An Assessment of Attitudes, Behaviors, and Outcomes of Patients with Type 2 Diabetes

Abstract

Objectives: Patient self-care behaviors, including taking medication, following a meal plan, exercising regularly, and testing blood glucose, influence diabetes control. The purpose of this research was to identify (1) which barriers to diabetes management are associated with problem behaviors and (2) which patient behaviors and barriers are associated with diabetes control.Methods: This was a cross-sectional study of linked medical record and self-reported information from patients with type 2 diabetes. A randomly selected sample of 800 clinic patients was mailed an investigator-developed survey. The study sample consisted of 253 (55%) individuals who had measured glycosylated hemoglobin (HbA1c) within 3 months of the survey date.Results: The barriers to each diabetes self-care behavior differed. Cost was the most common barrier to the 4 self-care behaviors. In a multivariable regression model, the belief that type 2 diabetes is a serious problem and depression were strongly associated with higher HbA1c levels. Lower HbA1c levels were significantly associated with being married and greater self-reported adherence-satisfaction with taking medication and testing blood glucose.Conclusion: This study expanded earlier research by focusing on 4 specific self-care behaviors, their barriers, and their association with HbA1c. Barriers that were significantly associated with HbA1c were specific to the behavior and varied across behaviors. Although the importance of glycemic control is well established, 1 it is often not achieved. 2 Factors contributing to poor control include inadequacies in patient self-care behaviors, medical management, or both. [3][4][5][6][7] Physicians know that patient self-care behaviors influence diabetes control but may lack training for and interest in motivating their patients to improve these behaviors. 8 Contributing to poor control is a paucity of information available about the frequency of problem behaviors, barriers to appropriate care behaviors, or the relationship of specific patient self-care behaviors to glycemic control. 9,10 Our conceptual model for this study is shown in Figure 1, adapted from the works of Glasgow. 11Factors that influence diabetes adherence in our model include personal factors, such as type and duration of diabetes, illness, and other health conditions and psychosocial factors. Glasgow's model places primary emphasis on the variables of the patient-health care provider interactions, compliance, and outcomes. The patient-provider interactions are composed of the patient's perspective and participation, appropriateness of prescriptions, and clarity and specificity of recommendations. The social/environmental influences included barriers to adherence, community resources, social support, and economic factors. The primary emphases of this study were the performance of 4 primary self-care behaviors and specific barriers to these behaviors: (1) medication use, (2) meal plans, (3) exercise, and (4) home glucose testing. In addition, our model attempts to include many ...

Nursing students’ perspectives regarding challenges of patient education in clinical settings

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“…56,57 Research suggests that sufficient knowledge about disease-specific risk factors, disease diagnostics and treatment, and the importance of self-managing symptoms to prevent detrimental health outcomes are important for patients to make an informed decision about whether or not to participate in chronic disease self-management. 32,37,[58][59][60] Findings from this review suggest that patient enrollment and retention was negatively influenced among those patients who did not fully understand the pathophysiology of their condition, the impact that their condition will have on their health-related quality of life, and how to coordinate chronic disease care and treatment, especially when living with comorbidities.…”

A Study of the Barriers and Facilitators of Patient Education from the Viewpoint of Nursing Students at Jahrom College of Nursing

“…Due to physical disorders and the resultant anxiety, patients may not be ready for education, or even realize the importance of education in their case 24 . Other studies have similarly referred to psychological disorders and lack of physical preparation on the part of patients as major obstacles to patient education 12,22,[25][26][27][28][29] .It should be noted that at the time of diagnosis, most patients are not prepared for education: being diagnosed with a disease is the beginning of a crisis for most people. The best time for education is when patients are in stable conditions and have begun to adapt to their new lives 1 .…”