Patients' attitudes and intentions towards taking medical advice for type 2 diabetes mellitus: a theory of planned behaviour analysis

PURPOSE

A key component of effective diabetes care is understanding patients' perceptions about diabetes management. Patients' attitudes and intentions towards taking medical advice may predict the outcomes for effective diabetes care. This study aims to measure participants' attitudes, beliefs and intentions towards following medical advice to manage their diabetes using the Theory of Planned Behaviour (TPB). The domains of the TPB are correlated with clinical measures of diabetes to determine if these attitudes and intentions are predictive of better diabetes control.

METHODS

A pilot study was conducted. A 34-item survey was designed using the Theory of Planned Behaviour (TPB) framework and administered via mail by four general practice clinics. Included participants (N = 104; response rate 29.5%) had a diagnosis of type 2 diabetes and were taking medication for glycaemic control. Scores for each domain of the TPB survey were correlated with participants' clinical indicators for diabetes: HbA1c, blood pressure, lipid profile, cholesterol, and kidney health (eGFR and albumin: creatinine ratio) and BMI.

RESULTS

Participants surveyed generally reported positive attitudes and intention to follow medical advice. Medical advice was perceived to be beneficial and useful by the majority. However, in general, there was no correlation between positive intentions and improved clinical indicators of disease. Clinical indicators did not improve with duration of illness. The burden of illness is likely a mitigating factor for positive intention as participants perceive medical advice as difficult and inconvenient to follow.

CONCLUSIONS

Patients' individual capacity to implement medical advice should be addressed in shared-decision making models to potentially improve patient outcomes towards therapeutic targets.

Snacking cessation: It’s time to challenge this eating behaviour

Our habits have changed over the generations. In particular, our eating behaviours continue to adapt and are intrinsically linked with changing social norms and myriad other influences leading us to consume more. In light of the obesity epidemic that threatens to be our greatest health challenge, the race is on to find new ways to modify or alter our food choices to those considered more “healthful”. Somewhere along the way snacking has become an acceptable eating pattern. We are uncomfortable foregoing these readily available and hedonistic food rewards. It may be time to change more than our food choice and question the need to snack at all.

Doctors have a limited role in managing obesity

Obesity management is one of the greatest challenges in medicine. While the obesity epidemic continues to grow, there is increasing pressure on doctors to do more to curb these trends. National bodies offer guidelines and action plans; however, these miss the mark within the constraints of modern practice. While urgent change is needed to combat the health challenges that global obesity raises, medical practice is generally ill-equipped to make an effective change for patients. Significant innovation is needed to be able to deliver strategies that will work in a healthcare context.

Is snacking the new smoking?

The way we eat is changing. Incrementally, between-meal snacking has increased over time, and our busy, on-the-run lifestyles and changing social norms fuel the consumption of convenience foods and calorie-dense snacks. The societal normalising of snacking behaviour has myriad influences, but the marketing narrative that snacking is “good for you” needs to be challenged. Cigarette promotion of yesteryear seems unconscionable today, but the way snack foods are now pitched to the public has some eerie parallels. The pervasiveness of aggressive targeted marketing, celebrity endorsement, social normalisation narrative, and dismissal of health consequences should give us pause for thought.

Epidemiology of soccer-related head injury in children 5-14 years in Victoria, Australia

AIM

Our aim was to use epidemiological data to determine the incidence of soccer-related head injuries in children aged 5-14 years who presented at emergency departments (EDs) or were admitted in hospitals in Victoria, Australia.

METHODS

ED presentation and hospital admission de-identified aggregate data were from the Victorian Injury Surveillance Unit. Soccer participation data were compared with the soccer-related head injury data to determine the incidence of this injury among these children.

RESULTS

The incidence of ED presentations was 0.17% of children participating in soccer during the study period (financial years 2011-2012 to 2015-2016). The 10-14-years age group presented with more head injuries than the 5-9-years age group. For the admissions data, soccer had a significantly lower (P = 0.0379) incidence of head injury when compared with 'sport as a whole'.

CONCLUSIONS

The low incidence of soccer-related head injuries presenting to an ED or admission to hospital is consistent with international findings.

How are junior doctors managing patients with self-limiting illnesses at their first presentation? A video vignette study

PURPOSE

To conduct a video vignette survey of medical students and doctors investigating test ordering for patients presenting with self-limiting or minor illness.

METHODS

Participants were shown six video vignettes of common self-limiting illnesses and invited to devise investigation and management plans for the patients' current presentation. The number of tests ordered was compared with those recommended by an expert panel. A Theory of Planned Behaviour Questionnaire explored participants' beliefs and attitudes about ordering tests in the context of self-limiting illness.

RESULTS

Participants (n=61) were recruited from across Australia. All participants ordered at least one test that was not recommended by the experts in most cases. Presentations that focused mainly on symptoms (eg, in cases with bowel habit disturbance and fatigue) resulted in more tests being ordered. A test not recommended by experts was ordered on 54.9% of occasions. With regard to attitudes to test ordering, junior doctors were strongly influenced by social norms. The number of questionable tests ordered in this survey of 366 consultations has a projected cost of $17 000.

CONCLUSIONS

This study suggests that there is some evidence of questionable test ordering by these participants with significant implications for costs to the health system. Further research is needed to explore the extent and reasons for test ordering by junior doctors across a range of clinical settings.