1D and their caregivers in low-resource settings cope and adapt to the challenges of T1D management. This study analysed textual and photo evidence on the coping and adaptation strategies employed by young persons living with T1D (warriors) and their caregivers in Ghana.

METHODS

Qualitative data were collected from 28 warriors, 12 caregivers, 6 healthcare providers and other stakeholders in southern Ghana using semi-structured interview guides. Participants were identified at T1D support group centres, hospitals, and their places of residence, and recruited into the study using maximum variation and snowball sampling approaches. Data were collected via face-to-face interviews, photovoice, telephone interviews and videoconferencing and were thematically analysed using QSR NVivo 11.

RESULTS

Four superordinate themes which are productive coping, non-productive coping, keeping T1D a secret, and coping with costs of care were identified. Productive coping entailed condition acceptance, planning ahead, seeking social support, borrowing insulin, and overcoming the barriers of insulin storage. On the other hand, avoidance, disengagement, and re-use of syringes were the common non-productive coping approaches. Due to stigma and discrimination, the warriors shrouded their condition in secrecy. As a response to the financial burden of T1D care, caregivers/patients borrowed money, took loans, and sold household items.

CONCLUSION

Young persons living with T1D and their caregivers adopted coping strategies which both promoted and compromised their T1D management. There was an occasional co-existence of diverse coping strategies (productive and non-productive), and these reflects the personal and contextual stressors they faced. The results call for the need to eliminate barriers of T1D management and equip patients and their caregivers with ongoing T1D coping competencies.

The Role of Religion, Spirituality and Fasting in Coping with Diabetes among Indian Migrants in Australia: A Qualitative Exploratory Study

Australia has a high proportion of migrants, with an increasing migration rate from India. While many factors influence diabetes self-management among Indian migrants, very little is known about the influence of religious beliefs and spirituality. This study explored the religious beliefs of Indian migrants in Australia and the influence of those beliefs on their diabetes self-management. Semi-structured interviews were conducted with a convenience sample of 23 Indian migrants. All interviews were audio-recorded, transcribed verbatim and thematically analysed. Most participants believed that prayers helped them alleviate stress and improve diabetes management participants also believed that receiving blessings/prayers from religious leaders prevent or cure diseases including diabetes. There were mixed views on beliefs about using insulin obtained from animal sources. Some participants were concerned about the use of animal-based insulin as it was against their religious beliefs and teachings. Some participants believed that religious fasting does not have any impact on their diabetes while others believed that it can be detrimental to their health. Religious beliefs therefore played an important role in how Indian migrants managed their diabetes. Healthcare professionals should consider their patients' religious beliefs during consultations, enlist support, such as religious scholars, to better address people's misconceptions, and identify strategies for effective diabetes management that consider religious beliefs.

Association between health locus of control and perceived stress in college student during the COVID-19 outbreak: a cross-sectional study in Iran

BACKGROUND

The COVID-19 pandemic as a global mental health crisis has affected everyone, including students. The present study aimed to determine and investigate the relationship between health locus of control and perceived stress in students of Bushehr University of Medical Sciences (southern Iran) during the outbreak of COVID-19.

METHODS

The present cross-sectional study examined 250 students of Bushehr University of Medical Sciences. We performed simple random sampling and utilized the demographic information form, Multidimensional Health Locus of Control scale (MHLCS) by Wallston, and Perceived Stress Scale (PSS) by Cohen to collect data. We analyzed data using the SPSS, Pearson correlation coefficient, and the hierarchical regression model with an error level of 5%.

RESULTS

The mean perceived stress was 30.74 ± 8.09, and 92.4% of the students had moderate and high stress levels. Among the components of the health locus of control, the internal health locus of control (IHLC) had the highest mean in students (27.55 ± 3.81). Furthermore, the internal health locus of control (R = - 0.30, P < 0.001) had a significant inverse relationship, with perceived stress and the chance health locus of control (CHLC) (R = 0.30, P < 0.001) had a significant direct relationship. In the final regression model, the health locus of control and all the variables predicted 22.7% of the perceived stress variation in students during the COVID-19 period.

CONCLUSION

The results indicated that the internal health locus of control was associated with a reduction of perceived stress, and the powerful others health locus of control (PHLC) was related to its increase in students during the COVID-19 pandemic. Given the uncertain future, in the present work, universities are suggested to design web-based educational interventions alongside the curriculum to further strengthen the internal health locus of control and thus help reduce their perceived stress.

A high burden of adverse life events and poor coping mechanisms experienced by urban-dwelling black South Africans

Aim

In view of the current context of poverty and socio-economic inequalities and the high and rising burdens of HIV infection and non-communicable diseases in South Africa, this study aims to describe the distribution of adverse life events (ALEs) by age and gender, and examine the socio-demographic characteristics, psychosocial coping mechanisms, risky lifestyle behaviours and family burden of HIV-related ill-health associated with ALEs in 25-74-year-old black residents of Cape Town.

Materials and methods

In a random cross-sectional sample, 12 ALEs, tobacco and alcohol use, sense of coherence (SOC), locus of control (LOC) and impact of HIV in the family were determined by administered questionnaires. Data analyses included descriptive statistics adjusted for the realised sample. Multivariable linear regression models assessed the independent associations of increasing number of ALEs.

Results

Among 1099 participants, mean lifetime score of ALE categories examined was 6.1 ±2.1 (range 0–12) with men reporting significantly higher number of events compared with women (p<0.001). The most frequent ALE was the death of a loved one (88.5%) followed by a major financial crisis (81.2%) with no trend across gender or age group. In the multivariable linear regression model, increasing ALEs were significantly associated with male gender, unemployment, having spent >50% of life in urban areas, >7 years of education, problematic alcohol use and poorer psychosocial coping mechanisms defined by low SOC and LOC. All four variables pertaining to HIV-related burden of ill-health in the family were significantly associated with increasing ALEs.

Conclusions

Considering that lower SOC and LOC and problem drinking were significantly linked to ALEs, policymakers need to formulate strategies that improve coping mechanisms and promote problem-solving behaviours, target the high burden of alcohol misuse and address unemployment.

The relation of alexithymia and attachment with type 1 diabetes management in adolescents: a gender-specific analysis

BACKGROUND

Several studies indicate the role of psychosocial factors in the management and control of chronic diseases in adolescents. In this regard, the roles of attachment and alexithymia in the management of type 1 diabetes in adolescents and related gender-specific patterns have rarely been the focus of empirical research. In this study we investigate the gender-specific relationship of alexithymia and attachment with self-care and blood glucose level in adolescents with type1 diabetes.

METHODS

This is a cross-sectional study conducted on adolescents aged 12-18 years, with type 1 diabetes. Participants were recruited from diabetes clinics and the Iranian Diabetes Society. Data were collected using the Farsi versions of the Toronto Alexithymia Scale (FTAS-20), the Inventory of Parent and Peer Attachment (IPPA) and the Summary of Diabetes Self-Care Activities Scale (SDSCA). Blood glucose levels were measured by determining HbA1c which were abstracted from medical records. Data were analyzed using SPSS21 software.

RESULTS

Participants were 150 adolescents (57% female), mean age 14.97 ± 2.30. Alexithymia (β = 0.10, P = 0.01), difficulty identifying feelings (β = 0.15, P = 0.03) and communication with mothers (β = - 0.08, P = 0.03) predicted HbA1c in girls, whereas no significant relationships were observed for HbA1c with alexithymia and attachment in boys. Factors that predicted self-care in girls were alexithymia (β = - 0.04, P = 0.02), difficulty identifying feelings (β = - 0.06, P = 0.04); in boys however in addition to these two factors predicting self-care [alexithymia (β = - 0.07, P = 0.01) and difficulty identifying feelings (β = - 0.11, P = 0.01)], we also found difficulty describing feelings (β = - 0.16, P = 0.02), communication with mother (β = 0.04, P = 0.04), alienation to mother (β = - 0.06, P = 0.03), to father (β = - 0.06, P = 0.01) and to peers (β = - 0.09, P = 0.03).

CONCLUSIONS

Our results suggest that, in a gender-specific pattern, alexithymia and attachment could affect self-care and blood glucose level in adolescents with type 1 diabetes; findings that can be used to facilitate more effective treatment strategies and interventions in this age group.

Locus of Control and Cognition in Older Adults With Type 1 Diabetes: Evidence For Sex Differences From the Study of Longevity in Diabetes (SOLID)

OBJECTIVE

Life expectancy for individuals with type 1 diabetes mellitus (T1DM) has increased recently; however, it is unknown how diabetes care attitudes affect late-life brain health.

RESEARCH DESIGN AND METHODS

The Study of Longevity in Diabetes (SOLID) consists of 734 older adults with T1DM, reporting diabetes locus of control (dLOC), age of diabetes diagnosis and other demographics, history of hypoglycemic episodes, and depressive symptoms. Global and domain-specific (language, executive function, episodic memory, simple attention) cognitive functioning was assessed at in-person interviews. Cross-sectional associations between dLOC and cognition were estimated using covariate-adjusted linear regression models in pooled and sex-stratified models.

RESULTS

In pooled analyses, a 1-point increase in dLOC (more internal) was positively associated with global cognition [β=0.05, 95% confidence interval (CI): 0.02, 0.07], language (β=0.04, 95% CI: 0.01, 0.07), and executive function (β=0.04, 95% CI: 0.01, 0.07), but not episodic memory or simple attention. However, in sex-stratified analyses, this effect was seen only in males and not females.

CONCLUSIONS

In elderly individuals with T1DM, we found associations between dLOC and cognition overall and in men but not women. Underlying sex differences should be considered in future research or interventions on psychosocial characteristics for cognition.

Medication Adherence and Its Associated Factors in Laotians With Type 2 Diabetes Mellitus

This study aims to explore diabetes mellitus (DM) medication adherence and its associated factors in Laotians with type 2 DM by determining the relationships among DM-related characteristics, diabetes knowledge, self-efficacy, diabetes locus of control, and DM medication adherence. The participants of the study were 175 patients who visited the DM clinics in Vientiane. The mean score of medication adherence was 6.26 ± 1.57 (M ± SD), corresponding to a medium adherence level. In the regression model, a total variance of medication adherence explained was 11.4%. Employment status, duration of illness, and self-efficacy were significant factors for predicting medication adherence. Self-efficacy was found to be the most important factor in explaining the variance of medication adherence. These findings indicate the need to develop an intervention program and clinical strategies in Laos promoting diabetic medication adherence that include diverse methods for enhancing self-efficacy.

Illness Perceptions, HbA1c, And Adherence In Type 2 Diabetes In Saudi Arabia

PURPOSE

Little is known about predictors of adherence to diabetes medication in Saudi Arabia. This study aimed to investigate whether illness perceptions, beliefs about medicine, and God locus of health control beliefs were associated with adherence to medication and glycaemic control (HbA1c) in Saudi patients with type 2 diabetes (T2D).

PATIENTS AND METHODS

A convenience sample of 115 adults with T2D were recruited from a diabetes outpatient clinic. Validated self-reported measures of adherence to medication, illness perceptions, beliefs about medicine, and God locus of health control were administered. Patients' most recent HbA1c levels were extracted from medical records. Multivariable logistic and linear regressions were used to examine the association between illness perceptions, beliefs about medicine and adherence to medication and HbA1c.

RESULTS

More than two thirds of patients (69%) reported poor adherence to medication. All illness perceptions domains, beliefs about medicine, and God locus of health control beliefs were associated with adherence. Multivariable logistic regression revealed that older age (OR= 3.76, p= 0.023), worse consequences perceptions (OR= 0.21, p= 0.011), worse illness identity (OR= 0.23, p= 0.010), and greater illness coherence (OR= 3.24, p= 0.022) were independent predictors of adherence. Two thirds of patients (67%) had suboptimal HbA1c; and perceptions of a cyclical timeline and lower insulin effectiveness were associated with higher HbA1c. In multiple linear regression, perceptions of a cyclical timeline (β= 0.19, p= 0.040) were an independent significant predictor of HbA1c.

CONCLUSION

In Saudi Arabia, patients' perceptions of T2D, beliefs about medicine, and God locus of control beliefs are associated with adherence. These results inform the development of interventions based on the Common-Sense Model (CSM) to encourage improved adherence and glycaemic control among Saudi patients with T2D. Further research with larger and more diverse samples is warranted to expand the generalizability of these findings.

Dutch Translation and Validation of the Headache-Specific Locus of Control Scale (HSLC-DV)

Background and Objective

The assessment of locus of control forms an important part of headache treatment, and there is need to adapting them to the Dutch population.

Methods

Forward-backward translation was used to obtain the Headache-Specific Locus of Control Scale-Dutch Version (HSLC-DV). The response of 87 participants with migraine, tension-type headache, and cervicogenic headache, aged between 18 and 55 years (75% female), is used. Test-retest reliability was measured by intraclass correlations. Construct validity was assessed by correlations with corresponding domains of the Pain Coping and Cognition List (PCCL) and by confirmation of known groups hypotheses. Structural validity was evaluated by factor analysis (principal axis factoring).

Results

The intraclass correlations for the External, Internal, and Chance domains were 0.79, 0.89, and 0.73, respectively. Internal consistencies for domains exceeded 0.73 and were similar to those observed in the original study. Convergent correlations were as expected and three of the seven known groups hypotheses were confirmed. Structural validity was supported by results of the factor analysis that matched the proposed structure of the original instrument.

Conclusions

The HSLC-DV is a valid and reliable questionnaire for measuring the locus of control.

A Structural Equation Model of Self-care Activities in Diabetic Elderly Patients

Background:

Self-care is a valuable strategy to improve health and reduce events of hospitalization and the duration of hospital stay in elderly diabetic patients. This study aimed to examine the model of self-care behaviors in elderly diabetic patients.

Materials and Methods:

A survey was conducted among 209 diabetic elderly patients who were admitted in three hospitals affiliated with the Isfahan University of Medical Sciences, Iran. Convenience sampling method was used to recruit the participants. Depression, anxiety, stress, and perceived social support were considered as predicting exogenous variables and elderly patients' self-care activities were treated as endogenous variables. The data were collected by a four-part questionnaire consisting of demographic and health-related characteristics; 21-item depression anxiety stress scale, multidimensional scale of perceived social support, and Diabetes Self-care Activities scale. Structural equation modelling by Statistical Package for the Social Sciences (SPSS) version 16 and Analysis of Moment Structures-7 (AMOS) software was applied for data analysis.

Results:

Mean (standard deviation) of depression, anxiety, stress, perceived social support, and self-care activities of participants were 14.29 (4.3), 13.62 (3.74), 16.83 (4.23), 57.33 (14.19), and 44.56 (13.77), respectively. The results showed that the overall model fitted the data (χ²/df = 3.8, goodness-of-fit index (GFI) = 0.52, incremental fit index (IFI) = 0.48, and root mean square error of approximation (RMSEA) = 0.14). Three out of four variables (i.e., perceived social support, anxiety, and depression) significantly predicted adherence to self-care behaviors among diabetic elderly patients (p < 0.05).

Conclusions:

The perceived social support, anxiety, and depression were identified as key constructs which need to be taken into account and well managed by health care professionals to enhance adherence to self-care activities in diabetic elderly patients.

The Relationship between Health Locus of Control and Health Behaviors in Emergency Medicine Personnel

BACKGROUND

Health locus of control defined as individual beliefs based on past experiences in health issues and having external or internal control over them, could affect health. Health locus of control plays a role in health behaviors. We aimed to investigate the relationship between health locus of control and health behavior in emergency medical personnel in Ahvaz during 2016.

METHODS

This is a cross-sectional descriptive study, which began in August 2016 for a period of six months on 215 emergency medical personnel in Ahvaz who were selected randomly. The data were collected by a demographic questionnaire, Rotter's locus of control questionnaire, and health behavior questionnaire and analyzed using SPSS software, version 22. The correlation between variables was estimated by Pearson's correlation coefficient and independent t test. The level of significance for all statistical tests was set at 0.05.

RESULTS

We found no significant relationship between health locus of control (external and internal) and health behavior (P>0.05).Health behaviors were very good in terms of personal health (86.5%), nutrition (53%), and sleep and rest (48.4%), and poor in terms of physical activity (52.6%) and stress management (79.5%). Furthermore, 79.5% of the emergency personnel, in general, had poor heath behaviors.

CONCLUSION

Leaders and officials in the field of health must necessarily design programs in relation to health locus of control and the factors developing and affecting it as well as the role of health locus of control in doing correct behaviors.

Factors associated with medication adherence among patients with diabetes in the Middle East and North Africa region: A systematic mixed studies review

Multiple systematic reviews were conducted investigating factors associated with medication adherence worldwide. However, investigations from the Middle East and North Africa (MENA) region were largely underrepresented in those reviews. Therefore, the objective of this systematic review is to identify the factors influencing medication adherence among patients with diabetes in the MENA region. A systematic literature search was conducted through Cochrane Library, EBSCO, EMBASE, Google Scholar, ISI Web of Science, PubMed, ScienceDirect, SCOPUS, and ProQuest. Studies were included if they determined factors associated with medication adherence among patients with diabetes within the MENA region. Quality was assessed using Crow Critical Appraisal Tool. Thirty primary studies from 10 MENA countries were included. The factors associated with medication adherence were categorized into demographics-related; disease- and medication-related; perception, attitude and psychological feelings-related; and societal-related factors. Positively associated factors included knowledge about the disease and medications, regular follow-up visits, and patients' positive beliefs about effectiveness and motivations about medications, while negatively associated factors included forgetfulness, side effects, and polypharmacy. Factors associated with medication adherence among patients with diabetes in the MENA region are highly diverse. The identified factors can serve as potential targets for culturally-relevant interventions to improve medication adherence and overall health outcomes.

Predictor effect of Locus Of Control (LOC) on self-care activities and metabolic control in individuals with type 2 diabetes

Background

Previous studies have examined the role of individuals’ personal characteristics in diabetes management and used the locus of control theory to assess adherence to a diabetes management regimen. These studies have emphasized that having internal locus of control may be a protective factor in diabetes management.

Objective

The purpose of this study is to determine the predictor effect of locus of control on self-care activities and A1c level.

Method

The study is descriptive and relational. Researchers used a Diabetes Self-Care Activities Scale and a Locus of Control Scale to collect data. The study sample consisted of 129 individuals with type 2 diabetes.

Results

The average score of locus of control of individuals with diabetes was 10.26, and the frequency of self-care activities in the past week was 2.9 days. A weak but statistically significant negative relation was found between the locus of control level and self-care activities of individuals with diabetes, which had no effect on A1c. It was determined that locus of control predicts 19% of self-care activities.

Conclusion

According to the study results, having internal locus of control had positive effects on self-care activities. Training and planning activities to improve internal locus of control can improve diabetes management.

Health locus of control in Indonesian women with breast cancer: a comparison with healthy women

The aims of this study were to assess whether Indonesian women with breast cancer havea higher external health locus of control (HLC) than healthy women, and to explore the association between HLC and symptoms of anxiety and depression. In this study, 120 consecutive women with breast cancer were recruited at the outpatient surgical oncology clinic at the Hasan Sadikin Hospital in Bandung. One hundred and twenty two healthy women were recruited from the Bandung area as controls. A standard demographic form, Form C of the Multidimensional Health Locus of Control, as well as the Hospital Anxiety and Depression Scale and patients' medical records were used. Data were analyzed using descriptive statistics, t-test, Pearson's correlation, MANOVA and multiple linear regressions. Women with breast cancer had higher scores on all external HLC subscales, i.e. chance, doctor, powerful others and God, and lower internal HLC compared to healthy women. High God LHC scores were associated with a high level of anxiety (β=0.21, p<0.05), whereas none of the HLC subscales were associated with depression. Our results suggest that women with breast cancer tend to have high external HLC, while healthy women tend to have high internal HLC. A strong belief in an external source of control, i.e. God, might be negatively associated with patient emotional adjustment. Further research is needed to give an insight into the direction of this association.

The influence of locus of control on self-rated health in context of chronic disease: a structural equation modeling approach in a cross sectional study

BACKGROUND

Self-rated health is a robust predictor of several health outcomes, such as functional ability, health care utilization, morbidity and mortality. The purpose of this study is to investigate and explore how health locus of control and disease burden relate to self-rated health among patients at risk for cardiovascular disease.

METHODS

In 2009, 414 Swedish patients who were using statins completed a questionnaire about their health, diseases and their views on the three-dimensional health locus of control scale. The scale determines which category of health locus of control - internal, chance or powerful others - a patient most identifies with. The data was analyzed using logistic regression and a structural equation modeling approach.

RESULTS

The analyses showed positive associations between internal health locus of control and self-rated health, and a negative association between health locus of control in chance and powerful others and self-rated health. High internal health locus of control was negatively associated with the cumulative burden of diseases, while health locus of control in chance and powerful others were positively associated with burden of diseases. In addition, age and education level had indirect associations with self-rated health through health locus of control.

CONCLUSIONS

This study suggests that self-rated health is positively correlated with internal locus of control and negatively associated with high locus of control in chance and powerful others in patients at high risk for cardiovascular disease. Furthermore, disease burden seems to be negatively associated with self-rated health.

Barriers to the delivery of optimal antidiabetic therapy in the Middle East and Africa

BACKGROUND

The prevalence of type 2 diabetes is increasing worldwide, but developing nations will bear a disproportionate share of this burden. Countries in the Middle East and Africa are in a state of transition, where marked disparities of income and access to education and healthcare exist, and where the relatively young populations are being exposed increasingly to processes of urbanisation and adverse changes in diet that are fuelling the diabetes epidemic. Optimising diabetes care in these nations is crucial, to minimise the future burden of complications of diabetes.

METHODS

We have reviewed the barriers to effective diabetes care with special relevance to countries in this region.

RESULTS

The effects of antidiabetic treatments themselves are unlikely to differ importantly in the region compared with elsewhere, but economic inequalities within countries restrict access to newer treatments, in particular. Values relating to family life and religion are important modifiers of the physician-patient interaction. Also, a lack of understanding of diabetes and its treatments by both physicians and patients requires more and better diabetes education, delivered by suitably qualified health educators. Finally, sub-optimal processes for delivery of care have contributed to a lack of proper provision of testing and follow-up of patients in many countries.

CONCLUSION

Important barriers to the delivery of optimal diabetes care exist in the Middle East and Africa.

Locus of control and anti-hypertensive medication adherence in Ghana

Introduction

Medication non-adherence is a major public health problem in Ghana. Locus of control (LoC) may influence adherence to medication. In this study we examine the association between locus orientation and adherence to hypertensive medication among adult patients. We also take into account the role of medication side effects.

Methods

We conducted a hospital-based cross-sectional study involving two tertiary hospitals in southern and northern Ghana. Data were collected from 400 hypertensive patients using a structured questionnaire. We gathered information on patient’s sociodemographic characteristics, health LoC, side effects of anti-hypertensive medication and adherence to anti-hypertensive medication.

Results

Participants exhibited features of mixed LoC (both internal and external) usually referred to as bi-local expectancy. However, orientation was skewed towards external LoC. Females were marginally more likely than males to have an internal LoC. Education was associated with a greater likelihood of internal LoC. While most patients (93.3%) poorly adhered to antihypertensive medications, logistic regression model revealed that non-adherence was significantly associated with low internal LoC, medication side effects and the combined effect of medication side effects and external LoC.

Conclusion

Medication non-adherence, experiences of medication side effects and LoC are associated. Multifaceted intervention programmes highlighting personality characteristics like LoC may improve anti-hypertensive medication adherence.

Importance of social support in diabetes care

BACKGROUND AND OBJECTIVES

Diabetes is one of the major concerns in the third millennium, affecting more people every day. The prevalence of this disease in Iran is reported to be high (about 7.7%). The most important method to control this disease and prevent its complications is self-care. According to various studies, this method has not found its proper place among patients with diabetes due to several reasons. The present study was aimed at determining the relationship between social support, especially family support, and self-care behavior of diabetes patients.

MATERIALS AND METHODS

This study was a narrative review in which the relevant papers of cross-sectional, cohort, clinical trial, and systematic review designs were selected using databases and scientific search engines such as PubMed, ProQuest, SCOPUS, and Elsevier, with the keywords diabetes, social support, and self-care. Moreover, Persian papers were selected from MEDLAB and IRANMEDEX databases and through searching the websites of original research papers published in Iran. All the papers published from 1990 to 2011 were reviewed.

RESULTS

The results of the study indicated that the status of self-care and social support in patients with diabetes was not favorable. All the studied papers showed that there was a positive relationship between social support and self-care behavior. Also, some studies pointed to the positive effect of social support, especially family support and more specifically support from the spouse, on controlling blood sugar level and HbA1c.

CONCLUSION

As social support can predict the health promoting behavior, this concept is also capable of predicting self-care behavior of patients with diabetes. Therefore, getting the family members, especially the spouse, involved in self-care behavior can be of significant importance in providing health care to patients with diabetes.

Can health promotion model constructs predict nutritional behavior among diabetic patients?

Since, the nutritional behavior is a complicated process in which various factors play the role, this study aimed at specifying the effective factors in nutritional behavior of diabetic patients based on Health Promotion Model. This paper reviews the published articles from 2000 to the beginning of 2012, using the various data banks and search engines such as PubMed, ProQuest, Scopus, Elsevier, and the key words" perceived benefits and barriers, perceived self-efficacy, social support, activity related affect, situational influences, commitment to plan of action, immediate competing demands and diabetes, self-caring and diabetes. Unfavorable self-care situation especially, inappropriate nutritional behavior is related to some effective modifiable factors. Perceived benefits and self-efficacy regarding behaviors play a major role in the nutritional behaviors. Social support especially, spouses' support has a significant role in this regard. Moreover, there is a reverse relationship between perceived barriers and nutritional self-care. In addition, behavioral feelings, situational influences, commitment to plan of action and immediate competing demands and preferences can also impact and overshadow the nutritional self-care. Following the relationship between constructs of Health Promotion Model and nutritional behavior the constructs of this model can be utilized as the basis for educational intervention among diabetes.

Women's perceived internal control of future pregnancy outcomes and its related factors

BACKGROUND AND PURPOSE

With regards to the importance of women's beliefs in improving pregnancy outcomes, this study was performed to determine the perceived internal control on future pregnancy outcomes and its related factors in women who participated in pre-marital counseling.

MATERIALS AND METHODS

In a cross-sectional study, women's perceived internal control was investigated. The study population comprised the women in reproductive age of whom 400 were selected by random sampling. Data collection instrument was a questionnaire consisting of demographic, pre-conceptional care, and internal control questions. Two categories of favorite and not favorite levels of internal control were defined based on the total score. The validity of the questionnaire was determined via content validity method by use of experts' opinion and its reliability was evaluated through the calculation of Cronbach's alpha coefficient which was 0.76. Data were analyzed through frequency tables, correlation coefficient, and Chi-square test at the confidence level of 0.95.

RESULTS

Two hundred sixty-five (65%) women had a good perceived internal control and it was significantly associated with the age, educational level, and hearing about pre-conceptional care. The internal control score also showed a positive and significant correlation with both age and the subject knowledge about folic acid (r = 0.19 and r = 0.15, respectively).

CONCLUSION

The majority of women had a favorite perceived internal control. Since age and educational level were the affecting factors on the perceived internal control of women, promoting the level of internal control in young women and those with low education in pre-marital counseling classes seems necessary.

The influence of locus control on adherence to treatment regimen among hypertensive patients

BACKGROUND

The purpose of this study was to investigate the influence of locus of control on adherence to a treatment regimen among hypertensive patients.

METHODS

The participants were 100 previously diagnosed hypertensive patients drawn from the Ituku-Ozalla University of Nigeria teaching hospital, using a purposive sampling technique. All participants were individually administered the Wallston, Wallston & Devellis (1978), Multidimensional Health Locus of Control (MHLC) scale, and Drug Adherence Questionaire (DAQ) by the researchers. A one-way factorial design and analysis of variance with unequal sample sizes were used to analyze the data.

RESULTS

Internally-oriented patients adhered more to their treatment regimen than externally-oriented patients, F(1.98) = 18.2 (P < 0.01).

CONCLUSION

Locus of control should be taken into consideration in the review of treatment packages for patients. This is because the efficacy of drugs depends to a reasonable extent on adherence to the schedule. If drugs are not taken as prescribed, their potency may be affected or wrongly assessed.

How are adherent people more likely to think? A meta-analysis of health beliefs and diabetes self-care

PURPOSE

Diabetes is increasingly prevalent, and nonadherence with diabetes treatment regimens is associated with physical and social costs. Psychological predictors of adherence have been investigated in the literature, including cognitive factors. The present meta-analysis was conducted to investigate the association between beliefs related to diabetes and adherence to diabetes regimens.

METHODS

Studies that measured both (a) beliefs, perceptions, or cognitions about diabetes and (b) the relationship between such cognitive factors and blood glucose levels or other adherence behaviors were included. This research focused on adults with any type of diabetes, reaching a final sample of 48 studies. The effect size r was calculated for all types of beliefs and outcomes.

RESULTS

The types of beliefs most strongly associated with adherence were self-efficacy, perceiving a positive relationship with physician, and beliefs about the personal consequences of adherence. A few limitations of this meta-analysis are that studies were only retrieved through databases and other sources were not searched, only articles in English were included, and only adult participants were included.

CONCLUSIONS

People who are more adherent have a higher level of confidence in their ability to follow medical recommendations, expect more meaningful positive consequences for adherence, and perceive a more positive relationship with their health care provider. Educators and clinicians could use cognitive restructuring techniques to facilitate these types of beliefs and perceptions in people with diabetes.