Skip to main content

Advertisement

SpringerLink
Log in

Glycemic control, self-care behaviors, and psychosocial factors among insulin treated diabetics: A test of an extended health belief model

  • Empirical Contributions
  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

The relations of diet adherence (DA) and self-monitoring of blood glucose (SMBG) to metabolic control, as measured with glycosylated hemoglobin A10(GHbA10), and correlates of self-care were examined among a type 1 diabetic sample (n = 423). The Health Belief Model (HBM), supplemented by other factors (locus of control, self-efficacy, health value, and social support), was used as a theoretical model. In multiple regression analyses both DA(p> .001) and SMBG (p > .001) were related to GHbA10. Theoretically derived path models for HBM (estimated by LFSREL) required modifications. DA showed strong associations with diabetes related social support (p > .001) and net benefits of DA (p > .001). SMBG showed strong associations with self-efficacy in SMBG (p > .001) and net benefits of SMBG (p > .001). The revised models explained 14% and 21% of the variation in DA and SMBG, respectively. The results suggest that although perceived net benefits are important determinants of both SMBG and DA, DA is also related to diabetes support, whereas SMBG is more strongly related to perceived self-efficacy. Thus self-care regimen should he planned individually for diabetic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aallo, A.-M., & Kangas, T. (1993). Diabetekseen liittyvät hallintakäsitykset ja terveysuskomukset hoitomuodon ja diabeteslyypin mukaan [Diabetes related cognitive beliefs according to the type of diabetes and regimen]. Sosiaalilääketieleellinen Aikakauslehti, 30, 348–360

    Google Scholar 

  • Aikens, J. E., Wallander, J. L., Bell, D. S. H., & Cole, J. A. (1992). Daily stress variability, learned resourcefulness, regimen adherence, and metabolic control in Type I diabetes mellitus: Evaluation of a path model. Journal of Consulting and Clinical Psychology, 60, 113–118.

    Article  PubMed  Google Scholar 

  • Ary, D. V., Toobert, D., Wilson, W., & Glasgow, R. E. (1986). Patient perspective on factors contributing to nonadherence to diabetes regimen. Diabetes Care, 9, 168–172.

    Article  PubMed  Google Scholar 

  • Balfour, L., White, D. R., Schiffrin, A., Dougherty, G., & Dufresne, J. (1993). Dietary disinhibition, perceived stress, and glucose control in young. Type I diabetic women. Health Psychology, 12, 33–38.

    Article  PubMed  Google Scholar 

  • Bandura, A. (1977). Self-efficacy: Towards a unifying theory of behavioral change. Psychological Review, 84, 191–215.

    Article  PubMed  Google Scholar 

  • Becker, M. H., & Maiman, L. A. (1975). Sociobehavioral determinants of compliance with health and medical care recommendations. Medical Cure, 13, 10–24.

    Article  Google Scholar 

  • Bond, G. C., Alken. L. S.. & Somerville, S. C. (1992). The Health Belief Model and adolescents with insulin-dependent diabetes mellitus. Health Psychology, 11, 190–198.

    Article  PubMed  Google Scholar 

  • Brownlee-Duffeck, M., Peterson, L., Simonds, J. F., Goldstein, D., Kilo, C., & Hoelte, 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, 139–144.

    Article  PubMed  Google Scholar 

  • Burroughs, T. E., Pontious, S. L., & Santiago, J. V. (1993). The relationship among six psychosocial domains, age healthcare adherence and metabolic control in adolescents with IDDM. The Diabetes Educator, 19, 396–402.

    Article  PubMed  Google Scholar 

  • Connell, C. M., Davis, W. K., Gallant, M. P., & Sharpe, P. A. (1994). Impact of social support social cognitive variables and perceived threat on depression among adults with diabetes. Health Psychology, 13, 263–273.

    Article  PubMed  Google Scholar 

  • Cronenwelt, L. R. (1985). Network structure, social support, and psychological outcomes of pregnancy. Nursing Research, 34, 93–99.

    Google Scholar 

  • Delahanty, L. M., & Halford, B. N. (1993). The role of diet behaviors in achieving improved glycemic control in intensively treated patients in the diabetes control and complications trial. Diabetes Care, 16, 1453–1458.

    Article  PubMed  Google Scholar 

  • Ferraro, L. A., Price, J. H., Desmond, S. M., & Roberts, S. M. (1987). Development of a diabetes locus of control scale. Psychological Reports, 61, 763–770.

    PubMed  Google Scholar 

  • Gafvels, C., Lithner, F., & Börjeson, B. (1993). Living with diabetes: Relationship to gender, duration and complications. A survey in northern Sweden. Diabetic Medicine, 10, 768–773.

    Article  PubMed  Google Scholar 

  • Glasgow, R. E., Toobert, D. J., Riddle, M., Donnelly, J., Mitchell, D. L., & Calder, D. (1989). Diabetes-specific social-learning variables and self-care behaviors among persons with Type II diabetes. Health Psychology, 8, 285–303.

    Article  PubMed  Google Scholar 

  • Harris, R., & Linn, M. W. (1985). Health beliefs, compliance, and control of diabetes mellitus. Southern Medical Journal, 78, 162–166.

    PubMed  Google Scholar 

  • Harris, R., Linn, M. W., Skyler, J. S., & Sandifer, R. (1987). Development of Diabetes Health Belief Scale. The Diabetes Educator, 13, 292–297.

    Article  PubMed  Google Scholar 

  • Janis, I. L., & Mann, L., (1977). Decision making A psychological analysis of conflict, choice, and commitment. New York; Free Press.

    Google Scholar 

  • Janz, N. K., & Becker, M. H. (1984). The Health Belief Model: A decade later. Health Education Quarterly, 11, 1–47.

    PubMed  Google Scholar 

  • Kangas, T. (1996). The FinnDiab Report: Health care of people with diabetes in Finland. Saarijävi: Gummerus Kirjapaino Oy.

    Google Scholar 

  • Kavanagh, D. J., Cooley, S., & Wilson, P. H. (1993). Prediction of adherence and control in diabetes. Journal of Behavioral Medicine, 16, 509–522.

    Article  PubMed  Google Scholar 

  • Lazar, M., & Kotterba, S. (1993). Kontrollüherzeugungen von Patienten mit schubfömig verlaufender Encephalomyelitis disseminata [The control beliefs of patients with phasic course of Encephalomyelitis disseminata]. Schweizer Archiv Für Neurologie and Psvchiatrie, 144, 147–162.

    Google Scholar 

  • Littlefield, C. H., Daneman, D., Craven, J. L., Murray, M. A., Rodin, G. M., & Rydall, A. C. (1992). Relationship of self-efficacy and bingeing to adherence to diabetes regimen among adolescents. Diabetes Care, 15, 90–94.

    Article  PubMed  Google Scholar 

  • Lloyd, C. E., Wing, R. R., Orchard, T. J., & Becker, D. J. (1993). Psychosocial correlates of glycemic control: The Pittsburgh Epidemiology of Diabetes Complications (EDC) study. Diabetes Research and Clinical Practice, 21, 187–195.

    Article  PubMed  Google Scholar 

  • Lundman, B., Asplund, K., & Norberg, A. (1990). Living with diabetes: Perceptions of well-being. Research in Nursing and Health, 13, 255–262.

    Article  PubMed  Google Scholar 

  • Malman, L. A., & Becker, M. H. (1974). The Health Belief Model: Origins and correlates in psychological theory [Monograph]. Health Education Monographs, 2, 336–353.

    Google Scholar 

  • McCaul, K. D., Glasgow, R. E., & Schafer, L. C. (1987). Diabetes regimen behaviors: Predicting adherence. Medical Care, 25, 868–881.

    PubMed  Google Scholar 

  • Meize-Grochowski, A. R. (1990). Health locus of control and glycosylated hemoglobin concentration of implantable insulin pump recipients in Austria. Journal of Advanced Nursing, 15, 804–807.

    Article  PubMed  Google Scholar 

  • Metsch, J., Tillil, H., Köbberling, J., & Sartory, G. (1995). On the relation among psychosocial distress. diabetes-related health behavior, and level of glycosylated hemoglobin in Type 1 diabetes. International Journal of Behavioral Medicine, 2, 104–117.

    Article  PubMed  Google Scholar 

  • Nagy, V. T., & Wolfe, G. R. (1984). Cognitive predictors of compliance in chronic disease patients. Medical Care, 22, 912–921.

    Article  PubMed  Google Scholar 

  • Norman, P., & Conner, M. (1996). The role of social cognition models in predicting health behaviours: Future directions. In M. Conner & P. Norman (Eds.), Predicting health behaviour (1st ed., pp. 197–225). Philadelphia: Open University Press.

    Google Scholar 

  • Peacock, I. (1984). Glycosylated haemoglobine: Measurement and clinical use. Journal of Clinical Pathology, 37, 841–851

    Article  PubMed  Google Scholar 

  • Peyrot, M., & Rubin, R. R. (1994). Structure and correlates of diabetes-specific locus of control. Diabetes Care, 17, 994–1001

    Article  PubMed  Google Scholar 

  • Reid, D. W. (1984). Participatory control and the chronic-illness adjustment process. In H. M. LefCourt (Ed.), Research with the locus of control construct (Vol. 3, pp. 361–389). New York: Academic.

    Google Scholar 

  • Rosenstock, L. M. (1966). Why people use health services. Milbank Memorial Fund Quarterly, 44, 94–127.

    Article  PubMed  Google Scholar 

  • Rosenstock, L. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the Health Belief Model. Health Education Quarterly, 15, 175–183.

    PubMed  Google Scholar 

  • Rost, K. M., Flavin, K. S., Schmidt, L. E., & McGill, J. B. (1990). Self-care predictors of metabolic control in NIDDM patients. Diabetes Care, 13, 1111–1113.

    Article  PubMed  Google Scholar 

  • Rubin, R. R., Peyrot, M., & Saudck, C. D. (1991). Differential effect of diabetes education on self-regulation and life-style behaviors. Diabetes Care, 14, 335–338.

    Article  PubMed  Google Scholar 

  • Ruggiero, L., Spirilo, A., Bond, A., Coustan, D., & McGarvey, S. (1990). Impact of social support and stress on compliance in women with gestational diabetes. Diabetes Care, 13, 441–443.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. National Research and Development Centre for Welfare and Health, Health Services Research Unit, P.O. Box 220, 00531, Helsinki, Finland

    Anna-Mari Aalto

  2. National Public Health Institute, Helsinki, Finland

    Antti Uutela

Authors
  1. Anna-Mari Aalto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antti Uutela
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anna-Mari Aalto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aalto, AM., Uutela, A. Glycemic control, self-care behaviors, and psychosocial factors among insulin treated diabetics: A test of an extended health belief model. Int. J. Behav. Med. 4, 191–214 (1997). https://doi.org/10.1207/s15327558ijbm0403_1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1207/s15327558ijbm0403_1

Key words

Search

Navigation