Exploring the connection between self-efficacy and effective diabetes self-management

PURPOSE: The purpose of this study was to review the existing empirical evidence about factors that contribute to effective diabetes self-management as indicated by healthy outcomes in persons with the disease, with a specific focus on self-efficacy, to determine the link between learned self-efficacy and effective diabetes self-management in adults. METHODS: A systematic review was conducted of the extant literature from 1985-2001 that described factors related to effective self-management of diabetes. The review included theoretical and empirical articles. The search engines included CINAHL, MEDLINE, PUBMED, and COCHRANE. RESULTS: Empirical evidence supports the following factors to improve the education outcomes for adults with diabetes: involve people with diabetes in their own care, guide them in actively learning about the disease, explore their feelings about having the disease, and teach them the skills necessary to adjust their behavior to control their own health outcomes. Thus, the goal for educating people with diabetes is to improve their individual self-efficacy and, accordingly, their self-management ability. CONCLUSIONS: Education sessions need to involve fewer lectures and more practical, interactive exercises that focus on developing specific skills. Follow-up contact is a valuable method for helping people make a healthy adjustment to living with diabetes.     

The diabetes educator: trying hard, but must concentrate more on behaviour.

Current guidelines state that education is fundamental to help people with diabetes modify their lifestyle and prevent ill health and early death. However, many people with diabetes are not receiving adequate education. There is a widespread assumption that transferring knowledge will improve health outcomes but there is little empirical support for this assertion. Indeed, knowledge and behaviour are poorly correlated. Knowledge may be a necessary condition but is rarely a sufficient condition for behaviour change. Single interventions, cognitive or behavioural, have had disappointing results, unsurprisingly given the complexity of human behaviour. The most effective interventions are multifaceted and include education, behavioural and psychosocial elements, and target lifestyle change and factors such as self-efficacy and empowerment. We advocate that educational interventions should have multiple components. They should aim to improve patients' sense of self-efficacy and empowerment, and build attitudes towards diabetes that will support the lifestyle changes needed for successful self-management. These conclusions have implications for future research and clinical practice.     

What are the characteristics of the best type 1 diabetes patient education programmes (from diagnosis to long-term care), do they improve outcomes and what is required to make them more effective?

The last 20 years have witnessed a marked change in approaches to the management of type 1 diabetes in the UK. This is exemplified by National Institute of Health and Care Excellence (NICE) guidance which acknowledges that reaching and maintaining target glucose depends on people with type 1 diabetes effectively implementing flexible intensive insulin therapy. The guidance emphasizes that successful self-management requires the acquisition of complex skills and is best achieved by participation in high-quality structured education. Controlled trials and other research have shown that programmes teaching self-management can lower glucose levels while reducing hypoglycaemia, improve psychological outcomes and are highly cost-effective. An important principle of successful programmes is therapeutic education in which learning becomes a partnership between the professional and the person with diabetes who learns to fit diabetes into his/her everyday life. Other recommended elements of programmes include a written curriculum, group teaching by a professional multidisciplinary team and quality assurance. Yet many participants struggle post-course to implement and maintain skills, and overall HbA_1c levels, particularly in the UK, remain far from target. Recent studies have identified the barriers to sustained effective self-management and concluded that even high-quality programmes generally lack critical components. These include incorporating evidence from behaviour change research, exploiting the promise of new technologies in reducing the burden of self-management, and providing structured professional support once people have completed the training. Studies are currently underway to evaluate structured training courses which have added these elements and examine whether they can lower glucose to levels closer to target without impairing quality of life.     

Patient activation among people living with HIV: a cross-sectional comparative analysis with people living with diabetes mellitus

Standardized self-management supports are an integral part of care delivery for many chronic conditions. We used the validated Patient Activation Measure (PAM®) to assess level of engagement for self-management from a sample of 165 people living with HIV (PLWH) and 163 people with diabetes. We conducted multivariable logistic regression to assess associations between demographics and PAM® scores. PLWH had high levels of activation that were no different from those of people with diabetes (mean score?=?67.2, SD?=?14.2 versus 65.0, SD?=?14.9, p?=?0.183). After adjusting for patient characteristics, only being on disability compared to being employed or a student was associated with being less activated (AOR?=?0.276, 95%CI?=?0.103–0.742). Our findings highlight the potential for the implementation of existing standardized chronic disease self-management programs to enhance the care delivery for PLWH, with people on disability as potential target populations.     

Overcoming obstacles: collaboration for change

Effective diabetes care requires a partnership between prepared, proactive practice teams and informed, activated patients. Diabetes education helps to overcome many of the barriers to effective self-management by enabling people with diabetes to make informed decisions about their day-to-day self-care. Both psychosocial and health outcomes have been improved through a variety of training programmes; however, education must be coupled with ongoing self-management support if these benefits are to be sustained. The principal goal of diabetes education has undergone a major shift over the past few years--evolving from primarily didactic interventions, focused on encouraging patients to adhere to the prescribed therapy, towards more interactive learning that supports people in making informed, self-directed decisions.     

探讨提高糖尿病患者自我管理水平对策

目的了解糖尿病患者自我管理水平及其影响因素,寻找对策提高其自我管理水平。方法采用整群抽样的方法,选取福建医科大学附属协和医院中2019年10—12月的住院糖尿病患者100例,对其进行问卷调查。结果患者自我管理水平总体较差,各因子水平不一,92%的患者能较好的按医生要求规律服药,但是在饮食、运动、血糖监测、足部护理等方面却表现较差。得分最高的是用药行为,而在饮食、运动、血糖监测、足部护理等方面的实际得分较低。影响糖尿病自我管理水平主要因素有:60例(23.1%)自己对有关糖尿病的自我保健知识了解较少(如饮食、运动、自我护理等方面);56例(21.5%)缺乏专业人员帮助制定适合自己的糖尿病控制方案,并给予监督。结论糖尿病患者的自我管理水平较差,疾病控制情况也较差,因此,护理人员应积极寻找对策提高其自我管理水平,进而改善糖尿病控制效果。     

Using focus groups to develop a culturally competent diabetes self-management program for Mexican Americans

PURPOSE: The purpose of this study was to describe factors that facilitate or hinder diabetes self-management and elicit participants' preferences and recommendations about the essential components of a culturally competent diabetes self-management program. METHODS: Latino patients with type 2 diabetes and their family caregivers were interviewed in focus groups. Four focus groups consisted of patients, and 2 groups consisted of family caregivers for a total of 40 participants. Participants were assigned to groups based on break characteristics of gender and preferred language. RESULTS: "Being in the dark" emerged as an important concern, and patient respondents wanted timely access to information that they deemed understandable about how to manage their diabetes. Family members' support and understanding were crucial in maintaining lifestyle changes. Patient and family caregiver participants wanted a self-management program to incorporate information on how to modify traditional foods, home remedies, and stress management. Preferences for information delivery included group didactic and interactive sessions, written information, and videotapes. Higher technology strategies using computers were not seen as useful. CONCLUSIONS: Culturally competent diabetes self-management for Latinos should incorporate the family and include techniques for stress management as well as diet modification. Information delivery should include a variety of techniques.     

Lay explanations and self-management of diabetes in Kathmandu, Nepal

OBJECTIVE: This research explores the lay explanations and self-management of diabetes among residents in greater Kathmandu, Nepal. METHODS: Interviews were done with 300 respondents drawn from diabetes patient listings and members of a national diabetes club. Sociodemographic and health-related data were collected with two standardized instruments: the Illness Perception Questionnaire and the Summary of Diabetes Self-Care Activities. Hierarchical ordinary least squares regression analyses were employed to examine predictors of self-management of diabetes. RESULTS: Across seven equations, R(2) values ranged from .020 to .221, and with the exception of one domain of self-management (blood sugar testing), one or more lay explanatory factors entered each equation. DISCUSSION: Respondents from this sample appear to hold lay explanations of diabetes that are similar to those of their peers in developed nations. Findings are discussed, including the caveat that these mostly male, relatively educated, and urban-residing adults with diabetes are not necessarily representative of Nepali society.     

Awareness and practices of self-management and influence factors among individuals with type 2 diabetes in urban community settings in Anhui Province, China

This study aimed to determine the knowledge of diabetes, practices of self-management (SM), and potential factors influencing patient knowledge and practices of self-management among individuals with type 2 diabetes in urban Anhui Province, China. A cross-sectional study was conducted between October and November, 2009. Three hundred sixty-five subjects with type 2 diabetes were randomly selected from three urban communities in three seperate cities. An interview was conducted to determine subject knowledge regarding diabetes, practices of self-management, and potential factors influencing this knowledge and these practices of self-management. Fewer than half of subjects (45.6%) had a basic knowledge of diabetes and 49.7% practiced adequate self-management. Significant associations were found between subject knowledge of diabetes and their education level (OR 2.096, 95% CI 1.578-2.784) and the length of disease (OR 1.307, 95% CI 1.016-1.681). Those with good self-management were influenced by greater knowledge, (OR 2.057,95% CI 1.228-3.445), strong self-efficacy in diabetes self-management (OR 1.899, CI 1.253-2.878), and household income (OR 0.537, 95% CI 0.419-0.689). Factors found by univariate analysis regarding self-management included: glucose monitoring was influenced by perception of social support (p = 0.006), adherence to medication was influenced by attitude toward self-management (p < 0.001), physical activity was influenced by knowledge (p < 0.01), attitude (p < 0.01), self-efficacy (p < 0.01), and social support (p < 0.01). However, there were no factors significantly related to healthy dietary practices. Our findings show that best performance in self-management is achieved when those with type 2 diabetes have a high degree of knowledge of diabetes, positive attitudes toward diabetes, strong self-efficacy for self-management and perceptions of good social support.     

The personal meaning of having diabetes: implications for patient behaviour and education or kicking the bucket theory

Most diabetes educators (physicians, nurses, nutritionists) lack the time and expertise to become familiar with theories of human behaviour even though they may be relevant to the education of their patients. As a result, the current practice of diabetes patient education reflects, in many instances, an extension of the information transfer approach found in most schools. This approach is based on the idea that lack of knowledge and skills accounts for the major portion of the poor self-care behaviour observed in some diabetic patients. The emphasis on information transfer is probably partially attributable to the fact that it is easier to measure and evaluate. This approach is too narrow a view of behaviour or learning and fails to meet the needs of diabetes patient educators and their clients. The idea that the behaviour of patients with diabetes will be strongly influenced by their view of diabetes is explored. Diabetes educators need to become skilled designers of patient education programmes which facilitate changes in the personal meaning of diabetes. Researchers should test the utility of seeing disease-related behaviour and education as a process, at least in part, concerned with the personal meaning of diabetes.     

The effect of diabetes self-management education with frequent follow-up on the health outcomes of African American men

PURPOSE: This study was conducted to determine whether objective clinical, patient performance, quality-of-life, and subjective outcomes are significantly different among African American men with type 2 diabetes who received follow-up at either monthly or 3-month intervals after participating in a structured diabetes self-management education program. METHODS: Prior to the diabetes self-management education program, 30 African American men with type 2 diabetes were randomly assigned to 2 groups to receive telephone follow-up at either monthly or 3-month intervals over a 6-month period. Information obtained at follow-up contact included HbA1c level, perception of general health, and present diabetes knowledge. In addition, daily foot care, dietary, exercise, and medication compliance measures were assessed postprogram. RESULTS: There were no significant differences between the participants who received follow-up at monthly and 3-month intervals on any measures of the selected clinical, patient performance, quality-of-life, and subjective outcomes. CONCLUSIONS: This cross-sectional study showed that telephone follow-up at 3-month intervals following a structured program of diabetes self-management education may be just as effective in contributing to favorable diabetes health outcomes as monthly follow-up.     

When do patients and their physicians agree on diabetes treatment goals and strategies,and what difference does it make?

BACKGROUND: For patients with chronic illnesses, it is hypothesized that effective patient-provider collaboration contributes to improved patient self-care by promoting greater agreement on patient-specific treatment goals and strategies. However, this hypothesis has not been tested in actual encounters of patients with their own physicians. OBJECTIVE: To assess the extent to which patients with type 2 diabetes agree with their primary care providers (PCPs) on diabetes treatment goals and strategies, the factors that predict agreement, and whether greater agreement is associated with better patient self-management of diabetes. DESIGN: One hundred twenty-seven pairs of patients and their PCPs in two health systems were surveyed about their top 3 diabetes treatment goals (desired outcomes) and strategies to meet those goals. Using several measures to evaluate agreement, we explored whether patient characteristics, such as education and attitudes toward treatment, and patient-provider interaction styles, such as shared decision making, were associated with greater agreement on treatment goals and strategies. We then examined whether agreement was associated with higher patient assessments of their diabetes care self-efficacy and self-management. RESULTS: Overall, agreement on top treatment goals and strategies was low (all kappa were less than 0.40). In multivariable analyses, however, patients with more education, greater belief in the efficacy of their diabetes treatment, and who shared in treatment decision making with their providers were more likely to agree with their providers on treatment goals or strategies. Similarly, physician reports of having discussed more content areas of diabetes self-care were associated with greater agreement on treatment strategies. In turn, greater agreement on treatment goals and strategies was associated both with higher patient diabetes care self-efficacy and assessments of their diabetes self-management. CONCLUSION: Although patients and their PCPs in general had poor agreement on goals and strategies for managing diabetes, agreement was associated with higher patient self-efficacy and assessments of their diabetes self-management. This supports the hypothesis that enhancing patient-provider agreement on both overall treatment goals and specific strategies to meet these goals may lead to improved patient outcomes.     

Diabetes educators' perspectives on barriers for patients and educators in diabetes education

PURPOSE: This study assessed diabetes educators' perspectives on barriers that potentially affect patient access to and utilization of diabetes education. METHODS: A 40-item questionnaire was developed to collect needs assessment data on diabetes education programs. The questionnaire was mailed to a Washington State professional practice group in diabetes education (N = 143). RESULTS: Most respondents were registered nurses (61%) or registered dietitians (27%); 74% were certified diabetes educators. The educators' perceptions of the difficulty that type 1 versus type 2 patients experience in different areas of self-management after diabetes education underscored the importance of learning effective long-term skills for self-care. Some of the reasons given for type 2 patients dropping out of diabetes education programs were also cited as barriers to conducting follow-up, such as education being a low priority for the patient and the patient not being able to afford diabetes care services. CONCLUSIONS: Educators appeared to relate many patient barriers to a lack of patient understanding of the evolving nature of diabetes and the subsequent need for educational support. The role of continuing education for all patients needs to be emphasized to the patient during the initial education, as well as to the healthcare community and the patient's support network.     

Informal diabetes education: impact on self-management and blood glucose control

PURPOSE: The purpose of this study was to determine if participation in screening clinics to detect and treat diabetes-related eye disease also led to informal patient learning that had an impact on self-management behavior and blood glucose control. METHODS: To evaluate the evidence for patient learning over time, the data of patients who returned as advised for 2 subsequent annual diabetes disease screenings were analyzed. Evaluation measures included medication use, self-management behavior, and hemoglobin A1c (A1C). RESULTS: During the 2-year study period, the use of insulin increased by 37% at the first exam, 43% at the second exam, and 42% at the third exam (P = .02). No significant changes were found in the use of oral medication. Glucose self-monitoring also increased by 61% at the first exam, 71% at the second exam, and 76% at the third exam (P < .01). Mean A1C values for returning participants declined by 9.2% at the first exam, 8.9% at the second exam, and 8.6% at the third exam (P = .03). CONCLUSIONS: The screening clinics had an educational impact associated with behavior change (improved self-management and glucose control) even though the clinics were not intended to produce such change. Therefore, caregivers should consider that patient learning can and should be part of every diabetes care encounter.     

Patient education and self-management of musculoskeletal diseases

The research literature reports that patient (consumer) education and self-management programs and practices help people with chronic disease live better lives by improving health outcomes and psycho-emotional and psychosocial measures. However, arthritis charities that offer self-management programs in the United Kingdom, the United States and Canada anecdotally report significant drops in enrollment, and emerging data suggest that these types of programs are not a panacea for people attending them. This chapter will provide the reader with the following: an introduction to patient education and self-management; a discussion on participation rates in patient education and arthritis self-management programs; an overview of the 'state-of-the-art' in patient education and self-management programs; new ideas on patient education delivery models; tips on improving physician-patient communication; and suggested areas of research required to advance the area of patient education and self-management.     

How important is patient self-management?

This chapter addresses the issues associated with self-management in arthritis care. Alternative approaches to traditional medical care have gained popularity in the past decade. Some of the factors that have led to this are discussed in this chapter, including personal self-determination, the patient as consumer in a global economy, the backlash against medical technology, and fundamental questions about the medical model of care. Following this introduction, the goals of the Arthritis Self-Management and Bone-up on Arthritis Programs are outlined, along with the major theoretical underpinnings of both programmes. The impact of self-management programmes on the outcomes of disability, pain, depression and fatigue are reviewed, as are the potential implications for both the direct and indirect cost savings for a health system and society. The potential negative effects of self-management programmes are considered, and issues related to implementation, dissemination, quality control and long-term maintenance are reviewed. Finally, the value of self-management as a tool to be used effectively by the person with arthritis, in conjunction with his or her rheumatologist, is outlined. The relevance of well-established, valid and reliable self-management programmes is underscored by the growing number of people who seek help over the Internet. Without guidance, information can become harmful or distracting rather than helpful.     

Changing office practice and health care systems to facilitate diabetes self-management

Diabetes is a self-managed disease for which patients provide 99% of their own care. For patients to succeed as diabetes self-managers, they need office practices and health care systems that can prepare and support them in their diabetes self-management efforts over the long term. In order to provide effective diabetes education and ongoing support, office practices and health care systems will have to fundamentally redefine the roles of health professionals and patients with diabetes, and redesign practices and systems to allow for effective long-term self-management education and support. Although it is difficult for both people and systems to change, change is essential if we are going to provide self-management support for the majority of patients suffering from this serious chronic disease.     

The impact of telehealth on self-management of patients with type 2 diabetes: A systematic review on interventional studies

Background and aimsSelf-management is critical to manage the glycemic and metabolic outcomes for patients with diabetes. Telehealth applications are recognized as a potential approach to promote self-management of people with type 2 diabetes. This study aimed to investigate the impact of telehealth on self-management among patients with type 2 diabetes.MethodsA systematic review was conducted on several databases, including PubMed, EbscoHost Medline, and Science Direct, with the keywords: Diabetes Mellitus AND Mobile-phone based OR Telemedicine OR Telehealth OR Web-based OR Telenursing AND Self-management. Inclusion criteria were articles with type 2 diabetic respondents, published between 2015 and 2020, open-access articles, and had self-management as outcomes. Hence, qualitative, protocol, or review articles, commentaries, letters to editors, and case study/reports were excluded. The Joanna Briggs Institute critical appraisal tools and Cochrane collaboration's tools were used for assessing risk of bias.ResultsThe total of six studies were included in the qualitative synthesis, with five randomized control trials and one cross-sectional study. Telehealth applications were formed as an online or app-based platform with the key features of educational programs, text or voice messages, consultations and counseling, and active participation of the subjects. Besides improving the self-management outcomes, the telehealth also indicated improvements in positive behaviors, attitudes, and the intention of self-management.ConclusionThe study concluded that implementation of telehealth provided positive self-management results among patients with type 2 diabetes. The users need to consider an intensive training, peer or family support, and provision of full support for the patients during the implementation of telehealth.     

A focus group study of accessibility and related psychosocial issues in diabetes education for people with visual impairment

PURPOSE: This study was conducted to identify accessibility and related psychosocial issues in diabetes care and education for visually impaired adults who have diabetes. METHODS: Two focus groups of adults with visual impairment and diabetes were conducted; data were recorded and analyzed. RESULTS: The 3 main issues identified were lack of access to up-to-date diabetes information in an accessible format, lack of understanding by healthcare providers of the needs and competencies of people with both visual impairment and diabetes, and lack of access to nonvisual diabetes self-management equipment. CONCLUSIONS: This study provides qualitative support for the view that visually impaired people in the United States may, as a group, be systematically excluded from receiving high quality diabetes care and education. Equal access to diabetes care and education for visually impaired people requires increased accessibility of diabetes care and education programs, and increased professional and public awareness that the diabetes programs are accessible. Some specific recommendations are to make all patient education materials available in low-vision/nonvisual formats and to teach all diabetes education professionals how to work effectively with visually impaired people.     

Patient Self-Management of Diabetes Care in the Inpatient Setting: Pro

Patients should be allowed to manage their diabetes in the hospital. Diabetes mellitus is a common and sometimes difficult to control medical issue in hospitalized patients. Oftentimes patients who have been controlling their diabetes well as an outpatient are not allowed to continue this management on the inpatient setting, which can lead to hypo- and hyperglycemia. Involving the patient in his or her diabetes care, including self-management in select patients, may provide a safe and effective way of improving glycemic control and patient satisfaction. This may particularly benefit the dosing and coordination of meal-time