Determinants of active self-care behaviour of insulin treated patients with diabetes: Implications for diabetes education

The most important aim of diabetes education is to alter the self-care behaviour of patients with diabetes. In order to change their behaviour its determinants must be known. The pretest of a multicentre evaluation study with 558 participating insulin treated patients with diabetes was analysed to test the usefulness of the attitude-behaviour theory of Fishbein & Ajzen in explaining and possibly changing diabetes related active self-care behaviour. The theory of Fishbein & Ajzen is based on the assumption that human behaviour is reasoned behaviour. The theory views a person's intention as the immediate determinant of action. Determinants of intention are attitude and social norm. The results showed that the attitude was the most important determinant of active self-care, while a sufficient level of knowledge and a low orientation on the powerful others health locus of control scale were prerequisites for a positive attitude. The influence of the social environment was detrimental; although people tried to motivate patients to active self-care, they could not provide any real help in performing this desired behaviour. According to the results of this study, diabetes education should first aim at improving the level of knowledge and the health locus of control of the patients and second, at a positive attitude to active self-care. It is necessary to educate the social environment to create a more supportive atmosphere for the patient with diabetes.diabetes education attitude-behaviour theories self-care behaviour Fishbein & Ajzen

Has patients' involvement in the decision-making process changed over time?

Objective: To get insight into the changes over time of patients' involvement in the decision-making process, and into the factors contributing to patients' involvement and general practitioners' (GPs) communication related to the Medical Treatment Act (MTA) issues: information about treatment, other available treatments and side-effects; informed decision making; asking consent for treatment. Background: Societal developments have changed the doctor-patient relationship recently. Informed decision making has become a central topic. Patients' informed consent was legalized by the MTA (1995). Design: Data of two cross-sectional studies, the First (1987) and Second (2001) Dutch National Survey of General Practice, were compared. Setting and participants: General practice consultations; 16 GPs and 442 patients in 1987; 142 GPs and 2784 patients in 2001. Methods: Consultations were videotaped and rated using Roter's Interaction Analysis System and observer questionnaires; pre- and post-consultation patient questionnaires; and GP questionnaires. Descriptive analyses and multivariate, multilevel analysis were applied. Main results: Most patients reported to have received the information they had considered as important prior to the consultation. There were discrepancies in involvement in treatment decisions and in giving information about other available treatments, side-effects and risks. GPs who were more affective and gave more information, more often involved their patients, especially younger patients, in decision making. In 2001, more informed decision making was observed and the GPs asked consent for a treatment more often, but they less often asked for the patients' understanding. Conclusion: Patients' involvement in decision making has increased over time, but not in every respect. However, this does not apply for all patients, especially the older ones. It should be questioned whether they are willing or capable to be involved and if so, how they could be encouraged