Regulatory focus and adherence to self-care behaviors among adults with type 2 diabetes

The aims of this study were, first, to test the association between regulatory focus of adults with type 2 diabetes and their adherence to two types of self-care behaviors – lifestyle change (e.g. physical activity and diet) and medical care regimens (blood-glucose monitoring, foot care and medication usage). Second, to explore whether a fit between the message framing and patients’ regulatory focus would improve their intentions to adhere specifically when the type of behavior fits the patients’ regulatory focus as well. A cross-sectional study was conducted among 130 adults with type 2 diabetes who were hospitalized in an academic medical center. The patients completed a set of questionnaires that included their diabetes self-care activities, regulatory focus, self-esteem and demographic, socioeconomic and clinical data. In addition, participants were exposed to either a gain-framed or a loss-framed message, and were then asked to indicate their intention to improve adherence to self-care behaviors. A multivariable linear regression model revealed that promoters reported higher adherence to lifestyle change behaviors than preventers did (B = .60, p = .028). However, no effect of regulatory focus on adherence to medical care regimens was found (B = .46, p = .114). In addition, preventers reported higher intentions to adhere to medical care behaviors when the message framing was congruent with prevention focus (B = 1.16, p = .023). However, promoters did not report higher intentions to adhere to lifestyle behaviors when the message framing was congruent with promotion focus (B = ?.16, p = .765). These findings justify the need to develop tailor-made interventions that are adjusted to both patients’ regulatory focus and type of health behavior.     

Feasibility of a pilot intervention targeting self-care behaviors in adults with diabetes mellitus

Diabetes has reached epidemic proportions and is widely encountered by clinicians in medical settings. National Standards for diabetes education recommend utilization of an interdisciplinary team, setting individual lifestyle goals and managing barriers. However, typical diabetes education programs lack integration of strategies for translating recommendations into behavioral actions. The present intervention was developed to assess the feasibility and efficacy of a short-term cognitive-behavioral intervention aimed at optimizing self-care behaviors in adults with diabetes in a “real world” medical setting. Participants were 20 adults who had completed medical model outpatient diabetes education. The intervention consisted of 6 weekly sessions that addressed the role of behavior in diabetes including self-care barriers, cognitions and self-regulation. Pre-post intervention data indicated greater specificity in goal-setting. Participants who kept activity records had the greatest lifestyle activity behavior change. Findings suggest that a brief intervention addressing realistic goal-setting is feasible and can promote meaningful health behavior changes. Clinical psychology can provide a bridge between current diabetes care recommendations and available medical resources by providing training in and delivery of empirically supported behavior change strategies and evaluation of diabetes care treatment approaches.     

Differential effects of social support and social network on physiological and social outcomes in men and women with type II diabetes mellitus

Patients with non-insulin-dependent diabetes mellitus (NIDDM) were advised to comply with a complex behavioral regimen of diet and exercise. The relationship between social support satisfaction and social support network size was evaluated using the Social Support Questionnaire for 32 men and 44 women with a confirmed diagnosis of NIDDM. Control of diabetes, as measured by the glycosylated hemoglobin assay, was significantly correlated with social support satisfaction for women but negatively correlated with social support satisfaction for men. Social support network size differentially predicted success in a program for men and women. For women, network size was significantly correlated with failure to attend sessions and with failure to complete a diary. For these women, network size was not significantly correlated with weight loss, which was the goal of the program. For men, network size was correlated with increases in weight, cholesterol, and triglycerides over an 18-month period. We conclude that social support network size and satisfaction have different functions for men and women faced with a serious chronic illness. Network size adversely affects success in a program, whereas social support satisfaction has some benefits for women. The direction of the influence of social network may be determined by the similarity or dissimilarity of network norms to the desired behavior.     

Comorbid anxiety and mood disorders among persons with social anxiety disorder.

Axis I comorbidity is associated with greater severity of social anxiety disorder. However, the differential effects of comorbid mood and anxiety disorders on symptom severity or treatment outcome have not been investigated. We evaluated 69 persons with uncomplicated social anxiety disorder, 39 persons with an additional anxiety disorder, and 33 persons with an additional mood disorder (with or without additional anxiety disorders). Those with comorbid mood disorders reported greater duration of social anxiety than those with uncomplicated social anxiety disorder. They were also judged, before and after 12 weeks of cognitive-behavioral group treatment and at follow-up, to be more severely impaired than those with no comorbid diagnosis. In contrast, persons with comorbid anxiety disorders were rated as more impaired than those with no comorbid diagnosis on only a single measure. Type of comorbid diagnosis did not result in differential rates of improvement of social anxiety disorder.     

Influence of functional impairment and social support on depressive symptoms in persons with diabetes

Tested the buffering model of social support among 158 adults with diabetes. We predicted that, among patients with higher levels of illness-related impairment, adequate social support would act as a buffer against depression. Measures included the Beck Depression Inventory; the Sickness Impact Profile; and an assessment of the adequacy of social support to enable the patient to deal with illness-related tasks, domestic chores, financial responsibilities, and emotional needs. Depressive symptoms correlated positively with functional impairment (r = .58, p less than .001) and negatively with the adequacy of social support (r = -.31, p less than .001). In addition, social support moderated depression in the face of greater impairment such that, among patients who reported the most illness-related functional disabilities, adequate support provided a relative protection from depression. The findings suggest that individuals with inadequate support are most at risk to become depressed when disability related to illness increases.     

Determinants of physical activity among patients with type 2 diabetes: the role of perceived autonomy support,autonomous motivation and self-care competence

Based on self-determination theory (SDT), this study investigated, whether the three central SDT variables (perceived autonomy support, autonomous motivation and self-care competence), were associated with engagement in physical activity (PA) among patients with type 2 diabetes when the effect of a wide variety of other important life-context factors (perceived health, medication, duration of diabetes, mental health, stress and social support) was controlled for. Patients from five municipalities in Finland with registry-based entitlement to a special reimbursement for medicines used in the treatment of type 2 diabetes (n = 2866, mean age 63 years, 56% men) participated in this mail survey in 2011. Of all measured explanatory factors, autonomous motivation was most strongly associated with engagement in PA. Autonomous motivation mediated the effect of perceived autonomy support on patients’ PA. Thus, perceived autonomy support (from one’s physician) was associated with the patient’s PA through autonomous motivation. This result is in line with SDT. Interventions for improved diabetes care should concentrate on supporting patients’ autonomous motivation for PA. Internalizing the importance of good self-care seems to give sufficient energy to maintain a physically active lifestyle.     

Mother-child play and emerging social behaviors among infants from maltreating families

Mother-child play of 12-month-old infants (N=130) from maltreating (N=78) and non-maltreating (N=52) families was analyzed as a context that integrates infants' developing social and cognitive skills. Play was coded from semistructured and unstructured play paradigms. No group differences were found in infants' play maturity. Infants from abusing families demonstrated more imitative play than infants from non-maltreating families, and engaged in less independent play than infants from both neglecting and non-maltreating families, suggesting a delay in emerging social behaviors. Mothers from abusing and non-maltreating families differed in attention directing behaviors. Maternal behaviors predicted child play style variables, but did not mediate the effects of maltreatment. Findings discuss the influence of an early maltreating environment upon the development of the emergent self. Implications for early intervention are underscored.     

Comparison of the role of self-efficacy and illness representations in relation to dietary self-care and diabetes distress in adolescents with type 1 diabetes

This cross-sectional study examined the joint effects of self-efficacy and illness representations on dietary self-care and diabetes distress in adolescents with type 1 diabetes by comparing two theoretical models: the Self-regulation Model (Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common-sense representations of illness danger. In S. Rachman (Ed.), Medical Psychology (Vol. 2, pp. 7–30). New York: Pergamon.) and Social Cognitive Theory (Bandura, A. (1997). Self efficacy: The exercise of control. New York: W.H. Freeman.). One hundred and fifty-one adolescents with type 1 diabetes completed self-report measures of dietary self-efficacy, illness representations, dietary self-care and diabetes distress. Data were analysed using structural equation modelling. The model best supported by the data (Leventhal's Self-regulation Model) showed that dietary self-efficacy, perceived consequences and treatment effectiveness had direct and independent effects on both dietary self-care and diabetes distress. Together with dietary self-efficacy, perceived short-term treatment effectiveness was a significant predictor of dietary self-care. Age was found to be a negative predictor of short-term treatment effectiveness beliefs. Diabetes distress was best predicted by self-efficacy and perceived consequences. It can be concluded that to target effectively dietary self-care and distress, clinicians should focus on key illness representation variables (perceived short-term treatment effectiveness and perceived consequences) in conjunction with self-efficacy.     

Stigma and social participation in Southern India: differences and commonalities among persons affected by leprosy and persons living with HIV/AIDS

Stigma is a common phenomenon worldwide and infectious diseases like HIV/AIDS and leprosy are often associated with high levels of stigma. Several studies have been conducted concerning the effects of stigma and the impact on social participation, but comparative studies are rare. The objective of this study was to identify differences and similarities between HIV/AIDS and leprosy-related stigma. From April till July 2009, 190 questionnaire-based interviews were conducted to assess the levels of internalized stigma (Internalized Stigma of Mental Illness scale), perceived stigma (Explanatory Model Interview Catalogue stigma scale) and social participation (Participation scale) in a cross-sectional sample of people affected by leprosy (PL) and people living with HIV/AIDS (PLHA). Respondents were selected from several hospitals, charity projects and during home visits in Vellore district, Tamil Nadu. Our results showed that both PLHA (n?=?95) and leprosy-affected respondents (n?=?95) faced a substantial burden of internalized and perceived stigma, with the former reporting a significantly higher level of stigma. As a result, PLHA faced more frequent and also more severe participation restrictions than PL. Especially, restrictions in work-related areas were reported by the majority of the respondents. In conclusion, PLHA faced a significantly higher level of stigma and participation restriction than PL. However, the latter also reported a substantial burden of stigma and participation restrictions. The study suggests that it may be possible to develop joint interventions based on the commonalities found. More research is needed to define these more precisely and to test the effectiveness of such joint interventions in reducing stigma and improving social participation.     

Studies in observational paired-associate learning: Informational,social, and individual difference variables

Four experiments examined the relative importance of informational (proportion of correct responses and kinds of errors emitted by a model), social (model competency, sex of model, video vs. audio taped model), and individual difference (sex of subject, grade) variables in observational paired-associate learning. In Experiments I–III, vicarious subjects received cycles of study-model-test trials, while direct subjects were given the same sequences with intervening test or stimulus familiarization trials. In Experiment IV, vicarious subjects received cycles of study-test-model-test trials, while direct subjects received the cycles with a test trial replacing the model trial. No confirmation was provided on test and model trials. Whereas the effects attributable to social and individual difference variables were generally negligible, mere accuracy of the model's responses repeatedly covaried with performance on the last test trial of each cycle. Conditional analyses established that (1) vicarious facilitation is comparable across cycles and localized in items responded to incorrectly on immediately preceding test trials, and (2) observers learn fewer incorrect than correct model responses. Vicarious groups performed at reliably higher levels than direct subjects on model correct but not incorrect items. The results strongly suggest a close correspondence between direct and vicarious verbal learning principles and mechanisms.     

Intellectual disability examinations and social context variables among patients of low socioeconomic status

The purpose was to investigate the demographic, clinical, and social context variables of clients seeking intellectual disability screening assessments, so as to promote planning and development of services in the KwaZulu-Natal midlands region of South Africa. Of 100 consecutive attendees seeking intellectual disability examinations at state mental health facilities, 70% were male and 70% were less than 18 years of age. 51% had Moderate or Severe Mental Retardation, 52% lived in homes with more than six people, and 52% in homes where nobody was employed. Of participants' families, 85% relied on social grants, 46% of attendees or caregivers wanted a social grant, 28% hoped for appropriate school placement, and 17% wanted both. Of the participants' households, 26% reported going without food for days. The results are discussed within the context of the regional social deprivation.     

Stress and blood glucose in type II diabetes mellitus

Six adults with non-insulin dependent diabetes mellitus participated in a laboratory procedure to determine the effects of an acute Stressor, mental arithmetic, on blood glucose, cardiovascular, and subjective indices of stress. They then completed 12 days home monitoring of stressful events, subjective stress, and blood glucose. Diet and activity were controlled to evaluate the direct effects of stress on blood glucose in the natural environment. Laboratory results showed significant increases in blood glucose, cardiovascular (HR and SBP), and subjective stress ratings during the mental arithmetic task when compared to a resting condition. Home monitoring data were consistent with the laboratory findings; blood glucose range tended to be greater on high vs low stress days, especially when the difference between high and low stress was greatest. These findings suggest that the laboratory stress induction procedure was externally valid and that in the natural environment, stress has a hyperglycemic effect on blood glucose.     

Testing mediator variables in a resistance training intervention for obese adults with type 2 diabetes

A poor understanding of behaviour change mechanisms has hindered the development of effective physical activity interventions. The aim of this study was to identify potential mediators of change in a home-based resistance training (RT) program for obese individuals with type 2 diabetes. Obese individuals with type 2 diabetes (N?=?48) were randomly allocated to either an RT intervention (n?=?27) or a control group (n?=?21) for the 16-week study period. The study sample included 16 men and 32 women and the mean age of participants was 54.4 (±11.7) years. Participants in the RT group received a multi-gym and dumbbells and home supervision from a certified personal trainer. RT behaviour was measured using a modified Godin Leisure Time Questionnaire. Social-cognitive constructs were measured and tested in a mediating variable framework using a product-of-coefficients test. The intervention had a significant effect on RT behaviour (p?相似文献   

Testing mediator variables in a physical activity intervention for women with type 2 diabetes

ObjectivesA limited understanding of the mechanisms of behavior change has hindered the development of more effective interventions. The aim of this study was to identify potential mediators of objectively measured physical activity (PA) behavior change in women with type 2 diabetes (T2DM).DesignMediation test of a randomized controlled trial.MethodWomen with T2DM (n = 93) from the control group (standard PA materials, n = 44) and the full intervention group (control + stage-matched printed material and telephone counseling, n = 49) of a larger PA intervention trial were included. PA outcomes were minutes of MET weighted moderate and vigorous PA/week (self-report) and steps/3-days (objective) recorded at baseline and 12-months. Social-cognitive constructs were measured and tested in a mediating variable framework.ResultsPerceived behavioral control and barrier self-efficacy mediated intervention effects on objective PA (proportion of intervention effect mediated = 18% and 24% respectively). Intention was a mediator of objective PA (23%).ConclusionPerceived behavior control, barrier self-efficacy, and intention are effective mechanisms of PA behavior change in women with T2DM.     

Testing mediator variables in a resistance training intervention for obese adults with type 2 diabetes

A poor understanding of behaviour change mechanisms has hindered the development of effective physical activity interventions. The aim of this study was to identify potential mediators of change in a home-based resistance training (RT) program for obese individuals with type 2 diabetes. Obese individuals with type 2 diabetes (N?=?48) were randomly allocated to either an RT intervention (n?=?27) or a control group (n?=?21) for the 16-week study period. The study sample included 16 men and 32 women and the mean age of participants was 54.4 (±11.7) years. Participants in the RT group received a multi-gym and dumbbells and home supervision from a certified personal trainer. RT behaviour was measured using a modified Godin Leisure Time Questionnaire. Social-cognitive constructs were measured and tested in a mediating variable framework using a product-of-coefficients test. The intervention had a significant effect on RT behaviour (p?<?0.001) and muscular strength (p?<?0.001). The intervention had a significant effect on RT planning strategies (p?<?0.01), which mediated the effect of the intervention on RT behaviour. The home-based RT program successfully targeted participants’ RT planning strategies which contributed to their exercise adherence.     

Personality variables and metabolic control in children with diabetes

Insulin-dependent diabetic children and a group of their nondiabetic peers were compared on measures of self-concept, locus of control and health locus of control. A metabolic measure of long term diabetes control was also obtained on the children with diabetes. Data analyses revealed that metabolic control was not related to any of the personality measures in the diabetic sample. Diabetic and non-diabetic children did not differ on measures of locus of control and self-concept, but diabetics exhibited a health locus of control which was significantly more internal than that of control subjects. A possible explanation for these results was discussed and practical implications for health care providers working with young diabetics were presented.