Physicians' understanding of patients' personal representations of their diabetes: accuracy and association with self-care

The degree of accuracy with which physicians understand their patients' views may be of central importance for promoting self-care in the majority of chronic illnesses and in type 2 diabetes in particular. The objectives of this study were to measure the accuracy of the general practitioners' understanding of the patients' views and relate it to health behavioural outcomes in patients with non-complicated type 2 diabetes. The participants in this cross-sectional study consisted of 14 clinicians and 78 of their patients from Paris, France. The predictors were levels of accuracy in understanding the patients' views derived from the illness perception questionnaire-revised (IPQ-R). The outcomes were patient-reported self-care measures. In regression models controlling for clinical and personal variables, higher accuracy on chronicity beliefs was associated with an improved diet and increased blood glucose self-testing and higher accuracy in identifying treatment control beliefs was associated with better dietary self-care. Accuracy was higher with regard to beliefs about causes, treatment control and consequences. These results suggest that accuracy may impact self-care in specific domains of illness perception but not others. The results may help identify useful avenues of communication training designed for professionals.     

Beliefs About Willpower Are Related to Therapy Adherence and Psychological Adjustment in Patients With Type 2 Diabetes

Research suggests that self-control, the ability to forego immediate needs for the sake of future rewards, promotes health behavior. The present study examined the role of beliefs about willpower as predictor of self-control in the context of diabetes. Seventy-nine type 2 diabetes patients reported their beliefs about willpower, therapy adherence (i.e., self-care activities, diet, exercise), and psychological adjustment (i.e., emotional distress, well-being, life quality). Endorsing the belief that willpower is a limited versus nonlimited resource was associated with lower therapy adherence and lower psychological adjustment. How people think about their willpower might be crucial for therapy success in diabetes patients.     

Personality, personal model beliefs, and self-care in adolescents and young adults with Type 1 diabetes.

This study compared 3 models of association between personality, personal model beliefs, and self-care in a cross-sectional design. These models were as follows: (a) Emotional stability determines self-care indirectly through personal model beliefs, and conscientiousness is a direct predictor of self-care; (b) emotional stability determines self-care indirectly through personal model beliefs, and conscientiousness moderates the association between beliefs and self-care; (c) both emotional stability and conscientiousness determine self-care indirectly through personal model beliefs. Participants (N = 358, aged 12-30 years) with Type 1 diabetes completed measures of personality, personal model beliefs, and self-care. Structural equation modeling indicated that Model C was the best fit to the data.     

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.     

Diabetes-specific social learning variables and self-care behaviors among persons with type II diabetes

This study assessed the relationship between diabetes-specific social learning factors and diabetes self-care. Predictor variables were collected within the categories of knowledge (e.g., behavioral demonstrations, pencil-and-paper tests), beliefs/expectations (e.g., self-efficacy, self-motivation), skills (e.g., problem-solving and refusal skills), and environmental support (e.g., barriers to adherence, family support). Different results emerged across the three areas of the regimen assessed: diet, exercise, and glucose testing. Multiple-regression analyses revealed that the social learning variables consistently improved the prediction of self-care beyond that attributable to demographic variables but that the categories of social learning variables most closely related to self-care varied across regimen areas. These findings suggest that programs to enhance diabetes self-care could beneficially focus on life-style behaviors and employ strategies to increase regimen-related expectations and diabetes-specific social and problem-solving skills.     

Implications of Psychosocial Factors for Diabetes Outcomes among Children with Type 1 Diabetes: A Review

We adopt a risk and resistance framework to review the literature on the psychosocial factors that influence diabetes outcomes—specifically self‐care behavior (blood glucose monitoring, diet, exercise, insulin administration) and glycemic control. We examine both personal and social/environmental risk and resistance factors. We conclude by suggesting conceptual and methodological directions for future research. Conceptually, we suggest that researchers examine the synergy among variables that cut across domains, mechanisms linking psychosocial factors to diabetes outcomes, and the impact of goals on health. Methodologically, we suggest that researchers examine age, gender, and race as moderator variables; utilize momentary data collection technology; and employ more sophisticated longitudinal analyses.     

Perceived stress and diabetes control in adolescents

Studies of diabetes control have traditionally focused on patients' regulation of insulin, diet, and exercise. Although psychosocial stress may also influence blood glucose, researchers have infrequently accounted for the three primary physiological factors when estimating the effects of stress. In addition, few investigators have considered the influence of everyday minor stressors on health outcome. The Tennessee Camp for Diabetic Children provided an opportunity to monitor insulin administration, dietary intake, and exercise levels and to obtain measures of blood glucose and perceived minor stressors. The best index of stress was one in which number and magnitude of negative stressors were combined into a cumulative stress measure. Negative cumulative stress significantly correlated with blood glucose levels after controlling for the effects of insulin, diet, and exercise. In addition, diabetes control tended to be better when adolescents, particularly boys, adjusted well to negative stress. These findings suggest that minor stressors can influence health outcome, but positive and negative stress need to be assessed independently.     

Partners’ representations of diabetes as mediators between patients’ representations and adherence to self-care behaviors,in type 2 diabetes

The purpose of this study was to analyze partners’ representations of diabetes as mediators between patients’ illness representations and adherence to all self-care behaviors, in recently diagnosed type 2 diabetes (T2DM) patients. The sample included 340 patients and their respective partners. The instruments used were: Revised Summary of Diabetes Self-Care Activities (RSDSCA); Medication Adherence Report Scale (MARS); and the Brief Illness Perception Questionnaire (Brief-IPQ). A mediational effect of partners’ representation of diabetes consequences was found between the same patients’ representations and exercise, foot care, and self-monitoring of blood glucose. Partners’ representations of personal and treatment control, were mediators between the same partners’ representations and self-monitoring of blood glucose. No partners’ representations mediated patients’ representation and adherence to medication or diet . This study emphasized partners’ representations on patient’s adherence to exercise, foot care and monitoring of blood glucose, in recent diagnosed T2DM patients. Interventions to promote adherence in T2DM should promote convergence between patients and partners’ diabetes representations. This study provides some evidence for the need to treat T2DM within the dyad to improve adherence, starting after the diagnosis.     

Illness perceptions and self-care behaviours in the first years of living with type 2 diabetes; does the presence of complications matter?

Objective: To assess illness perceptions, self-care behaviours and their relationship in recently diagnosed type 2 diabetes mellitus (T2DM) patients with and without diabetes-related complications.

Design: Cross-sectional survey among 192 recently diagnosed T2DM patients of whom 23% reported the presence of diabetes-related complications. Illness perceptions and self-care were assessed by the Revised Illness Perception Questionnaire (IPQ-R) and the revised Summary of Diabetes Self-Care Activities (SDSCA) measure.

Results: Generally, participating patients perceived T2DM as a chronic, but relatively controllable condition with minor consequences. In the presence of complications, however, T2DM was perceived as more unpredictable with more (serious) consequences and less controllable by self-care or medical treatment. Furthermore, engagement in exercise and foot care was reported more often by patients with complications. Self-care was related to certain illness perception dimensions, and interactions between perceptions and complications were found.

Conclusion: T2DM patients in the first years of their illness are often recommended to make lifestyle changes in the absence of noticeable diabetes-related symptoms or complaints. As many T2DM patients do not seem to perceive their condition to be serious and postpone lifestyle changes until diabetes-related complications appear, a major challenge for professionals is to convince asymptomatic patients of the importance of self-care.     

Development of the Diabetes Self-Care Efficacy Scale

The present study elaborates the conceptualization and process of development of a scale for assessing diabetes self-care efficacy (DSCE) in patients of diabetes, type 1 and type 2. Health maintenance in chronic illness as diabetes is dependent on performing several key self-care behaviours. The present study discusses two parts—Part I elaborates the qualitative exploration of the research construct through semi-structured interview of diabetic patients. It included 25 diabetic patients, Type-I (n?=?5) and Type-II (n?=?20). Part II discusses the quantitative research methods. The sample consisted of 233 diabetic patients, Type-1 (n?=?39) and Type-2 (n?=?194), who were randomly selected from diabetes and endocrine outpatient department (OPD) of a hospital in, Kolkata, India. Following an exploratory approach employing Principal Component Analysis (PCA), three components were yielded that accounted for approximately 60% of explained variance. Cronbach’s alpha was established at 0.89 indicating satisfactory internal reliability. The components were identified as component 1, “Beliefs about physical exercise regimen” (BPE), component 2, “Beliefs about food and insulin administration and medication recommendations” (FMR) and component 3, “Beliefs about learning and following from others” (LFO). To test the obtained factor structure of the proposed DSCE scale, a confirmatory analysis was performed to help validate the 3-factor, 15-item DSCE scale. The scale is first one of its kind to be proposed and developed in an Indian diabetes context and can prove useful in other settings. Study findings have implications for use in hospital setup and for development of intervention programs in dealing with diabetes patient population.     

The timing of psychosocial transitions and changes in women's lives: an examination of women aged 45 to 60

Sixty-four middle-class women from four cohorts aged 45, 50, 55, and 60 participated in a retrospective interview concerning psychosocial changes in their adult lives. Their responses provided self-report data relating to specific psychosocial changes, and judges who read the interview protocols provided independent ratings of major psychosocial transitions. The results indicated that major psychosocial transitions were more likely to be associated with phases of the family cycle than with chronological age; within the family cycle, transitions were more likely to occur during the preschool (28% of the women), launching (42% of the women), and postparental (33% of the women) phases than during the no children, school-age, or adolescent phases; transitions associated with the preschool and launching phases were characterized by dissatisfaction, personal disruption, marital unhappiness, and decreased personal development, whereas transitions associated with the postparental phase were characterized by personal mellowing and improved marital relations; and finally, numerous self-reported psychosocial changes were associated with family cycle phase, and a small number of changes was associated with chronological age.     

Are exercise social-cognitive factors and behaviours different for adults with diabetes? A randomized community sample

Exercise plays a key role in the prevention and delay of the onset of Type 2 diabetes and in the management of this disorder. To determine if there are differences in key social-cognitive determinants of exercise and self-reported physical activity levels between adults with diabetes and those without the condition, a random selected sample of adults was surveyed. A telephone interview assessed physical activity behaviour and key social-cognitive constructs from major health behaviour change theories/models. The mean energy expenditure was not significantly different between the diabetes (n?=?46) and the non-diabetes (n?=?1556) groups. The diabetes group reported significantly lower scores for self-efficacy and perceived behavioural control, but higher for fear of, and vulnerability to, general health and cardiovascular disease threat. The data suggest that it may not be necessary to promote health threat messages, as threat is already high for this diabetes population and studies have shown that excess threat does not promote recommended exercise and health behaviours. Instead, the low levels of self-efficacy and perceived behavioural control among those with diabetes emphasize the importance of designing specific strategies (e.g., skills, incremental success) to increase their self-confidence in undertaking physical activity.     

Beyond good intentions: The role of proactive coping in achieving sustained behavioural change in the context of diabetes management

This study examines the effectiveness of a brief self-management intervention to support patients recently diagnosed with type-2 diabetes to achieve sustained improvements in their self-care behaviours. Based on proactive coping, the intervention emphasizes the crucial role of anticipation and planning in maintaining self-care behaviours. In a randomised controlled trial among recent screen-detected patients, participants who received the intervention were compared with usual-care controls, examining changes in proximal outcomes (intentions, self-efficacy and proactive coping), self-care behaviour (diet, physical activity and medication) and weight over time (0, 3 and 12 months). Subsequently, the contribution of proactive coping in predicting maintenance of behavioural change was analysed using stepwise hierarchical regression analyses, controlling for baseline self-care behaviour, patient characteristics, and intentions and self-efficacy as measured after the course. The intervention was effective in improving proximal outcomes and behaviour with regard to diet and physical activity, resulting in significant weight loss at 12 months. Furthermore, proactive coping was a better predictor of long-term self-management than either intentions or self-efficacy. Proactive coping thus offers new insights into behavioural maintenance theory and can be used to develop effective self-management interventions.     

Reasoning in the personal and moral domains: Adolescent and young adult women's decision-making regarding abortion

The present investigation of adolescent and young adult women's reasoning, and decision-making about abortion was conducted to determine whether reasoning about abortion could be described by moral, social-conventional, and personal concepts and to examine relationships between domain of reasoning and action choices. Seventy single women, ranging in age from 13 to 31 and divided between 25 women having abortions, 23 women continuing their pregnancies, and 22 never-pregnant women, were administered a semi-structured clinical interview about abortion and two hypothetical moral judgement dilemmas. A classification task was developed to provide an additional measure of reasoning in different domains. Another 29 single, first-pregnant women provided a comparison of the effects of these procedures on decision-making. Content analysis of the protocols revealed that responses to the abortion interview could be reliably distinguished between concepts of morality and personal issues and their coordination or lack of coordination. Subjects treating abortion as a moral issue were more likely to continue their pregnancies while subjects treating abortion as a personal issue were more likely to obtain an abortion. Differences in reasoning between pregnant and nonpregnant subjects were not observed. Moral responses to the abortion interview were found to be highly related to hypothetical moral judgments.     

Diabetes mellitus as a model of psychosomatic and somatopsychic interrelationships

The article reviews research on the problem of interrelationship between different physical and psychosocial factors in type 1 diabetes mellitus (DM1). The authors consider methodological principles of health-related quality of life (HRQoL) assessment in DM1 patients and stress the need for an integrated biopsychosocial approach to the management of the disease. DM1 is a chronic metabolic disease with an absolute requirement for insulin replacement therapy. The stress-inducing nature of DM1 is associated with its unexpected and dramatic manifestation in juvenile years, life-threatening nature of severe hypo-/hyperglycaemias and long-term complications, with the burden of diabetes self-management, threat of work disability, employment and career problems etc. These features of DM1 increase the likelihood of the development of anxiety and depressive disorders, which, in turn, may negatively influence the course of diabetes and in particular, diabetes self-care. This necessitates early diagnosis of emotional and behavioral disturbances in DM1 using self-report instruments as well as clinical assessment. Evidence suggests that active problem-focused coping behavior and adequate social support promote adherence to diabetes regimes and may act as a buffer against negative effects of the disease on HRQoL in DM1 patients. The core element in the HRQoL structure is personal disease picture (as opposed by objective clinical picture)--the cognitive-affective-behavioral complex reflecting the patient's personal perception of the disease. Examination of the personal disease picture and attitude towards the ailment in DM1 patients may help to improve understanding of the mechanisms of poor adjustment. Problems in disease adjustment can be detected also by diabetes-specific HRQoL assessment. The measures of HRQoL can be applied as screening instruments useful in increasing the effectiveness of patient-provider interactions and diabetes care.     

What are the combined effects of negative emotions and illness cognitions on self-care in people with type 2 diabetes? A longitudinal structural equation model

Objective: To explore whether negative emotions mediate the effect of diabetes cognitions on diabetes self-care and conversely whether diabetes cognitions mediate the effect of negative emotions on diabetes self-care.

Design: Longitudinal observational study in adults with type 2 diabetes.

Main outcome measures: Self-reported depression and anxiety (Diabetes Wellbeing Questionnaire), cognitions (Illness Perceptions Questionnaire-Revised; Beliefs about Medicines Questionnaire), and diabetes self-care (Summary of Diabetes Self-Care Activities Scale) were completed at baseline and six months. Analyses used structural equation modelling.

Results: Baseline medication concerns were associated with elevated symptoms of depression and anxiety at follow-up, but emotions did not mediate medication concern’s effect on diabetes self-care. Baseline depression and anxiety symptoms were associated with specific diabetes cognitions over time, but these cognition domains did not mediate emotion’s effect on diabetes self-care. Personal control remained independent of emotions and was associated with diabetes self-care over time.

Conclusions: Negative emotions did not act directly or alongside cognitions to influence diabetes self-care. The reciprocal relationship between diabetes cognitions and emotions suggests cognitive restructuring, in addition to other mood management intervention techniques would likely improve the emotional wellbeing of adults with type 2 diabetes. Likewise, personal control beliefs are likely important intervention targets for improving self-care.     

Getting one's thoughts straight: a dialogical analysis of women's accounts of poorly controlled type 2 diabetes

Type 2 diabetes is a metabolic disorder characterised by chronically elevated blood glucose and a high risk of cardiovascular and other complications. Self-management is central to diabetes care and includes taking regular exercise, low-fat/sugar diet and blood glucose monitoring. However, little is understood about how people with diabetes make sense of self-management. Our aim, therefore, is to explore the process of 'getting one's thoughts straight' in relation to illness self-management for women with poorly controlled type 2 diabetes. Eight women were recruited from two hospitals in the North of England. Each was interviewed using a biographic-narrative method. Narratives were analysed using a dialogical approach. We use Bakhtin's concepts of voice, official and unofficial truth, and internally persuasive discourse to explore how participants considered, struggled with, and, sometimes, acted upon self-management. We demonstrate how the truth by which participants lived shifted as they encountered new perspectives and experiences. The accounts revealed tension between official, authoritative voices, typically concerned with optimal illness control and unofficial voices that speak at a lived, embodied level. In conclusion, we suggest moving beyond the notion of self-management towards a conceptualisation of life with chronic illness that includes personal goals, values and embodied experience in context.     

Getting one's thoughts straight: A dialogical analysis of women's accounts of poorly controlled type 2 diabetes

Type 2 diabetes is a metabolic disorder characterised by chronically elevated blood glucose and a high risk of cardiovascular and other complications. Self-management is central to diabetes care and includes taking regular exercise, low-fat/sugar diet and blood glucose monitoring. However, little is understood about how people with diabetes make sense of self-management. Our aim, therefore, is to explore the process of ‘getting one's thoughts straight’ in relation to illness self-management for women with poorly controlled type 2 diabetes. Eight women were recruited from two hospitals in the North of England. Each was interviewed using a biographic-narrative method. Narratives were analysed using a dialogical approach. We use Bakhtin's concepts of voice, official and unofficial truth, and internally persuasive discourse to explore how participants considered, struggled with, and, sometimes, acted upon self-management. We demonstrate how the truth by which participants lived shifted as they encountered new perspectives and experiences. The accounts revealed tension between official, authoritative voices, typically concerned with optimal illness control and unofficial voices that speak at a lived, embodied level. In conclusion, we suggest moving beyond the notion of self-management towards a conceptualisation of life with chronic illness that includes personal goals, values and embodied experience in context.     

Perceptions of Type 1 Diabetes among Affected Youth and their Peers

Management of type 1 diabetes (T1D) involves balancing several components including diet, exercise, and medication. Peer involvement in management tasks is an important, but understudied, issue in T1D. This study presents results of a preliminary examination of perceptions of disease management in youth with T1D and their peers. Data were collected using a mixed methods (qualitative and quantitative data) approach during medical education time at a camp for youth with T1D and their peers. Results suggest that both youth with T1D and their peers believe that peers need more information about medical consequences of having diabetes. Further, youth with T1D and their peers would like coaching on how peers may help the child with T1D manage their illness better. Results provide preliminary ideas for intervention (i.e., including peers, assessing social support) in the medical setting as well as ideas for future research (i.e., examining relationships among perceptions and gender, time since diagnosis).