Perceived Treatment Efficacy: An Overlooked Opportunity in Diabetes Care

Abstract

In seeking to understand and address the self-management obstacles our patients with diabetes face, clinical and research efforts during the past decade have typically focused on such crucial factors as depressive disorders,1 perceived severity of diabetes,2 impaired social support,3 diabetes self-efficacy,4,5 and environmental costs.6 However, we suggest that a core obstacle has been overlooked: the issue of perceived treatment efficacy (PTE). Simply put, when patients do not believe that a recommended treatment action is accomplishing anything, when no tangible positive outcome is apparent, they are likely to lose interest in continuing to perform the action.7 There are a number of other terms that overlap with the PTE concept; these include “outcome expectancies,” “medication beliefs,” and “perceived benefits.” Outcome expectancies refers to patients' beliefs about the positive and negative outcomes of following through on a specific behavior;8 as a subset of that concept, medication beliefs refer to patients' outcome expectancies regarding the specific use of their medications. The medication beliefs literature originates from the work of Horne and Weinman,9 who have drawn the distinction between patients' perceptions of the necessity of taking a specific medication and their concern about the medication's potential adverse effects. Finally, both PTE and the concept of perperceived benefits relate directly to the potentially positive consequences that are believed to accrue in response to effective self-management behavior.7 No matter the name, the research literature shows, not surprisingly, that the more individuals believe that a self-management action will produce a positive outcome and that negative consequences will be absent or minimal, the more likely they are to continue that behavior.7 We strongly suspect that it is the specific belief in promoting tangible, positive, short-term outcomes that motivates ongoing self-management more effectively than a belief in influencing …