Health value & perceived control over health: behavioural constructs to support Type 2 diabetes self-management in clinical practice.

Abstract

To explore health value and perceived control over health in relation to self-management behaviours in adults with Type 2 diabetes mellitus. Helping people to modify health related behaviour in diabetes is complex due to a multitude of factors. Exploring the meaning of the constructs of Modified Social Learning Theory could be beneficial to identifying people at risk of poor diabetes self-management. An exploratory qualitative study. Thirteen adults with insulin-treated Type 2 diabetes mellitus were purposively sampled. Data were collected through semi-structured interviews. An in-depth thematic analysis was carried out. Health became a value priority on diagnosis of Type 2 diabetes mellitus. Participants described holding both terminal (relating to desired end states) and instrumental (a means to an end) health values pre-diagnosis but these became instrumental post-diagnosis to meet new lifestyle needs and maintain their quality of life. Descriptions of 'conflicts' in locus of control beliefs when managing Type 2 diabetes mellitus demonstrated influences on levels of self-efficacy and health value. Common themes that impacted on diabetes self-management included co-morbidities, medication management, blood glucose monitoring and reasoning for Type 2 diabetes mellitus. Locus of control beliefs, levels of self-efficacy and health value were influenced by complications associated with Type 2 diabetes mellitus. The findings on Modified Social Learning Theory and instrumental health value as a moderator to health behaviour resulted in the development of a proposed framework with potential practical utility. This research demonstrates the relevance of exploring the constructs of Modified Social Learning Theory (MSLT) in relation to diabetes self-management behaviours in Type 2 diabetes mellitus. The proposed Type 2 diabetes mellitus Self-management Behaviour Support framework incorporates Modified Social Learning Theory and instrumental health value as the theoretical basis for development and could provide clinical nurses and doctors with a tool that will allow for in-depth assessment and planning of Type 2 diabetes mellitus patients' self-management behaviours.