Journal of Behavioral Medicine

, Volume 14, Issue 1, pp 71–86 | Cite as

Problem solving and diabetes self-care

  • Deborah J. Toobert
  • Russell E. Glasgow
Article

Abstract

An important objective of diabetes care is to provide patients with self-regulation skills. For patients to assume responsibility for their own regimens, they need to have good problem-solving skills to cope with ongoing personal, social, and environmental barriers to adherence. Therefore, a Diabetes Problem Solving Interview for adults was developed and evaluated with 126 non-insulin-dependent outpatients. Interviewers elicited problem-solving strategies patients would use to cope with a variety of situations potentially interfering with dietary, exercise, and glucose testing adherence. Interviews were tape recorded and coded by trained raters to produce scores on both overall problem-solving skill ratings and frequency of use of different types of strategies. Results revealed only minor influences of patient characteristics on problem-solving measures. Prospective analyses revealed that problem-solving measures were significant and independent predictors of levels of dietary and exercise self-care at a 6-month follow-up.

Key words

diabetes self-care problem solving adherence diet exercise 

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References

  1. Anderson, L. A. (1990). Health-care communication and selected psychosocial correlates of adherence in diabetes managment.Diabetes Care 13: 66–76.Google Scholar
  2. Ary, D. V., Toobert, D., Wilson, W., and Glasgow, R. E. (1986). A patient perspective on factors contributing to nonadherence to diabetes regimens.Diabetes Care 9: 168–172.Google Scholar
  3. Chancy, E. F., O'Leary, M. R., and Marlatt, G. A. (1978). Skill training with alcoholics.J. Consult. Clin. Psychol. 46: 1092–1104.Google Scholar
  4. Cox, D. J., Gonder-Frederick, L., Pohl, S., and Pennebaker, J. W. (1986). Diabetes. In Holroyd, K. A., and Creer, T. L., (eds.),Self-Management of Chronic Disease, Academic Press, New York.Google Scholar
  5. D'Zurilla, T. (1986).Problem Solving Therapy, Springer, New York.Google Scholar
  6. D'Zurilla, T., and Goldfried, M. (1971). Problem-solving and behavior modification.J. Abnorm. Psychol. 78: 104–126.Google Scholar
  7. Follansbee, D. J., La Greca, A. M., and Citrin, W. S. (1983). Coping skills training for adolescents with diabetes. Paper presented at the Annual Meeting of the American Diabetes Association, San Antonio, Texas.Diabetes 32 (Suppl. 1): 147 (abstr.).Google Scholar
  8. Foxx, R. M., Martella, R. C., and Marchand-Martella, N. E. (1989). The acquisition, maintenance, and generalization of problem-solving skills by closed head-injured adults.Behav. Ther. 20: 61–76.Google Scholar
  9. Gilchrist, L. D., Schinke, S. P., Bobo, J. K., and Snow, W. H. (1986). Self-control skills for preventing smoking.Addict. Behav. 11: 169–174.Google Scholar
  10. Glasgow, R. E. (1990). Compliance to diabetes regimens: Conceptualization, complexity, and determinants. In Cramer, J. A., and Spilker, B. (eds.),Patient Compliance in Medical Practice and Clinical Trials, Raven Press, New York.Google Scholar
  11. Glasgow, R. E., Klesges, R. C., Mizes, J. S., and Pechacek, T. F. (1985a). Quitting smoking strategies used and variables associated with success in a stop-smoking contest.J. Consult. Clin. Psychol. 55: 905–912.Google Scholar
  12. Glasgow, R. E., Wilson, W. W., and McCaul, K. D. (1985b). Regimen adherence: A problematic construct in diabetes research.Diabetes Care 8: 300–301.Google Scholar
  13. Glasgow, R. E., McCaul, K. D., and Schafer, L. D. (1986). Barriers to regimen adherence among persons with insulin-dependent diabetes.J. Behav. Med. 9: 65–77.Google Scholar
  14. Glasgow, R. E., McCaul, K. D., and Schafer, L. D. (1987). Self-care behaviors and glycemic control of Type I diabetes.J. Chron. Dis. 40: 399–412.Google Scholar
  15. Glasgow, R. E., Toobert, D. J., Riddle, M., Donnelly, J., Mitchell, D. L., and Calder, D. (1989). Diabetes-specific social learning variables and self-care behaviors among persons with Type II Diabetes.Health Psychol. 8: 285–303.Google Scholar
  16. Goldfried, M. R., and D'Zurilla, T. J. (1969). A behavioral-analytic model for assessing competence. In Spielberger, C. D. (ed.),Current Topics in Clinical and Community Psychology, Vol. 1, Academic Press, New York.Google Scholar
  17. Heppner, P. P., Neal, G. W., and Larson, L. M. (1984). Problem solving training as prevention with college students.Personnel Guid. J. 62: 514–519.Google Scholar
  18. Hollingshead, A. B. (1975). Four factor index of social status. Unpublished manuscript, Yale University, New Haven, Conn.Google Scholar
  19. Irvine, A. A., Bobbitt, S. A., and Carter, W. R. (1990). Adherence to the diabetic regimen: The role of environmental barriers (submitted for publication).Google Scholar
  20. Johnson, S. B., Pollak, T., Silverstein, J. H., Rosenbloom, A. L., Spillar, R., McCallum, M., and Harkavy, J. (1982). Cognitive and behavioral knowledge about insulin-dependent diabetes among children and parents.Pediatrics 69(6): 708–713.Google Scholar
  21. Johnson, S. B., Silverstein, J., Rosenbloom, A., Carter, R., and Cunningham, W. (1986). Assessing daily management in childhood diabetes.Health Psychol. 5: 545–564.Google Scholar
  22. Kovacs, M., and Feinberg, T. (1982). Coping with juvenile onset diabetes mellitus. In Baum, A., and Singer, J. (eds.),Handbook of Psychology and Health, Vol. 2, Erlbaum, Hillsdale, N.J.Google Scholar
  23. McCaul, K. D., Glasgow, R. E., and Schafer, L. D. (1987). Diabetes regimen behaviors: Predicting adherence.Med. Care 25: 868–881.Google Scholar
  24. Meichenbaum, D., and Turk, D. C. (1987). Teaching self-regulatory skills. In Meichenbaum, D., and Turk, D. C. (eds.),Facilitating Treatment Adherence: A Practitioner's Guidebook, Plenum Press, New York.Google Scholar
  25. Nezu, A. M. (1986a). Cognitive appraisal of problem solving effectiveness: Relation to depression and depressive symptoms.J. Clin. Psychol. 42: 42–48.Google Scholar
  26. Nezu, A. M. (1986b). Efficacy of social problem-solving therapy approach for unipolar depression.J. Consult. Clin. Psychol. 54: 196–202.Google Scholar
  27. Nezu, A. M., Nezu, C. M. Saraydarian, L., Kalmar, K., and Ronan, G. F. (1986). Social problem solving as a moderating variable between negative life stress and depressive symptoms,Cognit. Ther. Res. 10(5): 489–498.Google Scholar
  28. Orme, C. M., and Binik, Y. M. (1989). Consistency of adherence across regimen demands.Health Psychol. 8: 27–43.Google Scholar
  29. Platt, J. J., and Spivack, G. (1975).Manual for the Means-End Problem-Solving Procedure (MEPS): A Measure of Interpersonal Cognitive Problem Solving Skill, Hahnemann Community Mental Health/Mental Retardation Center, Department of Mental Health Sciences, Hahnemann Medical College and Hospital, Philadelphia, Penn.Google Scholar
  30. Turk, D. C., Holzman, A. D., and Kerns, R. D. (1986). Chronic pain. In Holroyd, K. A., and Creer, T. L. (eds.),Self-Management of Chronic Disease: Handbook of Clinical Interventions and Research, Academic Press, Orlando, Fla.Google Scholar
  31. Wilson, W., Ary, D., Biglan, A., Glasgow, R. E., Toobert, D. J., and Campbell, D. (1986). Psychosocial predictors of self-care behaviors (compliance) and glycemic control in non-insulin-dependent diabetes mellitus.Diabetes Care 9: 614–622.Google Scholar
  32. Wysocki, T., Green, L., and Huxtable, K. (1989). Blood glucose monitoring by diabetic adolescents: Compliance and metabolic control.Health Psychol. 8: 267–284.Google Scholar

Copyright information

© Plenum Publishing Corporation 1991

Authors and Affiliations

  • Deborah J. Toobert
    • 1
  • Russell E. Glasgow
    • 1
  1. 1.Oregon Research InstituteEugene

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