The role of health beliefs in the regimen adherence and metabolic control of adolescents and adults with diabetes mellitus.

Abstract

The current study examined the role of health beliefs in diabetic regimen adherence and metabolic control. The subjects were 143 insulin-dependent diabetic outpatients, including 54 from a university juvenile diabetes care clinic with a mean age of 18 and 89 from a private practice clinic with a mean age of 37. Subject age and knowledge about diabetes were statistically controlled for in the multiple regression equations used to analyze the data. Overall, health beliefs accounted for a statistically significant portion of the variance in both self-reported adherence and metabolic control, as measured by level of glycosylated hemoglobin. For older patients from the private practice clinic, the most important aspects of health beliefs related to both reported adherence and metabolic control were those associated with the perceived benefits of adhering to the diabetic regimen. For younger patients from the university clinic, although perceived costs figured most prominently in their reports of adherence, perceived severity and susceptibility were the most important health beliefs associated with their actual levels of metabolic control. These findings suggest that health beliefs may play an important role in diabetic regimen adherence and metabolic control.Diabetes mellitus affects over 5 million Americans (Karam, 1981). Treatment of this chronic condition requires careful regulation of diet, exercise, and (often) drug or insulin dosage, along with frequent monitoring of blood or urine sugar levels to maintain blood glucose levels within as near normal a range as possible. Most diabetics manage their disease well enough to avoid serious effects from acute complications. However, there are a number of long-term complications associated with chronically elevated blood glucose levels (Brownlee & Cerami, 1981;Pirart, 1978) that make diabetes the leading cause of blindness in the United States and contribute to a markedly shortened life span among diabetics (Lipsett, 1980; U.S. Department of Health, Education, and Welfare, 1979). Although diabetic blood glucose levels are influenced by physiological factors, behavioral adherence to the complicated diabetes care regimen is a major determinant of blood sugar control. 1 As with other medical regimens, adherence to the diabetic regimen is often inadequate (Cerkoney& Hart, 1980;Ruff, 1983;Wiholm, This article is based on a master's thesis by the first author conducted under the supervision of the second author. Thanks are due to Judy Broughton for her comments on the Diabetes Knowledge Questionnaire and to Don Diner for his help with data analysis. Special appreciation is also extended to Michael A. Brownlee for his advice throughout this project and to the participating patients who made the study possible.

Diabetes and behavioral medicine: The second decade.

“…A number of studies demonstrated that both personal health beliefs and self-efficacy predicted self-care across a wide range of behaviors in both adolescents and adults (Brownlee-Duffeck et al, 1987;McCaul, Glasgow, & Schafer, 1987). A recent meta-analysis concluded that research findings have continued to show that these cognitive and attitudinal processes have direct effects on self-management and, thus, significant indirect effects on clinical outcome (Robiner & Keel, 1997).…”

Frequency and perceived burden of diabetes self-management activities in employees with insulin-treated diabetes: relationships with health outcomes

“…Previous studies sometimes calculated a total score for self-management [13,14], but researchers now agree that different aspects of self-management should be assessed separately because of its multidimensional nature [15][16][17]. A variety of questionnaires have been developed, most of which focus on the frequency with which people perform their selfmanagement tasks in a variety of areas.…”

Personal Models of Diabetes in Relation to Self-Care, Well-Being, and Glycemic Control

“…Differentiating between long-and short-term beliefs may also be important in understanding the conflicting results for threat expectancies in previous work on adolescents with diabetes (18,20,25). Whether predicting anxiety, depression, or dietary self-management in adolescents, it was the short-term effects of the illness and its treatment (perceived impact of diabetes and effectiveness of treatment to control diabetes) that were important (19).…”