Illness perceptions and perceived barriers to self-care in patients with type 2 diabetes mellitus: an exploratory study from India

  • Anisha Mary Abraham
  • Paulomi M. SudhirEmail author
  • Mariamma Philip
  • Ganapathi Bantwal
Original Article


The aim of the present study was to examine the relationship between perceived barriers to self-care, illness perceptions, metabolic control and quality of life. Sixty patients with type 2 diabetes mellitus, aged 30–60 years, were recruited from the endocrinology department of a general hospital in Bangalore. They were assessed on the Barriers to Self-Care scale, Illness Perceptions Questionnaire (Revised), Summary of Diabetes-Specific Self-Care Activities. The outcomes were assessed by the brief Diabetes Quality of Life scale and the current glycosylated haemoglobin (HbA1c) level. Results were analysed using descriptive statistics, correlation coefficients and regression analysis. Perceived barriers to self-care were significantly associated with identity, consequence, timeline cyclical, and emotional representation, personal control, treatment control and illness coherence dimensions of illness perceptions. Self-care was associated with personal and treatment control and illness coherence dimensions of illness perceptions. Self-care was positively associated with metabolic control. Barriers to self-care were associated with self-care and were an important predictor of self-care and quality of life. The findings of this study emphasize the importance of social cognitive variables such as illness perceptions, self-efficacy beliefs and perceived barriers in impacting self-care and quality of life in patients with type 2 diabetes mellitus.


Barriers to self-care Illness perceptions Adherence Self-care Quality of life 



The authors would like to thank Dr. D. K. Subbakrishna for his inputs on the study.



Conflict of interest


Author contributions

The paper is based on the academic research carried out by A.M.A. A.M.A. carried out the assessments, wrote the manuscript; P.M.S. supervised the planning of the study and assessments, reviewed and edited the manuscript; M.P. contributed to the statistical analysis of the data and reviewed the manuscript; G.B. screened patients for the study, reviewed the manuscript.


  1. 1.
    Sigurdardottir AK. Self-care in diabetes: model of factors affecting self-care. J Clin Nurs. 2005;14(3):301–14.CrossRefPubMedGoogle Scholar
  2. 2.
    Polly RK. Diabetes health beliefs, self-care behaviors and glycemic control among older adults with non-insulin dependent diabetes mellitus. Diabetes Educ. 1992;18:321–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Delamater AM. Improving patient adherence. Clin Diabetes. 2006;24:71–7.CrossRefGoogle Scholar
  4. 4.
    Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res. 2007;125:217–30.PubMedGoogle Scholar
  5. 5.
    Hayes L, White M, Unwin N, Bhopal R, Fischbacher C, Harland J, et al. Patterns of physical activity and relationship with risk markers for cardiovascular disease and diabetes in Indian, Pakistani, Bangladeshi and European adults in a UK population. J Public Health Med. 2002;24(3):170–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Fischbacher CM, Bhopal R, Steiner M, Morris AD, Chalmers J. Is there equity of service delivery and intermediate outcomes in South Asians with type 2 diabetes? Analysis of DARTS database and summary of UK publications. J Public Health. 2009;31(2):239–49.CrossRefGoogle Scholar
  7. 7.
    Mather HM, Chaturvedi N, Fuller JH. Mortality and morbidity from diabetes in South Asians and Europeans: 11-year follow-up of the Southall Diabetes Survey, London, UK. Diabet Med. 1998;15(1):53–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Gary TL. Meta-analysis of randomized educational and behavioural interventions in type 2 diabetes. Diabetes Educ. 2003;29:488–501.CrossRefPubMedGoogle Scholar
  9. 9.
    Levensky ER, O’Donohue WPO. Patient adherence and nonadherence to treatment. In: Levensky ER, O’Donohue WPO, editors. Promoting treatment adherence: a practical handbook for healthcare providers. 1st ed. Thousand Oaks: Sage Publications; 2006. p. 6.Google Scholar
  10. 10.
    Janz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 1984;11:1.CrossRefPubMedGoogle Scholar
  11. 11.
    Patel M, Patel I, Patel YM, Rathi SK. A hospital-based observational study of type 2 diabetic subjects from Gujarat, India. J Health Popul Nutr. 2011;29(3):265–72.PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Glasgow RE. Perceived barriers to self management and preventive behaviours. National Cancer Institute. 2003. Available from: Accessed 05 July 2011.
  13. 13.
    Aljasem L, Peyrot M, Wissow L, Rubin R. The impact of barriers and self-efficacy on self-care behaviors in type 2 diabetes. Diabetes Educ. 2001;27:393–404.CrossRefPubMedGoogle Scholar
  14. 14.
    Gazmararian J, Ziemer D, Barnes C. Perception of barriers to self-care management among diabetic patients. Diabetes Educ. 2009;35(5):778–88.CrossRefPubMedGoogle Scholar
  15. 15.
    Tu KS, Barchard K. An assessment of self-care barriers in older adults. J Community Health Nurs. 1993;10:113–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Nagelkerk J, Reick K, Meengs L. Perceived barriers and effective strategies to diabetes self-management. J Adv Nurs. 2006;54(2):151–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Leventhal H, Meyer D, Nerenz D. The common sense representation of illness danger. In: Rachman S, editor. Contributions to medical psychology. 2nd ed. New York: Pergamon; 1980.Google Scholar
  18. 18.
    Paddison C, Alpass F, Stephens C. Psychological factors account for variation in metabolic control and perceived quality of life among people with type 2 diabetes in New Zealand. Int J Behav Med. 2008;15:180–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Potluri R, Purmah Y, Dowlut M, Sewpaul N, Lavu D. Microvascular diabetic complications are more prevalent in India compared to Mauritius and the UK due to poorer diabetic control. Diabetes Res Clin Pract. 2009;86(2):39–40.CrossRefGoogle Scholar
  20. 20.
    Rosal MC, Ockene IS, Restrepo A, White MJ, Borg A, Olendzki B, et al. Literary-sensitive, culturally tailored diabetes self management intervention for low income Latinos. Diabetes Care. 2011;34(4):833–44.CrossRefGoogle Scholar
  21. 21.
    Simmons D, Williams R. Dietary practices among Europeans and different South Asian groups in Coventry. Br J Nutr. 1997;78(1):5–14.CrossRefPubMedGoogle Scholar
  22. 22.
    Vishram S, Crosland A, Unsworth J, Long S. Engaging women from South Asian communities in cardiac rehabilitation. Br J Community Nurs. 2007;12(1):13–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Stone M, Pound E, Pancholi A, Farooqi A, Khunti K. Empowering patients with diabetes: a qualitative primary care study focusing on South Asians in Leicester, UK. Fam Pract. 2005;22:647–52.CrossRefPubMedGoogle Scholar
  24. 24.
    Sridhar GR, Madhu K, Veena S, Madhavi R, Sangeetha BS, Rani A. Living with diabetes: Indian experience. Diabetes Metab Syndr Clin Res Rev. 2007;1:181–7.CrossRefGoogle Scholar
  25. 25.
    U.K. Prospective Diabetes Study Group: Diabetes Study Group: Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). Diabetes Care. 1999;22(7):1125–36Google Scholar
  26. 26.
    Nam S, Chesla C, Stotts NA, Kroon L, Janson SL. Barriers to diabetes management: patient and provider factors. Diabetes Res Clin Pract. 2011;93:1–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Glasgow RE. Social-environmental factors in diabetes: barriers to diabetes self care. In: Bradley C, editor. Handbook of psychology and diabetes. Newark: Harwood Academic; 1994. p. 335–50.Google Scholar
  28. 28.
    Moss-Morris AD, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The revised illness perceptions questionnaire (IPQ-R). Psychol Health. 2002;17:1–16.CrossRefGoogle Scholar
  29. 29.
    Toobert DJ, Glasgow RE. Assessing diabetes self-management: the summary of diabetes self-care activities questionnaire. In: Bradley C, editor. Handbook of psychology and diabetes. Newark: Harwood Academic; 1994. p. 351–78.Google Scholar
  30. 30.
    Leventhal H, Benyamini Y, Brownlee S, Diefenbach M, Leventhal EA, Patrick-Miller L, et al. Illness representations: theoretical foundations. In: Petrie KJ, Weinman J, editors. Perceptions of health and illness. 2nd ed. Amsterdam: Harwood Academic; 1997. p. 19–46.Google Scholar
  31. 31.
    Engelgau MM, Narayan KMV, Herman WH. Screening for type 2 diabetes in asymptomatic adults. Diabetes Care. 2000;18:1563–80.CrossRefGoogle Scholar
  32. 32.
    Deepa M, Deepa R, Shanthirani CS, Manjula D, Unwin NC, Kapur A, et al. Awareness and knowledge of diabetes in Chennai—the Chennai Urban Rural Epidemiology Study (Cures—9). J Assoc Physicians India. 2005;53:283–7.Google Scholar
  33. 33.
    Balagopal P, Kamalamma N, Patel TG, Mishra R. A community-based diabetes prevention and management education program in a rural village in India. Diabetes Care. 2008;31:1097–104.CrossRefPubMedGoogle Scholar
  34. 34.
    Connell CM, Davis WK, Gallant MP, Sharpe PA. Impact of social support, social cognitive variables, and perceived threat on depression among adults with diabetes. Health Psychol. 1994;13:263–73.CrossRefPubMedGoogle Scholar
  35. 35.
    Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev. 1999;15:205–18.CrossRefPubMedGoogle Scholar
  36. 36.
    Kapur K, Kapur A, Ramachandran S, Mohan V, Aravind SV, Badgandi M, et al. Barriers to changing dietary behavior. J Assoc Physicians India. 2008;56:27–32.PubMedGoogle Scholar
  37. 37.
    Glasgow RE, Hampson SE, Strycker LA, Ruggiero L. Personal-model beliefs and social environmental barriers related to diabetes self management. Diabetes Care. 1997;20:556–61.CrossRefPubMedGoogle Scholar
  38. 38.
    Al-Shehri AH, Taha AZ, Bahnassy AA, Salah M. Health-related quality of life in type 2 diabetic patients. Ann Saudi Med. 2008;28:352–60.CrossRefPubMedGoogle Scholar

Copyright information

© Research Society for Study of Diabetes in India 2014

Authors and Affiliations

  • Anisha Mary Abraham
    • 1
  • Paulomi M. Sudhir
    • 2
    Email author
  • Mariamma Philip
    • 3
  • Ganapathi Bantwal
    • 4
  1. 1.Department of PsychiatryAmerican Mission HospitalManamaKingdom of Bahrain
  2. 2.Department of Clinical PsychologyNational Institute of Mental Health and NeurosciencesBangaloreIndia
  3. 3.Department of BiostatisticsNational Institute of Mental Health and NeurosciencesBangaloreIndia
  4. 4.Department of EndocrinologySt. John’s Medical CollegeBangaloreIndia

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