Identification of Psychological Factors Associated with Adherence to Self-Care Behaviors amongst Patients with Type 1 Diabetes

Abstract

Purpose. To explore the factors involved in adherence to self-care behaviors in patients with type 1 diabetes. Materials and Methods. Patients with type 1 diabetes (age range: 14-71 years) were invited to participate at seven Spanish hospitals. They completed a dossier which recorded sociodemographic and clinical variables and also measured personality variables, emotional state, beliefs, and concerns regarding the illness, by means of questionnaires. Results. A total of 428 patients with type 1 diabetes were included (58% women, age 36 (11.8) years, diabetes duration 18.3 (10.2) years, HbA1c 7.9 +/-1.3%). A total of 60.1% of patients found it difficult to follow the treatment recommendations for the care of their disease. The reasons given were mood (25.2%), lack of motivation (13.4%), work (12%), and economic difficulties (3.8%). Other personal reasons were reported by 5.7%. Motivation, training in diabetes management, importance the patient attributed to the disease, and self-efficacy were the variables that predicted adherence to self-care behaviors, together accounting for 32% of its variance. Anxiety and depression were highly prevalent in this study population (57.1% and 23.1%, respectively) and were associated with lower adherence. Conclusion. In the present study assessing patients with type 1 diabetes, motivation, training in diabetes management, beliefs regarding the disease, and self-efficacy were the main contributors to adherence to self-care behaviors. On the other hand, anxiety and depression were highly prevalent and associated with lower adherence. Thus, supplementing therapeutic education with strategies designed to raise levels of motivation, discussion of beliefs about the disease, and encouragement of self-efficacy might be a useful way to increase patient involvement in self-care.

Motivational Interviewing and Self-care in Type 1 Diabetes:a randomized controlled clinical trial study protocol

“…We estimated that each of the three clinical researchers involved the trial would be able to recruit around 20 patients in four months. With an expected sample size of 60 participants, we would be able to detect inter-group differences of 12.8 points on the SCI-R questionnaire and of 0.85% in HbA1c, with a power of 90% and a two-sided alpha of .05 [assuming an SD of 15 points in the SCI -R and 1% in HbA1c in line with previous studies (5)]. The equivalent detectable differences with a power of 0.8 would be 11 points and 0.74% respectively (calculated with http://hedwig.mgh.harvard.edu/sample_size/js/js_parallel_quant.html).…”

“…Patients set themselves a health-related goal which they aim to achieve through their participation in the trial. The degree of achievement is measured with a Likert scale (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”

“…In addition, patients must continuously make decisions regarding the adjustment of their insulin treatment and the everyday problems related to their illness (2)(3)(4). In a previous study which identified multiple factors related to self-care, the level of motivation reported by the patient was the strongest predictor of adherence to self-care, and was also recognized as one of the greatest obstacles to adherence to treatment (5). Currently, diabetes management is focused on person-centered care and empowerment, a philosophy that encourages patient involvement, awareness and participation in decisions concerning their health (6).…”

Effectiveness of the Freestyle Libre Flash Glucose Monitoring System on Diabetes Distress Among Individuals with Type 1 Diabetes: A Prospective Study

“…It is significant that many adult patients with T1D experience disease-related psychological difficulties that frequently go unnoticed and, consequently, are either untreated or poorly managed. Such poor treatment strategies can prevent patients from improving their individual care in terms of accomplishing several selfcare tasks and reaching good glucose control [4][5][6]. The clinical importance of recognizing and treating T1D-linked psychological distress and its outcomes as a crucial health problem is emphasized by the understanding that T1D ranks among the major factors that contribute towards both depression and distress in a high percentage of adults who suffer from this disease [7,8].…”

Motivational Interviewing and Self-Care in Type 1 Diabetes: A Randomized Controlled Clinical Trial Study Protocol

“…In addition, patients must continuously make decisions regarding the adjustment of their insulin treatment and the everyday problems related to their illness (2)(3)(4). In a previous study which identified multiple factors related to selfcare, the level of motivation reported by the patient was the strongest predictor of adherence to self-care, and was also recognized as one of the greatest obstacles to adherence to treatment (5). Currently, diabetes management is focused on person-centered care and empowerment, a philosophy that encourages patient involvement, awareness and participation in decisions concerning their health (6).…”