Protocol for a web-based study on the work environment and daily lifestyle of Japanese employees

Mental health problems are prevalent among the working population and must be resolved. We conducted a web-based large-scale study of workers, including a baseline survey and two follow-up surveys, to investigate the associations between self-care behaviors in daily life (e.g., stress coping, sleep, diet, and exercise), work environment improvements, and mental health among Japanese employees from various industries. In this protocol, we demonstrate the study design and demographic data of the participants in the baseline survey. Invitations to participate in this study were sent to 421,825 internet monitor registrants in February 2022. Overall, 20,000 registrants who met the inclusion criteria participated in the survey. There were large variations in occupations and working styles (e.g., physical work, night work, and teleworking) among the participants, and we also found significant differences between male and female participants in the demographic data. An overview of the survey data suggests that the demographic characteristics of the participants in this study are comparable to those reported in previous studies on Japanese employees. We plan to use these survey data in the future to examine the associations of daily lifestyles and work environments with the mental health of Japanese employees.

Effect of high-intensity interval training on self-care and anxiety-like behaviors in naive rats

Self-care behavior covers individual's health, life and well-being to maintain the necessary activities. The aim of this study is to examine the self-care and possible anxiolytic effects of high-intensity interval exercise (HIIT). Eight-week-old Wistar Albino male rats were divided into Control (n = 8), and Exercise (n = 8). Rat exercised for 38 min a day, 5 days a week, for 8 weeks The animals were then subjected to open field test and splash test, and the behaviors were video recorded. Student t test and Shapiro-Wilk test were used as statistical tests. In the exercise group, spray-induced grooming behavior increased significantly in terms of duration and frequency (p < 0.05), but no significant difference was observed in the latency of grooming (p > 0.05). In the open-field test, the total distance traveled, which is a locomotor activity parameter, did not change between the groups. Anxiolytic-like behaviors such as total rearing behavior, unsupported rearing, central time, and central region entries increased remarkably in the exercise group vs. control (p < 0.0001). Freezing as an anxiogenic behavior decreased in the exercise group positively (p < 0.0001). Intermittent high-intensity exercise improved and increased self-care behaviors. Further, the present study shows that HIIT has beneficial effects on different aspects of behaviors such as exploratory behaviors, increasing anxiolytic behaviors, and reducing anxiogenic behavior. The present study is a preclinical study that will pave the way for new studies.

Exploring the adaptive leisure activities of classified nursing model in elderly colon cancer patients: a perspective on interactive care

OBJECTIVE

The aims of the study were first to explore the adaptive leisure activities of classified nursing model from the perspective of nurse-patient interactive care, and to explore its impact on the physical and mental health of patients with colon cancer.

METHODS

From September 2017 to March 2022 as the observation time node, 82 patients with colon cancer who met the established inclusion and exclusion criteria were regarded as the research objects through the random number table as the grouping tool. The two groups of patients were named as the research group and the control group, with 41 patients in each group. The control group implemented routine nursing measures, and the research group implemented classified nursing mode and adaptive leisure activity mode. The two groups of patients received 4 weeks of nursing intervention. With the help of self-rating anxiety scale, self-rating depression scale, self-care ability evaluation scale and health status survey brief form, the two groups of patients were compared before intervention and at the end of the 4th week after intervention.

RESULTS

After the intervention, the anxiety score (t = 6.656, p < 0.001) and depression score (t = 4.851, p < 0.001) of the research group were lower than those of the control group, and the difference was statistically significant. After the intervention, the self-concept (t = 4.845, p < 0.001), self-responsibility (t = 6.071, p < 0.001), self-care skills (t = 3.341, p < 0.001), health knowledge (t = 3.698, p < 0.001) and total score (t = 9.246, p < 0.001) of the research group were higher than those of the control group, and the difference was statistically significant. After the intervention, physical functioning (t = 8.141, p < 0.001), bodily pain (t = 6.083, p < 0.001), general health (t = 9.424, p < 0.001), role-physical (t = 8.057, p < 0.001), role-emotional (t = 13.252, p < 0.001), mental health (t = 12.565, p < 0.001), social functioning (t = 10.813, p < 0.001) and vitality score (t = 12.890, p < 0.001) of the research group were higher than those of the control group, with significant differences.

CONCLUSION

Interactive care through adaptive leisure nursing improves mental well-being, self-management, and psychosocial functioning in elderly colon cancer patients, promoting overall health.

Occupational Performance Coaching for Adults with Heart Failure: Randomized Controlled Trial Protocol

Background: Patients with heart failure (HF) usually experience functional disabilities and face participation challenges. Self-care behavior is an essential component of long-term management of HF. Purpose: This study aims to investigate the effect of occupational performance coaching (OPC) on self-care behaviors and participation in people with HF. Method: This study is a parallel group, single-blind, randomized controlled trial of 44 adults with HF, to evaluate the efficacy of OPC. Patients will be randomly allocated (1:1) into two groups. Both groups will receive usual self-care education and the intervention group will receive eight weekly sessions of OPC as well. We will measure the primary and secondary outcomes at baseline, 8, and 12 weeks after the intervention initiation. Implications: If OPC is superior to usual self-care education on improving self-care behavior and participation, the finding will support the integration of OPC into practice to improve participation and self-care behaviors of HF patients.

Adherence in Diabetes Questionnaire (ADQ) score as predictor of 11-year HbA1c trajectories in children and adolescents with type 1 diabetes: A population-based longitudinal study

AIMS

To identify 11-year HbA_1c trajectories in children/adolescents with type 1 diabetes and determine whether baseline caregiver- and/or child/adolescent-reported Adherence in Diabetes Questionnaire (ADQ) scores and multiple covariates predict HbA_1c trajectory membership.

METHODS

For a 2009 population-based cohort of children/adolescents with type 1 diabetes, we analyzed HbA_1c follow-up (2010-2020) data from Danish diabetes registries. HbA_1c trajectories were identified with group-based trajectory modeling. Using multinomial logistic regression, we tested whether ADQ scores predicted trajectory membership when adjusting for sex, age at diabetes diagnosis, diabetes duration, family structure, and caregiver education.

RESULTS

For 671 children/adolescents (10-17 years at baseline) with 5644 HbA_1c observations over 11 years, four trajectories/groups were identified: 1) "on target, gradual decrease" (27%), 2) "above target, mild increase then decrease" (39%), 3) "above target, moderate increase then decrease" (25%), and 4) "well above target, large increase then decrease" (9%). Using group one as the reference, lower caregiver-reported ADQ scores predicted group 2, 3, and 4 membership. Lower child/adolescent-reported ADQ scores predicted group 3 and 4 membership. Low caregiver education predicted group 3 and 4 membership. Single-parent status predicted group 4 membership.

CONCLUSIONS

ADQ scores and socio-demographics may serve as tools to predict glycemic control in youth with type 1 diabetes.

Prediction of self-care behaviors among diabetic patients based on social cognitive theory

Background

Diabetes is a global health issue and the most prevalent chronic metabolic disease, which requires lifelong self-care behaviors. Thus, the present study was conducted with the aim of predicting the factors of self-care behaviors based on social cognitive theory in diabetic patients referred to comprehensive health service centers in Fasa.

Methods

This cross-sectional research comprised 106 type 2 diabetes patients who were referred to Fasa service providers to determine the optimal solution. Outcomes were assessed using an existing demographic questionnaire, the diabetic self-care questionnaire, and a unique questionnaire to assess social cognitive theory, the validity and reliability of which were estimated. SPSS21 software with a Chi license was used for data analysis, and Spearman correlations, independent t-tests, and one-way ANOVA were performed.

Results

The age range of patients was between 33 and 67 years. There was a significant relationship between gender, education, and type of treatment with self-care. According to the findings, the variables of self-efficacy (r = 0.200), self-efficacy of overcoming obstacles (r = 0.285), environmental factors (r = 0.334), observational learning ability (r = 0.148), situational perception (r = 0.297), emotional adaptation (r = 0.051), outcome assessment (r = 0.114) and outcome expectation (r = 0.082) had a positive and significant correlation with self-care behaviors. Also, the self-efficacy variable (Beta coefficient = 0.340) had the highest predictive value.

Conclusion

In designing and implementing educational interventions for self-care of diabetic patients, the theory of social cognition can be used as a framework to promote and maintain public health in patients.

Self-care behavior and associated factors among patients with heart failure in public hospitals of Southeast Ethiopia

Objective

This study was performed to assess self-care behavior and associated factors among patients with heart failure attending public hospitals in Southeast Ethiopia in 2021.

Methods

An institutional-based cross-sectional study was conducted among 420 patients with heart failure from 15 May to 30 June 2021 using a simple random sampling technique. A multivariable binary logistic model was used to identify factors associated with self-care behavior. Statistical significance was declared at p < 0.05.

Results

The magnitude of good self-care behavior among patients with heart failure was 53.6% [95% confidence interval (CI), 48.9–58.3]. Factors associated with self-care behavior were treatment with a beta blocker [adjusted odds ratio (AOR), 0.49; 95% CI, 0.27–0.89], treatment with digitalis (AOR, 0.11; 95% CI, 0.05–0.24), the level of social support (AOR, 0.07; 95% CI, 0.03–0.15), and the presence of depressive symptoms (AOR, 0.21; 95% CI, 2.70–8.33).

Conclusion

Slightly more than half of the respondents had good self-care behavior. Attention should be given to enhancing good self-care practice through integration of health education as routine care.

Oral self-care behavior and its influencing factors in a sample of school children from Central Iran

BACKGROUND

Oral health is an important part of public health and crucial to health promotion and enhancing the quality of life. This research examined childhood oral self-care behavior and their related factors using extended Theory of Planned Behavior (TPB).

METHOD

This cross-sectional study was conducted on 368 sixth-grade elementary school students in Saveh city, Iran, in 2019. The students were selected using a random multi-stage sampling method. The instrument included the socio-demographic questions, TPB constructs, and action and coping plan items. Data were analyzed by SPSS software (Version 21) at alpha level p ≤ 0.05.

RESULT

Overall, 24 (6.6%) students have never used toothbrushes, 222 (62.7%) have never used dental floss, and 298 (82.7%) students have never used mouthwash. The stepwise multiple linear regression analysis results indicated that the TPB with action and coping planning constructs had better predictive power than the original model. In the final model, coping planning (β = .28), intention (β = .24), action planning (β = .23), and perceived behavior control (β = .15) were the most important predictors of oral self-care behavior.

CONCLUSION

The results indicated that the oral self-care behavior status in Iranian elementary students was not favorable, and the extended model of the TPB with action and coping plan constructs were significant predictors of self-care behavior. Therefore, these findings emphasize the need for expanding educational interventions based on the extended model of the TPB to improve the oral self-care behavior of students.

Effect combined learning on oral health self-efficacy and self-care behaviors of students: a randomized controlled trial

BACKGROUND

In order to prevent oral diseases, the use of appropriate oral health education at childhood is one of the most important strategies for improving oral health knowledge and by extension positive oral health habits. Therefore, the present study aimed to evaluate the effect of animations and games as a strategy for improving oral health self-efficacy and self-care behaviors among 6-12-aged students.

METHODS

In this interventional study, 82 students were selected based on cluster random sampling including 38 for the case and 44 for the control group. The case group received four sessions of combined learning per week including animations and games while the control group received routine school education. The data were collected in six domains including demographics, self-care, knowledge, attitude, behavior and self-efficacy before and 5 months after the intervention using a questionnaire. SPSS version 20 was used for data analysis.

RESULTS

Five months after the intervention, the mean score of self-care, self-efficacy, behavior increased from 3.8 to 4.8, 36.8 to 48.9, and 17.07 to 18.29, respectively indicating a significant change (p < 0.05). However, no significant change was reported in these variables in the control group (p  > 0.05).

CONCLUSION

The use of animation combined with other strategies for oral health self-care education can positively influence the students' performance and self-efficacy. IRCT registration number This trial was registered at IRCT. IRCT2017042133565N1 Registration date: 2017-05-17 https://en.irct.ir/trial/25851.

A theory of planned behavior-enhanced intervention to promote health literacy and self-care behaviors of type 2 diabetic patients

Background

Improved health literacy and awareness could help type 2 diabetic patients to control the disease complications.

Objective

The current study aimed to evaluate the impact of theory-based educational intervention on health literacy and self-care behaviors of type 2 diabetic patients in Tonekabon city.

Methods

This randomized controlled trial study was conducted at health care centers in Tonekabon city, Iran, from April 5, 2017, to October 22, 2018. Using multistage random sampling, 166 patients with type 2 diabetes divided into two groups: theory-based intervention (n = 83) and custom education (n = 83). The data collection tools consisted of demographic information, Theory of Planned Behavior (TPB) measures, health literacy for Iranian adults (HELIA) and summary of diabetes self-care activities (SDSCA). The five 45-minute group training sessions based on the baseline assessment and model constructs along with the targeted pamphlet and m-health strategy were designed for the experimental group. Data were analyzed using chi-square, independent and paired t-test and Analysis of covariance (ANCOVA).

Results

After controlling for pre-test effect, there was a significant difference between the two groups in terms of mean scores of attitudes, subjective norms, perceived behavior control and intention in post-test (P < 0.001). Also, after controlling for the pre-test effect, the results showed a significant difference in the self-care domain in the post-test (P < 0.001). Finally, after controlling for the pre-test variable effect, covariance analysis reflects significant difference in total health literacy score and its dimension at posttest (P < 0.001).

Conclusions

Applying TPB based education is suggested to maintain and improve self-care behaviors and health literacy in type 2 diabetic patients and other chronic diseases.

Precipitating factors and clinical impact of early rehospitalization for heart failure in patients with heart failure in Awaji Island, Japan

BACKGROUND

Recent reports have revealed that patients who experienced early rehospitalization for heart failure (HF) had worse prognoses in terms of all-cause and cardiovascular deaths as compared to those who did not. However, precipitating factors for early rehospitalization for HF remain unknown. In this study, we assessed the precipitating factors for early rehospitalization and their impact in patients with HF.

METHODS AND RESULTS

We consecutively included 242 patients (mean age: 80.4 years, females: 46.3%) with a history of rehospitalization for HF. They were divided into 2 groups: the early rehospitalization group (71 patients who were readmitted within 3 months of discharge) and the late rehospitalization group (171 patients who were readmitted after more than 3 months following discharge). During the mean follow-up period of 1,144 days (range: 857-1,417 days), 121 patients (50.0%) died. Kaplan-Meier analysis revealed that patients in the early rehospitalization group had worse prognosis (all-cause death and cardiovascular death) than those in the late rehospitalization group (log-rank p<0.001). As the major precipitating factor for rehospitalization, poor compliance with the doctor's instructions on fluid and physical activity restrictions (determined by the patients or their families admittance of non-compliance with the instructions given at the time of discharge) was higher in the early rehospitalization group than in the late rehospitalization group [poor compliance with fluid restriction: 19.7% vs. 7.6% (p = 0.006), poor compliance with physical activity restriction: 21.1% vs. 9.4% (p = 0.013)].

CONCLUSIONS

We concluded that early hospital readmission in patients with HF was associated with higher mortality rates. Compared to late rehospitalization, precipitating factors for early rehospitalization were more strongly dependent on the self-care behaviors of the patients. A more effective approach, such as multidisciplinary intervention, is essential to prevent early hospital readmission and subsequent poor prognosis.

Distress and Type 2 Diabetes Self-Care: Putting the Pieces Together

BACKGROUND

Conflicting research emphasizes depression, diabetes distress, or well-being in relation to diabetes self-care and risk for poor health outcomes.

PURPOSE

The purpose of this study was to test whether a latent variable for general psychological distress derived from shared variance of depression symptoms, diabetes distress, and well-being predicts a latent variable of diabetes self-care and to examine evidence for unique effects once shared effects are adjusted for.

METHODS

Adults with suboptimally controlled diabetes were recruited from the South Bronx, NY, for a telephonic diabetes self-management support trial. Baseline diabetes self-care, medication adherence, depression symptoms, diabetes distress, and well-being were measured by validated self-report. Structural equation modeling specified a latent variable for general psychological distress derived from shared variance of depression symptoms, diabetes distress, and well-being. Diabetes self-care was a latent variable indicated by diet, glucose self-monitoring, and medication adherence.

RESULTS

Participants (N = 627, 65% female) were predominantly ethnic minority (70% Hispanic; 45% Black) and 77% reported household income <$20K/year. Mean (standard deviation) age = 56 (12) years; A1c = 9.1% (1.9%); body mass index = 32 (8) kg/m2. The latent variable for psychological distress was a robust predictor of poorer diabetes self-care (coefficient = -0.59 [confidence interval = -0.71, -0.46], p < .001) with good model fit. Unique paths from depression symptoms, diabetes distress, and well-being (all ps > .99) to self-care were not observed.

CONCLUSIONS

In this population of disadvantaged adults with suboptimally controlled diabetes, general psychological distress was strongly associated with poorer diabetes self-care and fully accounted for the effects of depression, diabetes distress, and positive well-being. This suggests that general distress may underlie previously reported associations between these constructs and diabetes self-care.

Self-care behavior: a new insight of the role of impulsivity into decision making process in persons with heart failure

Background

Self-care behavior has been reported to be below optimum in persons with heart failure, while the underlying decision making is not well understood. The Hot/Cool System model is a psychological model that may have potential applications in decision making process in persons with heart failure. The aim of this study was to examine the decision making process in self-care behavior in persons with heart failure in the light of the Hot/Cool System model.

Methods

We used the Hoot/Cool System Model to guide this study. Participants with heart failure from in-patients setting (N = 107) were recruited. Data were collected using self-report questionnaires. Moderated mediation analysis was used to study complex relationships among study variables.

Results

The current study showed that impulsivity and perceived stress were negatively associated with self-care behavior. The results also showed that self-care confidence and impulsivity significantly predict self-care maintenance. The moderated mediation analysis revealed that self-care confidence mediated the relationship between impulsivity and self-care maintenance at lower levels of perceived stress, but not at higher levels of perceived stress.

Conclusion

Our findings revealed that persons with heart failure tend to make impulsive choices that may negatively affect disease progression under higher levels of perceived stress. This study provides foundational knowledge regarding the decision making process in persons with heart failure.

Association between subthreshold depression and self-care behaviors in people with type 2 diabetes: a systematic review of observational studies

BACKGROUND

Self-care behaviors in people living with type 2 diabetes are important to achieving optimal glycemic control. Major depression in type 2 diabetes is associated with decreased adherence to self-care behaviors. The association between subthreshold depression and self-care behaviors, however, has not previously been systematically reviewed. The objective of this review is to determine the association between subthreshold depression and self-care behaviors.

METHODS

A systematic search was performed in five electronic databases that included MEDLINE, EMBASE, PsycINFO, Emcare, and CINAHL. Any observational studies in adults with type 2 diabetes, investigating the association between subthreshold depression and any self-care behaviors, were included in the review. Qualitative studies, review articles, and gray literature were excluded. Two reviewers independently completed the title and abstract and full-text screening, appraised the study quality, and extracted the data. A third reviewer resolved any discrepancies between the reviewers if needed. Included articles were critically appraised using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Meta-analyses were not conducted because criteria for conducting such analyses were not met.

RESULTS

A total of 6408 articles were identified through the database searching. After the abstract and full-text review, two articles met the inclusion criteria. One of the included study was cross-sectional while the other was a longitudinal study. Both studies showed inconsistent findings in the association between subthreshold depression and self-care behaviors. Important risks of bias were identified in the included studies.

DISCUSSION

The evidence from the two included studies on a possible association between subthreshold depression and self-care behaviors in adults with type 2 diabetes was not consistent and potentially biased. Our review established a gap in knowledge and suggests that further high-quality studies are needed to examine the association between subthreshold depression and self-care behaviors in people with type 2 diabetes.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018116373.

Cognitive determinants of self-care behaviors among patients with heart failure: A path analysis

Background: Heart failure (HF) is a common clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of ventricles to fill with or eject blood.Our aim in this study was to examine the possible direct/indirect effects of health belief model(HBM) constructs on self-care behaviors among HF patients. Methods: A secondary analysis was conducted on an HBM-based data set collected from 180 patients with HF who were recruited from a heart hospital in Tehran, Iran, during a prospective experimental study in 2008. A regression-based path analysis was conducted to examine the relationships between HBM constructs (as independent variables) and self-care behaviors (as dependent variable). Results: A conceptual path model was identified for the cognitive determinants of self-care behaviors among HF patients. Knowledge (β = 0.399), perceived barriers (β = 0.315) and susceptibility (β = 0.165) had direct effects on self-care (R2 = 0.512, P < 0.001). Perceived benefits, self-efficacy, severity and threat, locus of control and cues to action had indirect effects on self-care through the first three variables. Conclusion: HBM was found to be helpful in understanding direct and indirect associations between the cognitive determinants and self-care behaviors among HF patients. Based on this challenging path analysis, HF patients' knowledge and perceived barriers and susceptibility are suggested as the most core categories while designing HF educational programs. Better understanding on such associations may lead nurses and health practitioners in designing properly informed stage-specific educational interventions aiming to foster self-care behaviors among HF patients.

Relationships between health literacy, motivation and diet and physical activity in people with type 2 diabetes participating in peer-led support groups

AIMS

To investigate associations between health literacy (HL) and diet and physical activity, and motivation and diet and physical activity in Danish people with type 2 diabetes.

METHODS

We used a cross-sectional design including 194 individuals with type 2 diabetes participating in peer-led support groups provided by the Danish Diabetes Association between January-December 2015. The participants completed a questionnaire at the first meeting including; The Summary of Diabetes Self-Care Activities (SDSCA) measure, The Treatment Self-Regulation Questionnaire (TSRQ) (Self-Determination Theory) measuring type of motivation, and two HL scales: The HLS-EU-Q16, and the Diabetes Health Literacy scale (Ishikawa, H). Data were analyzed using linear regression models adjusting for age, gender, educational level, diabetes duration, motivation and HL.

RESULTS

The adjusted β (95%CI) showed that autonomous motivation and functional HL were associated with following recommended diet: autonomous motivation; 0.43 (0.06; 0.80) and functional HL; 0.52 (0.02; 1.00). Autonomous motivation was related to following physical activity recommendations; β (95%CI) 0.56 (0.16; 0.96).

CONCLUSIONS

This study indicates that, for people with type 2 diabetes, functional HL and autonomous motivation may be important drivers for following diet recommendations, and autonomous motivation may be the most important factor for following recommendations regarding physical activity. These concepts may therefore be highly relevant to address in interventions to people with type 2 diabetes. Different interventions are suggested.

Prolonged uninterrupted sitting increases fatigue in type 2 diabetes

Fatigue is a prevalent, costly and disabling clinical complaint among those with type 2 diabetes. In a randomized crossover trial, prolonged uninterrupted sitting increased fatigue by 29% relative to days when sitting was regularly interrupted by brief activity-breaks. This may have implications for diabetes-related quality of life, occupational productivity and self-care.

Association of Self-Care Behaviors and Quality of Life among Patients with Type 2 Diabetes Mellitus: Chaldoran County, Iran

BACKGROUND

Self-care of diabetes is an essential part for controlling the disease and improvement of quality of life in type 2 diabetes mellitus (T2DM) patients. This study aimed to analyze the associated factors of quality of life in patients with T2DM in order to design effective interventions.

METHODS

This cross-sectional study was conducted on 120 T2DM patients referred to health centers of Chaldoran, West Azerbaijan Province, Iran. The quality of life's questionnaires from World Health Organization and the self-care behaviors' questionnaires were used for data collection.

RESULTS

The mean age of patients was 46.30% and 53.30% of them were male. Among demographic variables, gender (P=0.002), age groups (P=0.007), and household monthly income (P=0.009) were significantly associated with total quality of life. Also, self-care nutrition (odds ratio [OR], 1.47; P=0.001), self-management of blood glucose control (OR, 1.29; P=0.002), and self-medication behavior (OR, 1.18; P=0.030) were identified as factors significantly associated with quality of life.

CONCLUSION

Self-care behaviors were significantly associated with quality of life; among them, the greatest influence was observed in self-care nutrition behavior. According to the findings of this study, appropriate interventions on self-care behaviors about nutrition can improve the quality of life for T2DM patients.

Relation of parent knowledge to glycemic control among emerging adults with type 1 diabetes: a mediational model

The study goal was to examine the links of parent knowledge of children's behavior to diabetes outcomes and to test a mediational model that focused on psychological distress and self-care behavior. We recruited 132 adolescents (average age 12) and followed them to average age 23. At age 23 (n = 107), we conducted in-person interviews with these emerging adults to measure parent knowledge, psychological distress, self-care behavior and glycemic control. We used structural equation modeling to test our hypotheses with these cross-sectional data. Higher levels of parent knowledge were linked to better glycemic control, and this path was mediated by reduced psychological distress and enhanced self-care behavior. Parents remain an important influence in the lives of emerging adults with type 1 diabetes. When emerging adults have a relationship with their parents in which they share general information, psychological distress may be reduced which then facilitates self-care and, ultimately, glycemic control.

Predicator of Pregnant Women's Self-care Behavior against Air Pollution: An explanation based on the Extended Parallel Process Model (EPPM)

Introduction

Air pollution is one of the most important problems of metropolitan cities. The level of air pollution in the city of Ahvaz is so much higher than the standard level, that it can create risks, particularly for pregnant women in the area. The aim of the study was to examine the predictors of self-care behavior of pregnant women against air pollution according to Extended Parallel Process Model (EPPM) in Ahvaz.

Methods

In this cross-sectional study, 330 pregnant women who were referred to health care centers in western Ahvaz in 2015 were examined. The data collection tool was a reliable and valid researcher-made questionnaire consisting of three parts: The first part was demographic information, the second part according to the extended parallel process model, included perceived susceptibility, perceived severity, response efficacy, and self-efficacy. The third part examined self-care behavior. Then, the collected data was analyzed by using the software SPSS 16. Data analysis was done by using Spearman’s correlation coefficient and linear regression.

Results

The average age of study subjects was 26.07 ± 2.3 years, and most (45.5%) were in the second trimester of pregnancy. These findings showed that self-efficacy constructs (β = 0.41) and response efficacy (β= 0.15) have predictive power of self-care behavior (p < 0.05).

Conclusion

The findings showed that self-efficacy and response efficacy, are important factors to predict air pollution self-care behavior. Therefore, to develop a theory-based behavioral modification program for pregnant women, more emphasis on these constructs is recommended.

Attributing discrimination to weight: associations with well-being, self-care, and disease status in patients with type 2 diabetes mellitus

This study examined the association between attributing self-reported discrimination to weight and diabetes outcomes (glycemic control, diabetes-related distress, and diabetes self-care). A community dwelling sample of 185 adults (mean age 55.4; 80 % White/Caucasian 65 % female) with poorly controlled type 2 diabetes (HbA1c level ≥ 7.5 %) provided demographic and several self-report measures (including diabetes-related distress, diabetes self-care activities, discrimination, and attributions of discrimination), and had height, weight, and glycated hemoglobin (HbA1c) assessed by trained research staff as part of a larger research study. Individuals who attributed self-reported discrimination to weight had significantly higher HbA1c levels, higher levels of diabetes-related distress, and worse diabetes-related self-care behaviors (general diet, exercise, and glucose testing). These relationships persisted even when controlling for BMI, overall discrimination, depressive symptoms, and demographic characteristics. Results indicate that the perception of weight stigma among individuals with type 2 diabetes is strongly associated with a range of poor diabetes outcomes. Efforts to reduce exposure to and/or teach adaptive coping for weight stigma may benefit patients with type 2 diabetes.

Adherence to self-care behavior and glycemic effects using structured education

Aims/Introduction

The purpose of the present study was to examine glycemic control in suboptimally controlled type 2 diabetes provided by a structured education group using the Diabetes Conversation Map™ (CM™) vs usual care in a university-based hospital primary care clinic.

Materials and Methods

This was a randomized, pragmatic clinical trial. Patients with type 2 diabetes were randomly assigned to structured education or usual care groups. The primary outcome was the difference in the mean change of glycated hemoglobin (HbA1c) from baseline to 12 months. Secondary outcomes included the percentage achieving therapeutic HbA1c goal and self-behavioral changes.

Results

A total of 245 patients were randomly assigned to two groups (CM™ group n = 121; usual care group, n = 116). The absolute reduction of HbA1c was significantly greater in the CM™ group at 3 and 6 months (Δ = −0.59% and Δ = −1.13%, P < 0.01), but the difference was no longer statistically significant at 9 and 12 months (Δ = −0.43% and Δ = −0.49%), based on an intention-to-treat analysis. A per-protocol analysis showed the significant change was maintained at 12 months (Δ = −0.67%). In the intervention group, greater percentages of patients achieved their American Association of Diabetes Educators Self-Care Behaviours™ framework (AADE7) behavioral goals at 3 months, in particular being active, problem-solving, reducing risk and health coping.

Conclusions

In type 2 diabetic patients with suboptimally controlled glucose, there were greater improvements in glucose control and self-care behavioral goals in those who underwent the CM™ education program compared with outcomes achieved in patients receiving usual care.