Health and illness self-care in adults with non-insulin dependent diabetes : a rest of Orem\u27s theory of self-care

This study examined the health and illness self-care of 57 (32 females, 25 males) subjects with Type II diabetes mellitus and their health, universal selfcare, and health-deviation self-care behaviors. Subjects, except 1, were white; the majority were currently married (74%) and retired (65%). Orem\u27s theory of self-care guided the selection of the variables and the hypothesized outcomes. Denyes Self-Care Practice Instrument and Denyes Health Status Instrument were used to measure universal self-care behaviors and health, respectively. The modified Diabetic Self-Care Practice Instrument was used to measure health-deviation self-care behaviors. An investigator developed questionnaire assessed sociodemographic characteristics. Findings included positive correlations between universal self-care and health, health-deviation self-care and universal self-care, health-deviation self-care and health, universal self-care and age, universal self-care and sleep hour, age at onset of diabetes mellitus and health-deviation self-care, age at onset of diabetes mellitus and universal self-care, and age at onset of diabetes mellitus and health; and negative correlations between duration of diabetes mellitus and health-deviation self-care, duration of diabetes mellitus and age of subjects, health-deviation self-care and metabolic control, and universal self-care and metabolic control. Significant differences were found among some of the groups in relation to health-deviation self-care and source of support and universal self-care and source of support. Subjects who received support from a friend in addition to family support reported higher universal self-care behaviors than those without support. Health explained 76% of variance in universal self-care behaviors while support system explained 16% of variance in the health-deviation self-care. Recommendations for future research and for nursing interventions included increasing the number of subjects with Type II diabetes mellitus to generalize findings, further inquiry regarding the number and source of support to facilitate health-deviation self-care behaviors and continued assessment of the source of support and perception of health state to facilitate self-care behaviors

Health Literacy and Self-efficacy as correlates of Self-Management of Type 2 Diabetes in Middle-Aged and Older Adults

The prevalence of type 2 diabetes is increasing with middle-aged and older adults being those at highest risk for developing this disease. Additionally, the demands of type 2 diabetes self-management can become difficult with age, which can result in poorer glycemic control. The current study examined the relations of health literacy, diabetes-related distress, and diabetes self-efficacy on diabetes self-management among 65 adults aged 40-66 with type 2 diabetes. Age was found to be positively associated with health literacy, but negatively associated with diabetes self-care activities. Additionally, only diabetes self-efficacy was found to be a unique contributor to diabetes self-care activities when controlling for age and gender. Lastly, body mass index was found to be negatively associated with diabetes self-efficacy and diabetes self-care activities. Future studies should consider using a longitudinal design to better inform interventions for those at risk for inadequate glycemic control (i.e., overweight/obese individuals, older adults, those with low self-efficacy)

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.</p

Cognitive Function, Self-care, and Glycemic Control in Rural Adults with Type 2 Diabetes

Cognitive Function, Self-Care, and Glycemic Control in Rural Adults with Type 2 Diabetes Abstract The prevalence of type 2 diabetes mellitus (DM) has increased dramatically over the past two decades, particularly among adults living in rural communities. Related health complications include structural brain changes and decreased cognitive function. Cognitive decline associated with DM may influence one’s ability to perform self-care and affect glycemic control. In turn, poor glycemic control contributes to increased complications associated with DM. Although one’s ability to maintain glycemic control may be highly dependent on cognitive abilities, there is limited understanding about the relationship between cognitive function, self-care, and glycemic control in rural adults with DM. Specific aims of this study were to: 1) examine the relationships between cognitive function, glycemic control, and contributing factors (age, years with DM, education category, cardiovascular (CV) risk, level of depression) in rural adults with DM; 2) examine whether cognitive function predicts glycemic control in rural adults with DM; 3) examine the relationship between cognitive function, self-care, and contributing factors (age, years with DM, education category, everyday problem-solving, and level of depression) in rural adults with DM; and, 4) examine whether cognitive function predicts self-care in rural adults with DM. This descriptive study included a convenience sample of (N=56) rural adults with DM. A face-to-face interview was conducted with each participant, where performance of the cognitive processes of attention, executive function, mental processing speed, and verbal episodic memory was measured with neuropsychological tests. Frequencies of performing DM self-care activities of adherence to diet, exercise, blood glucose monitoring, foot care and medications were queried to determine levels of self-care, and a recent glycohemoglobin was obtained to determine glycemic control. Main results were that cognitive function in domains of attention, executive function, mental processing speed, or verbal episodic memory, after controlling for modifiable and non-modifiable covariates, did not independently explain glycemic control or the frequency of DM self-care activity performance by rural adults with DM. The covariates cardiovascular risk and depression independently explained cognitive function, and depression independently explained self-care performance.PHDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/137032/1/frankini_1.pd

Understanding Older Adults Living in Medically Underserved Areas Perspectives Regarding Type 2 Diabetes Care Received

Older adults with type 2 diabetes living in medically underserved areas (MUAs) have unique health and social needs that must be taken into consideration when supporting their type 2 diabetes treatment and management care. Effective treatment and management of type 2 diabetes for older adults living in MUAs requires incorporating the preferences, desires, needs, values, and goals of the person at the center of the care into his/her care plan. Shifting care to be conducive to the treatment and management goals and plans co-created with older adults living in MUAs based on their individual physical, psychological, social, and spiritual preferences, values, desires, needs and goals requires health care systems to redesign and restructure their services and roles to be more favorable to elderly adults. Utilizing a basic qualitative research study design, semi-structured, in-depth interviews were conducted to understand the perspectives of older adults living in MUAs regarding health care received in the treatment and management of their type 2 diabetes. Twelve older adults with type 2 diabetes living in MUAs recruited from senior housing facilities in two designated MUAs participated in the study. The constant comparative method was used for qualitative data analysis. NVivo 12 was used to organize the emerging codes. The Donabedian Model of Care was used as a conceptual framework to guide this research study and provided a lens into which the findings of the study were interpreted, summarized, and reported. Six themes emerged from the qualitative analysis: care treatment and management, accessible services for older adults, information sharing and provider communication, attributes of health care providers, social support, and older adults’ diabetes self-management behavioral strategies. This study gave older adults living in MUAs a voice that offered health care providers with a better understanding of what is important to this vulnerable population in treating and managing their type 2 diabetes. This study provided a framework for health care providers striving to deliver type 2 diabetes treatment and management care to older adults living in MUAs that is holistic, respectful and individualized. Incorporating the findings from this study into practice could lead to greater empowerment and more effective treatment and management care of type 2 diabetes for older adults living in MUAs

Identifying the Need for Self-Management Education in Adult Patients with Type-2 Diabetes in Ho Chi Minh City, Vietnam

The purpose of this thesis project was to identify the need for self-management through investigating the existing knowledge about diabetes self-care and their perception of diabetic control in adult patients with type-2 diabetes Ho Chi Minh City, Vietnam. The 16-Item Diabetes Self Management Questionnaire (Schmitt et al., 2013) and a cross-sectional design was used in this study to explore the diabetes self management related to four subscales such as glucose management, dietary control, physical activity, health-care use and a sum scale as the perception of diabetic control among fifty five participants who were diagnosed with type-2 diabetes in Tan Phu District Hospital, Ho Chi Minh City. The study found that the age of the participants ranged from 40 to 83 years old, and the average age was 62 years old with more female (65.5%) than male (34.5%). They all had formal schooling at least elementary level, and 27.4% had higher education level (university or higher). The majority of them were retired (65.5%). The participants were all diagnosed with type-2 diabetes and their diabetes duration ranged from 1 to 30 years. The findings showed that respondents’ knowledge about diabetes self- management seemed overall to be sufficient since the mode of each item showed that they positively understood and applied the facts which were appropriate for their diabetes self-care activities. Then, the last item included as an overall sum scale varied by the demographic characteristics to generally explore participants’ perception of diabetic control. In general, the findings showed that most of the participants agreed that their diabetes self care was not poor (34.5% male never believed that their diabetes self-care was poor, and the rest of 65.5% female rarely believed that their diabetes self-care was poor). In conclusion, this study suggests that health professionals in Vietnam should use reliable and valid tools, such as this questionnaire from Schmitt et al. (2013), to have better understanding about patient’s self-care. Health professionals can use this information to provide diabetic patients with a suitable health education program. In addition, more research related to diabetes self-care needs to be conducted to provide more evidence-based information to support patients with diabetes in Vietnam

Heart failure self-care, factors influencing self-care and the relationship with health-related quality of life: A cross-sectional observational study.

Background:Self-care helps maintain health, prevents complications and improves the quality of life of patients living with heart failure (HF). Self-care is critical to HF management but has received limited attention in Nepal. Identification of the sociodemographic and clinical characteristics associated with self-care is crucial to tailoring appropriate self-care programs to improve health outcomes including patients' quality of life. Aims:The aims of this study were to describe self-care including the factors influencing self-care and the relationship between self-care and health-related quality of life in patients living with HF in Kathmandu, Nepal. Methods:We used a cross-sectional observational study design to measure self-care maintenance, self-care management, and self-care confidence using the Nepali Self-Care of Heart Failure Index. To analyze data, we used descriptive statistics, bivariate associations and regression modeling. Results:We recruited 221 patients with HF: mean age 57.5 ± 15.76 years, 62% male. The results in this sample indicated poor self-care maintenance (38.5 ± 11.56), management (45.7 ± 15.14), and confidence (40.9 ± 16.31). Patients with higher education were associated with higher self-care maintenance and management. Living alone and a better New York Heart Association functional classification for HF were related to higher self-care confidence. Higher social support was associated with better self-care. Self-care confidence was an independent predictor of self-care maintenance, management and health-related quality of life on adjusted analyses. Conclusion:Self-care was limited among patients living with HF in Nepal yet was associated with better quality of life. The study identified various sociodemographic and clinical factors related to self-care, which could be crucial while developing self-care interventions

Self-care behaviours and related psychosocial factors in men and women with Type 2 Diabetes Mellitus in Jordan: a cross sectional study

Background: Effective management of Type 2 Diabetes Mellitus (T2DM) depends on a number of specific elements of self-care. Theoretical and empirical evidence identify the important role of psychosocial factors in predicting self-care behaviours. Understanding of gender differences in these relationships is needed to guide appropriate management. However, evidence is limited, particularly in Middle Eastern populations. Aim: To examine the relationship between self-efficacy, social support, diabetes distress factors and self-care behaviours in men and women Jordanian Type 2 Diabetes Mellitus patients. Methods: 239 Type 2 Diabetes Mellitus patients from two family medicine clinics in Amman, Jordan were recruited. The study participants completed a self-reported questionnaire with measures of diabetes related self-efficacy, diabetes distress, diabetes social support and diabetes self-care. Statistical analyses used correlational and multiple regression methods. Results: Women were found to have significantly reported higher diabetes distress than men (p< 0.0001) and reported significant less support received by family and friends (p=0.006). Regarding self-care behaviours, men did more exercise than women, (p=0.032). Women had better foot care than men (p<0.0001). Self-efficacy was a strong predictor for self-care behaviours for both men and women. The modelled psychosocial variables explained more of the variance for men than for women for all the examined self-care behaviours. Models showed that gender was not a moderator of the relationship between psychosocial and self-care behaviours. Conclusion: There are significant gender differences in psychosocial and self-care behaviours among Type 2 Diabetes Mellitus Jordanian patients. Self-efficacy was the best predictor of self-care behaviour for both men and women. Clinicians need to be aware of the significant gender differences in both psychosocial factors and self-care behaviours. Interventions to improve self-care for both men and women should involve strengthening psychosocial factors, particularly self-efficacy

Diabetes Self-Management Education for Adults With Type 2 Diabetes Mellitus

Diabetes, a major public health challenge in St. Kitts, has been a focus of international public health community research. Although researchers have demonstrated that diabetes self-management education is a cost-effective strategy for the prevention of diabetes-related complications, they have yet to establish whether there is adequate education occurring in treatment settings with diabetic patients. The purpose of the study was to implement and evaluate the short-term effectiveness of a diabetes self-management education intervention on diabetes-related knowledge and accepted behavioral changes to decrease risk for complications. Based on a self-care approach, this education intervention was designed to improve diabetes-related knowledge and self-management behaviors. To test and evaluate the pre and post intervention effect, a convenience sample of 15 patients diagnosed with Type 2 diabetes attending a scheduled diabetic clinic completed the Diabetes Knowledge Test and a researcher-designed sociodemographic survey, which included self-report of blood glucose self-monitoring and foot care behaviors. The results of these analyses indicated that the participants’ knowledge level increased (p = \u3c .001). However, Chisquare and Fisher’s exact tests determined no significant changes in the participants’ self management behaviors. The results may be attributed to the short time frame of the intervention. The implications for positive social change include opportunities to improve inter-professional collaboration in programs that will create positive effects on diabetic self care and reduce the incidence of negative health outcomes. Furthermore, the use of a self-care approach by health care professionals could be a key factor in strengthening diabetes knowledge, engagement, and self-management for Type 2 diabetic patients