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Self-management behavior among patients with diabetic retinopathy in the community: a structural equation model

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Abstract

Purpose

Diabetic retinopathy (DR) is an important, chronic complication of diabetes, requiring competent self-management that depends on adherence to behavioral regimens. This study attempted to identify factors influencing self-management behaviors and develop a model illustrating the interdependence of several factors associated with DR patients.

Methods

In June–December 2012, 368 patients with DR completed questionnaires assessing self-management behavior, diabetes knowledge, health beliefs, social support, and treatment adherence. Structural equation modeling was used to test predicted pathways linking self-management behavior to diabetes knowledge, health beliefs, social support, and treatment adherence.

Results

The results indicated that health beliefs, treatment adherence, and duration of diabetes each had a direct impact on diabetes self-management (p < 0.05). Diabetes knowledge only indirectly influenced diabetes self-management, through health beliefs. Social support had a direct impact on diabetes self-management (β = 0.35, p < 0.01), and an indirect influence on diabetes self-management, through treatment adherence (β = 0.77, p < 0.01).

Conclusion

Health beliefs, treatment adherence, and social support directly affect diabetes self-management, and diabetes knowledge indirectly affects diabetes self-management. This suggests that enhancing DR patients’ health beliefs, treatment adherence, and social support would facilitate their diabetes self-management. Meanwhile, improved health education can strengthen diabetes knowledge, which in turn, can positively affect diabetes self-management.

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References

  1. Nagelkerk, J., Reick, K., & Meengs, L. (2006). Perceived barriers and effective strategies to diabetes self-management. Journal of Advanced Nursing, 54(2), 151–158.

    Article  PubMed  Google Scholar 

  2. Tumosa, N. (2008). Eye disease and the older diabetic. Clinics in Geriatric Medicine, 24(3), 515–527.

    Article  PubMed  Google Scholar 

  3. Glasgow, R. E., & Anderson, R. M. (1999). In diabetes care, moving from compliance to adherence is not enough. Something entirely different is needed. Diabetes Care, 22(12), 2090–2092.

    Article  CAS  PubMed  Google Scholar 

  4. Peeples, M., Tomky, D., Mulcahy, K., Peyrot, M., & Siminerio, L. (2007). Evolution of the American Association of Diabetes Educators diabetes education outcomes project. The Diabetes Educator, 33(5), 794–817.

    Article  PubMed  Google Scholar 

  5. Sousa, V. D., Zauszniewski, J. A., Musil, C. M., Price, L. P. J., & Davis, S. A. (2005). Relationships among self-care agency, self-efficacy, self-care, and glycemic control. Research and Theory for Nursing Practice, 19(3), 217–230.

    Article  PubMed  Google Scholar 

  6. Funnell, M. M., Brown, T. L., Childs, B. P., Haas, L. B., Hosey, G. M., Jensen, B., et al. (2012). National standards for diabetes self-management education. Diabetes Care, 35(Suppl 1), S101–S108.

    Article  PubMed  Google Scholar 

  7. Patel, A., MacMahon, S., Chalmers, J., Neal, B., Billot, L., Woodward, M., et al. (2008). Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. The New England Journal of medicine, 358(24), 2560–2572.

    Article  CAS  PubMed  Google Scholar 

  8. Yu, D. S., Lee, D. T., & Woo, J. (2004). Psychometric testing of the Chinese version of the medical outcomes study social support survey (MOS-SSS-C). Research in Nursing and Health, 27(2), 135–143.

    Article  PubMed  Google Scholar 

  9. Nam, S., Chesla, C., Stotts, N. A., Kroon, L., & Janson, S. L. (2011). Barriers to diabetes management: Patient and provider factors. Diabetes Research and Clinical Practice, 93(1), 1–9.

    Article  PubMed  Google Scholar 

  10. Tang, T. S., Brown, M. B., Funnell, M. M., & Anderson, R. M. (2008). Social support, quality of life, and self-care behaviors among African Americans with type 2 diabetes. The Diabetes Educator, 34(2), 266–276.

    Article  PubMed  Google Scholar 

  11. Toljamo, M., & Hentinen, M. (2001). Adherence to self-care and social support. Journal of Clinical Nursing, 10(5), 618–627.

    Article  CAS  PubMed  Google Scholar 

  12. Albright, T. L., Parchman, M., & Burge, S. K. (2001). Predictors of self-care behavior in adults with type 2 diabetes: An RRNeST study. Family Medicine, 33(5), 354–360.

    CAS  PubMed  Google Scholar 

  13. Garay-Sevilla, M. E., Nava, L. E., Malacara, J. M., Huerta, R., de Leon, J. D., Mena, A., et al. (1995). Adherence to treatment and social support in patients with non-insulin dependent diabetes mellitus. Journal of Diabetes and its Complications, 9(2), 81–86.

    Article  CAS  PubMed  Google Scholar 

  14. Chlebowy, D. O., & Garvin, B. J. (2006). Social support, self-efficacy, and outcome expectations: Impact on self-care behaviors and glycemic control in Caucasian and African American adults with type 2 diabetes. The Diabetes Educator, 32(5), 777–786.

    Article  PubMed  Google Scholar 

  15. Rodrigues, F. F., Zanetti, M. L., dos, S. M. A., Martins, T. A., Sousa, V. D., & de Sousa Teixeira, C. R. (2009). Knowledge and attitude: Important components in diabetes education. Revista Latino-Americana de Enfermagem, 17(4), 468–473.

    Article  PubMed  Google Scholar 

  16. Mazzuca, S. A. (1982). Does patient education in chronic disease have therapeutic value. Journal of Chronic Diseases, 35(7), 521–529.

    Article  CAS  PubMed  Google Scholar 

  17. Harvey, J. N., & Lawson, V. L. (2009). The importance of health belief models in determining self-care behaviour in diabetes. Diabetic Medicine: A Journal of the British Diabetic Association, 26(1), 5–13.

    Article  CAS  Google Scholar 

  18. Brownlee-Duffeck, M., Peterson, L., Simonds, J. F., Goldstein, D., Kilo, C., & Hoette, S. (1987). The role of health beliefs in the regimen adherence and metabolic control of adolescents and adults with diabetes mellitus. Journal of Consulting and Clinical Psychology, 55(2), 139–144.

    Article  CAS  PubMed  Google Scholar 

  19. Gillibrand, R., & Stevenson, J. (2006). The extended health belief model applied to the experience of diabetes in young people. British Journal of Health Psychology, 11(Pt 1), 155–169.

    Article  PubMed  Google Scholar 

  20. Zimet, G. D., Powell, S. S., Farley, G. K., Werkman, S., & Berkoff, K. A. (1990). Psychometric characteristics of the multidimensional scale of perceived social support. Journal of Personality Assessment, 55(3–4), 610–617.

    Article  CAS  PubMed  Google Scholar 

  21. Guan, N. C., Huai, S. L., Hway, A. A. Y., & Ong, H. K. (2015). Factorial validity and reliability of the malaysian simplified chinese version of multidimensional scale of perceived social support (MSPSS-SCV) among a group of university students. Asia-Pacific Journal of Public Health, 27(2), 225–231.

    Article  PubMed  Google Scholar 

  22. Toobert, D. J., Hampson, S. E., & Glasgow, R. E. (2000). The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care, 23(7), 943–950.

    Article  CAS  PubMed  Google Scholar 

  23. Wang, R. H., & Lin, C. C. (1998). Self-care behaviors and related factors in outpatients newly diagnosed with non-Insulin dependent. The Journal of Nursing (in Chinese), 4(5), 60–74.

    CAS  Google Scholar 

  24. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55.

    Article  Google Scholar 

  25. Hamta, A., Khalilian, A. R., Farhadi, R., & Ranjbaran, H. (2013). Path analysis of the risk of low birth weight for multipara. Iranian Red Crescent Medical Journal, 15(6), 462–466.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Gallant, M. P. (2003). The influence of social support on chronic illness self-management: A review and directions for research. Health Education and Behavior: The Official Publication of the Society for Public Health Education, 30(2), 170–195.

    Article  Google Scholar 

  27. Rosland, A. M., Kieffer, E., Israel, B., Cofield, M., Palmisano, G., Sinco, B., et al. (2008). When is social support important? The association of family support and professional support with specific diabetes self-management behaviors. Journal of General Internal Medicine, 23(12), 1992–1999.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mayberry, L. S., & Osborn, C. Y. (2012). Family support, medication adherence, and glycemic control among adults with type 2 diabetes. Diabetes Care, 35(6), 1239–1245.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Xu, Y., Toobert, D., Savage, C., Pan, W., & Whitmer, K. (2008). Factors influencing diabetes self-management in Chinese people with type 2 diabetes. Research in Nursing and Health, 31(6), 613–625.

    Article  PubMed  Google Scholar 

  30. Chan, Y. M., & Molassiotis, A. (1999). The relationship between diabetes knowledge and compliance among Chinese with non-insulin dependent diabetes mellitus in Hong Kong. Journal of Advanced Nursing, 30(2), 431–438.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We would like to thank all study participants, and the doctors and nurses from the Jianhua community clinics in Qiqihar city for their considerable assistance.

Funding

This study was funded by the Ministry of Education of Heilongjiang province (Grant Number 12541377).

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Author notes

    Authors and Affiliations

    1. School of Nursing, Harbin Medical University, Harbin, 150086, Heilongjiang province, People’s Republic of China

      Li Yang

    2. Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang province, People’s Republic of China

      Li Yang, Qunhong Wu, Yanhua Hao, Yu Cui, Libo Liang, Lijun Gao, Mingli Jiao, Ning Ning, Hong Sun, Zheng Kang, Ye Li & Hui Yin

    3. Department of Preventive Medicine Medical, School of Ningbo University, Ningbo, 315000, Zhejiang province, People’s Republic of China

      Liyuan Han

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    Correspondence to Qunhong Wu or Yanhua Hao.

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    The authors declare that they have no conflict of interests.

    Ethical approval

    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

    Informed consent

    Informed consent was obtained from all individual participants included in the study.

    Additional information

    Li Yang, Yu Cui, and Libo Liang contributed equally to this article.

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    Yang, L., Wu, Q., Hao, Y. et al. Self-management behavior among patients with diabetic retinopathy in the community: a structural equation model. Qual Life Res 26, 359–366 (2017). https://doi.org/10.1007/s11136-016-1396-1

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