Diabetes Family Behavior Checklist Research Articles

The Correlation Between Self-Care and Family Support With The Quality of Life of Type II Diabetic Mellitus Patient in Public Health Center I of West Denpasar

Diabetes mellitus (DM) is a metabolic disease with characteristics of hyperglycemia. Type 2 DM that is not handled properly will result in complications that affect the quality of life. Type 2 DM patients need to do self-care as one of the DM treatment. In addition to self-care, the quality of life of DM patients is also related to family support. This study aims to determine the relationship between variables of self-care and family support with the quality of life of patients with type 2 DM. The study was conducted on 26 March-23 April 2019. This study was a quantitative study with a cross sectional approach. The number of the respondents were 59 people, obtained through consecutive sampling technique. Self-care was measured using a summary of diabetes self-care activity (SDSCA) questionnaire, family support was measured using the diabetes family behavior checklist II (DFBC II) questionnaire, and quality of life was measured using the diabetes quality of life (DQOL) questionnaire. The data analysis was done using Pearson Product Moment test. The results showed that there was a relation between self-care and quality of life (p = 0.000, r = 0.548) and there was a relation between family support and quality of life (p = 0.005, r = 0.365). Health workers are expected to develop health education which is not only needed for type 2 DM patients but also their families in order to realize optimal quality of life.
 Index Terms— family support, quality of life, self-care, type 2 DM

Family Support for Medical Nutritional Therapy and Dietary Intake among Japanese with Type 2 Diabetes (JDDM 56).

The aim of this study was to investigate the association between habitual dietary intake for patients with diabetes and the content of family support for medical nutritional therapy (MNT). Analyzed were 289 Japanese with type 2 diabetes (men, 58.5%; mean age, 62.0 years; mean HbA1c, 53.4 mmol/mol) who completed the Food Frequency Questionnaire and Diabetes Family Behavior Checklist (DFBC). Relationships of mean values for food group intake to DFBC responses regarding MNT were examined using multivariate analysis of covariance. Positive response to “Praise for following diet” was associated with lower sweets intake (none: 60.1 g/day; ≥once monthly: 50.9 g/day, p = 0.038) and higher seasoning intake (none: 21.6 g/day, ≥once monthly: 24.1 g/day, p = 0.046). Energy intake was higher with positive responses to “Eat at the same time that you do” (none: 1636 kcal/day, ≥once monthly: 1818 kcal/day, p = 0.038). “Nags about not following diet” was associated with higher fish (none: 68.7 g/day, ≥once monthly: 78.7 g/day, p = 0.042) and salt intake (none: 8.3 g/day, ≥once monthly: 9.0 g/day, p = 0.014). Eating foods not part of the diabetic diet (none: 218.4 g/day, ≥once monthly: 246.9 g/day, p = 0.014) resulted in a higher vegetable intake. In females, significant differences in relationships in the overall analysis were reversed. Our results clarified relationships between types of family support of patients with type 2 diabetes and their dietary intake and the importance of sex differences for more effective MNT.

Self-Care and Family Support among People with Type 2 Diabetes

Objective: To assess the prevalence of self-care practices, and family support among people with type 2 diabetes. Material and Methods: We conducted a cross-sectional study among outpatients for people with type 2 diabetes, at a teaching hospital in Kathmandu, Nepal. We modified the Summary of Diabetes Self-Care Activities, and Diabetes Family Behavior Checklist scales; to measure self-care practices and perceived family support, respectively, so as to better suit the Nepali context. We performed an exploratory factor analysis to identify independent, latent dimensions of family support. Results: We recruited 411 patients (56.9% females), aged between 25 and 92. From these, we found high levels of adherence to daily intakes of the oral hypoglycemic agent (98.2%) and insulin (100.0%), daily physical activity (86.4%) and daily vegetable consumption (78.3%). Respondents commonly reported that they, and their family members ate meals together (98.1%). Family members also suggested things to help them take their medications on time (89.5%) and additionally helped them to decide on changes based on their glucose test results (84.2%). Exploratory factor analysis uncovered three behavior dimensions: nagging and arguing (“authoritarian”), praise and encouragement (“supportive”) and plan-making (“planning”). Conclusion: We presented data on self-care as well as family support among people with type 2 diabetes, tailored to the local context. From the data a high level of medication adherence and daily physical activity was observed. “Eating together” was the most reported family support behavior. We identified three dimensions of family support behaviors, which are potentially helpful for future health promotion programs, and provides a methodological basis for future studies in other low and middle-income countries.

767-P: Family Support for Medical Nutritional Therapy and Dietary Intake among Japanese Patients with Type 2 Diabetes

Although support from patients’ family members is essential in managing type 2 diabetes, evidence is sparse on family support for medical nutritional therapy (MNT) and habitual dietary intake. This study investigated the association between patients’ perception of family support for MNT and their dietary intake. Analyzed were 154 Japanese patients with type 2 diabetes (men, 45.5%) who completed the Food Frequency Questionnaire and Diabetes Family Behavior Checklist. Multivariate analysis of covariance was used adjusting for age, gender, BMI, duration for diabetes, HbA1c, and use of oral hypoglycemic agents and/or insulin. Participants’ mean age, duration of diabetes and HbA1c were 63.5 y, 12.7 y and 7.0%, respectively. After adjusting for confounders, positive family support, i.e., ‘Praise for following diet,’ was only significantly associated with higher fish intake (none 72.0 g/d, once a month 73.1 g/d, once a week 85.8 g/d, several times a week 97.6 g/d, and at least daily 92.1 g/d; trend p= 0.008). With greater frequency of eating at the same time as the family, salt intake was significantly higher (none 7.8 g/d, once a month 8.3 g/d, once a week 8.7 g/d, several times a week 9.3 g/d, and at least once daily 8.8 g/d; trend p= 0.037). Conversely, negative family support indicated by ‘Nags about following the diet’ was significantly associated with higher fish intake (none 70.3 g/d, once a month 84.4 g/d, once a week 84.3 g/d, several times a week 86.5 g/d, at least once daily 107.9 g/d; trend p= 0.012) and higher intake of vegetables was more frequent in those eating foods not part of the diabetic diet (none 242.1 g/d, once a month 192.1 g/d, once a week 270.4 g/d, several times a week 255.0 g/d, at least once daily 305.5 g/d; trend p= 0.027). These findings implied that patients’ perception of family support for MNT was not always associated with an ideal dietary intake to control diabetes. To facilitate diabetes treatment, sharing patient-family perceptions of MNT could be important. Disclosure C. Horikawa: None. Y. Takeda: None. M. Hatta: None. D. Ishii: None. S.Y. Morikawa: None. K. Fujihara: None. H. Maegawa: Research Support; Self; Antares Pharma, Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Funding Japan Association for Diabetes Education and Care

Experiences of Patients With a Diabetes Self-Care App Developed Based on the Information-Motivation-Behavioral Skills Model: Before-and-After Study.

BackgroundMobile phones have been actively used in various ways for diabetes self-care. Mobile phone apps can manage lifestyle factors such as diet, exercise, and medication without time or place restrictions. A systematic review has found these apps to be effective in reducing blood glucose. However, the existing apps were developed and evaluated without a theoretical framework to explain the process of changes in diabetes self-care behaviors.ObjectiveThis study aimed to evaluate the diabetes self-care app that we developed by measuring differences in diabetes self-care factors between before and after using the app with the Information-Motivation-Behavioral skills model of Diabetes Self-Care (IMB-DSC).MethodsWe conducted a single-group pre- and postintervention study with a convenience sample of diabetes patients. A total of 38 adult patients with diabetes who had an Android smartphone were recruited. After conducting a preliminary survey of those who agreed to participate in the study, we provided them with a manual and a tutorial video about the diabetes self-care app. The app has functions for education, recommendations, writing a diary, recording, goal setting, sharing, communication, feedback, and interfacing with a glucometer, and it was applied for 4 weeks. We measured the general characteristics of participants, their history of diabetes self-care app usage, IMB-DSC factors, and blood glucose levels. The IMB-DSC factors of information, personal motivation, social motivation, behavioral skills, and behaviors were measured using an assessment tool consisting of 87 items extracted from the Diabetes Knowledge Test, third version of the Diabetes Attitude Scale, Diabetes Family Behavior Checklist, and Diabetes Self-Management Assessment Report Tool.ResultsThe mean age of the participants was 43.87 years. A total 30 participants out of 38 (79%) had type 2 diabetes and 8 participants (21%) had type 1 diabetes. The most frequently used app function was recording, which was used by 34 participants out of 38 (89%). Diabetes self-care behaviors (P=.02) and diabetes self-care social motivation (P=.05) differed significantly between pre- and postintervention, but there was no significant difference in diabetes self-care information (P=.85), diabetes self-care personal motivation (P=.57), or diabetes self-care behavioral skills (P=.89) between before and after using the diabetes self-care app.ConclusionsDiabetes self-care social motivation was significantly improved with our diabetes self-care app by sharing experiences and sympathizing with other diabetes patients. Diabetes self-care behavior was also significantly improved with the diabetes self-care app by providing an interface with a glucometer that removes the effort of manual input. Diabetes self-care information, diabetes self-care personal motivation, and diabetes self-care behavioral skills were not significantly improved. However, they will be improved with additional offline interventions such as reflective listening and simulation.

Do supportive family behaviors promote diabetes self-management in resource limited urban settings? A cross sectional study

BackgroundSelf-management is an essential component of prevention and treatment of type 2 diabetes. Social and family support has been shown to influence self-management behaviors as well as glycemic control and complications. This study was conducted to assess whether diabetes family support improves diabetes self-management and glycemic control in a typical urban population in India.MethodsA cross-sectional study using a questionnaire that had items from the Summary of Diabetes Self Care Activities Scale (SDSCA), the Diabetes Family Behavior Checklist (DFBC) and some sociodemographic and diabetes related clinical data was conducted. The participants were consecutively sampled from the diabetes outpatient department in a tertiary care hospital in Chennai, south India.ResultsA total of 200 consecutive patients from the diabetes outpatient department were interviewed. Diabetes self-management practices were good with respect to avoiding fatty foods and carbohydrates and undergoing regular blood testing for glucose. But the self-management with respect to exercise and foot related care was rare. It was observed that a vast majority of the patients did not report receiving any support from their families. However, in the small proportion who did receive good family support, there is an association between diabetes self-management and diabetes family support (β = 0.527; p = 0.015). Further, the path model showed that there is a positive statistically significant association between family support score and the diabetes self-management score (β = 0.254, p < 0.001). However, the negative association between the diabetes self-management score and the mean plasma glucose did not reach statistical significance (β = − 46.378, p = 0.082).ConclusionsIn the urban south Indian setting, family support was significantly associated with better self-management activities, but better self-management did not reflect as better glycaemic control.

Parental Diabetes Behaviors and Distress Are Related to Glycemic Control in Youth with Type 1 Diabetes: Longitudinal Data from the DINO Study.

Objective To evaluate (1) the longitudinal relationship between parental well-being and glycemic control in youth with type 1 diabetes and (2) if youth's problem behavior, diabetes parenting behavior, and parental diabetes-distress influence this relationship. Research Design and Methods Parents of youth 8–15 yrs (at baseline) (N = 174) participating in the DINO study completed questionnaires at three time waves (1 yr interval). Using generalized estimating equations, the relationship between parental well-being (WHO-5) and youth's HbA1c was examined. Second, relationships between WHO-5, Strength and Difficulties Questionnaire (SDQ), Diabetes Family Behavior Checklist (DFBC), Problem Areas In Diabetes-Parent Revised (PAID-Pr) scores, and HbA1c were analyzed. Results Low well-being was reported by 32% of parents. No relationship was found between parents' WHO-5 scores and youth's HbA1c (β = −0.052, p = 0.650). WHO-5 related to SDQ (β = −0.219, p < 0.01), DFBC unsupportive scale (β = −0.174, p < 0.01), and PAID-Pr (β = −0.666, p < 0.01). Both DFBC scales (supportive β = −0.259, p = 0.01; unsupportive β = 0.383, p = 0.017), PAID-Pr (β = 0.276, p < 0.01), and SDQ (β = 0.424, p < 0.01) related to HbA1c. Conclusions Over time, reduced parental well-being relates to increased problem behavior in youth, unsupportive parenting, and parental distress, which negatively associate with HbA1c. More unsupportive diabetes parenting and distress relate to youth's problem behavior.

Development of a novel, short, self-completed questionnaire on empowerment for patients with type 2 diabetes mellitus and an analysis of factors affecting patient empowerment.

BackgroundPatient empowerment has recently been proposed as an important concept in self-management for effective glycemic control. A concise self-completed questionnaire for patients with type 2 diabetes mellitus was created to comprehensively evaluate their empowerment on the basis of self-managed dietary/exercise behaviors, psychological impact, and family support. The reliability and validity of this short questionnaire were tested and factors relating to patient empowerment were analyzed.MethodsThe self-completed empowerment questionnaire was based on questionnaires for self-managed dietary and exercise behaviors, the Appraisal of Diabetes Scale, and the Diabetes Family Behavior Checklist. The questionnaire was trialed on 338 male and female patients with type 2 diabetes mellitus who lived with family. The validity and reliability of the questionnaire were investigated and stepwise multiple linear regression analysis was used to identify factors that affect patient empowerment.ResultsThe self-completed patient empowerment questionnaire included 13 questions on background data (e.g., age, gender, and HbA1c) and 18 questions within five scales to assess self-managed dietary behaviors, self-managed exercise behaviors, and psychological impact of diabetes, as well as positive and negative feedback in patient-family communication. The questionnaire showed sufficient internal consistency, construct validity, reproducibility, factorial construct validity, and concurrent validity. The results were generally satisfactory, and the questionnaire reflected the particular characteristics of treatment methods. Multiple linear regression analysis showed that patient empowerment was strongly affected by the number of disease-related symptoms, age, and gender.ConclusionsThe results suggest that the concise self-completed empowerment questionnaire developed here is useful for measuring the empowerment of individual patients and evaluating the impact of symptoms and therapies on empowerment.

Parent–child relationships in Type 1 diabetes: Associations among child behavior, parenting behavior, and pediatric parenting stress.

Interactions between parents and children can influence behavioral and emotional functioning related to Type 1 diabetes (T1D), yet have been relatively unexplored during preadolescence. The present study examined associations among child problem behaviors, critical parenting behaviors, and pediatric parenting stress in a sample of preadolescent youth with T1D. Data are available from 86 preadolescent-parent dyads who participated in the initial baseline assessment of a randomized controlled trial designed to assess the efficacy of an adherence promotion program. Measures included the Eyberg Child Behavior Inventory, the Diabetes Family Behavior Checklist, and the Pediatric Inventory for Parents. After controlling for significant demographic and medical characteristics, parents who reported their child's behavior as more problematic reported more difficulty with pediatric parenting stress, which was also associated with more child-reported critical parenting behaviors. Child problem behaviors and critical parenting behaviors were associated with one another, partially via their association with increased pediatric parenting stress. Potential clinical applications include interventions geared toward helping parents manage difficult child behaviors as well as cope with pediatric parenting stress, with the ultimate goal of improving the parent-child relationship and management of T1D.

Family Support, Malnutrition and Barriers to Optimal Dietary Intake among Elderly Diabetic Patients in Benghazi, Libya

Background: Higher levels of social and family support especially regimen-specific are associated with better diabetes self management and less perceived barriers to diet. Objectives: To determine the level of perceived family support for diet and barriers to diet self care and their relation to malnutrition among elderly Libyan patients with type 2 diabetes. Methods: A cross-sectional study carried out on 312 elderly diabetic patients attending outpatient clinics of Benghazi diabetes Centre from end of February to the 1st of May 2013. Data was collected through personal interview. Perceived family support for diet was assessed with Diabetes Family Behavior Checklist II diet subscale. Barriers to diet were measured with diet subscale of Barriers to Self-care Scale. Participants screened for nutritional risk according to MNA (Mini Nutritional Assessment) tool. Results: Low level of family support was perceived by most of the studied elderly diabetic patients. Family support for diet was significantly correlated to perceived barriers to diet self-care and MNA score (p<0.01). According to diet barrier scale being “around people who are eating and drinking things patient shouldn’t” was the most frequent barrier perceived. Perceived barriers to diet self-care were significantly higher in male patients while their nutritional status found to be better than that of females. Gender, family size, satisfaction with prescribed diet, total MNA score and number of learning barriers were found as significant predictors of diet self-care barriers (Adjusted R2 was 0.357). Conclusion: Healthcare providers, dietitians and health educators should consider involvement of entire family as well as elderly diabetic patients in self management training and education programs with dietary counseling sessions that can enhance adherence to dietary regimen, decrease diet self-care barriers and consequently improve nutritional status of this vulnerable group.

The reliability and validity of the Japanese version of the Diabetes Family Behavior Checklist (DFBC) for assessing the relationship between Type 2 diabetes mellitus patients and their families with respect to adherence to treatment regimen

AimsAn appropriate questionnaire for assessing family support of self-management behavior of Japanese Type 2 diabetes patients has yet to be developed. We produced a Japanese version of the Diabetes Family Behavior Checklist (DFBC) and tested its reliability and validity. MethodsThe study enrolled Japanese patients with Type 2 diabetes mellitus who were living with their families: 158 patients in the Insulin Group and 169 in the Oral Hypoglycemic Agents Group. The external validity of the DFBC was tested with questionnaires of self-managed dietary and exercise behaviors, the Appraisal of Diabetes Scale (ADS), and HbA1c. ResultsThe DFBC comprised two components: “Negative” and “Positive” feedbacks. Cronbach's alpha in the subcategories was ≥0.93, and the test–retest showed an intraclass correlation coefficient of 0.89. “Positive” and “Negative” scores correlated with self-managed dietary and/or exercise behaviors, the ADS scores in the both Groups. For patients having HbA1c levels of ≤6.8% there was a correlation between their “Positive” and “Negative” scores and the scores of their families in both Groups. ConclusionThe DFBC showed evidence of validity and reliability and may be a useful tool for quick assessment of self-managed treatment behavior of Japanese Type 2 diabetes patients and support received from their family.

Parenting Behavior, Child Functioning, and Health Behaviors in Preadolescents With Type 1 Diabetes

To examine the association of critical parenting behaviors with preadolescent reported depressive symptoms, self-efficacy, and self-care behaviors in youth with type 1 diabetes (T1D). A total of 84 youth with T1D, ages 9-11 years, completed the Diabetes Family Behavior Checklist, Child Depression Inventory, Self-Efficacy for Diabetes scale, and Self-Care Inventory during a baseline assessment for a randomized controlled trial of an intervention to promote adherence. Preadolescents who reported more critical parenting behaviors reported more depressive symptoms and lower self-efficacy. The relationship between critical parenting and self-efficacy was partially mediated by depressive symptoms. In a second model, depressive symptoms were associated with lower self-efficacy and fewer self-care behaviors. The relationship between depressive symptoms and self-care was fully mediated by self-efficacy. Critical parenting behaviors are associated with preadolescents' psychological well-being, which has implications for self-care. Clinical implications include decreasing critical parenting behaviors and monitoring preadolescents with T1D for depressive symptoms.

Existing Measures of Diabetes-Specific Support for Use With Adolescents With Diabetes

The purpose of this article is to review existing measures of diabetes-specific support for use with adolescents with type 1 diabetes. Diabetes-specific support scales for use with adolescents with type 1 diabetes were reviewed in terms of the dimension of support measured as well as reported reliability and validity. The scales measure enacted and/or perceived support. However, various support categories are measured: supportive and nonsupportive by the Diabetes Family Behavior Checklist (DFBC); warmth and guidance/control by the Diabetes Family Behavior Scale (DFBS); instrumental, informational, companionship/belonging, and emotional by the Diabetes Social Support Interview (DSSI); insulin administration, glucose monitoring, meals, exercise, and emotional support by the Diabetes Social Support Questionnaire-Family Version (DSSQ-Family) and the Diabetes Social Support Questionnaire-Friends Version (DSSQ-Friends); and guidance for autonomy development by the Diabetes-Specific Parental Support for Adolescents' Autonomy Scale (DPSAAS). The DSSI, DSSQ-Family, DSSQ-Friends, the DFBS, and DPSAAS have adequate reliability. Predictive validity is suggested in that diabetes management was related to the DFBC supportive subscale, the DSSI, the DSSQ-Family, and the DSSQ-Friends; metabolic control was related to the DFBS total score and guidance subscale; and diabetes management responsibility was related to the DPSAAS. Health care professionals need to decide which aspects of support are relevant to measure in their specific situation.

The Diabetes Family Behavior Checklist: A Psychometric Evaluation

The Diabetes Family Behavior Checklist (DFBC) assesses supportive and non-supportive parental behavior specific to diabetes management via parent and child reports. The DFBC was administered to 133 children with type 1 diabetes (T1D) and their caregivers. Subsequent analysis verified the two-factor structure of the DFBC corresponding to positive and negative support behaviors. Internal consistency was high for DFBC scores. Moderate to strong correlations with other measures of diabetes-specific familial behaviors, adherence, and metabolic control support the validity of the DFBC. Clinical application of the DFBC is discussed.

Family environment, glycemic control, and the psychosocial adaptation of adults with diabetes.

To evaluate whether the family system variables of adults with diabetes relate to the adequacy of metabolic control or the psychosocial adaptation to the illness. A total of 150 insulin-requiring adults were assessed on a single occasion. They completed two family system measures (the Family Environment Scale [FES] and the Diabetes Family Behavior Checklist [DFBC]), two quality-of-life measures (the Diabetes Quality of Life Scale and the Medical Outcomes Study Health Survey-36), and one measure of cognitive appraisal (the Appraisal of Diabetes Scale). Glycemic control was assessed using HbA1c results. Demographic data (age, sex, diabetes type, duration of diabetes, and number of diabetes-related medical complications) were gathered from the patients' charts. Concerning glycemic control, none of the family system measures were significant predictors of HbA1c. Older age and longer duration of diabetes predicted higher HbA1c values. For psychosocial adaptation, when family members behaved in ways that supported the diabetes care regimen (measured by the DFBC), the individual with diabetes was more satisfied with his or her adaptation to the illness and reported less interference in role function due to emotional problems. Family cohesion (measured by the FES) also related to better physical function. Women reported higher levels of diabetes satisfaction. The Appraisal of Diabetes Scale predicted glycemic control and psychosocial adaptation. For insulin-treated adults with diabetes, family system variables do not relate to glycemic control, but they do relate to psychosocial adaptation. Future work should explore the impact of family-centered interventions on adaptation, sex differences in adaptation, and the use of the Appraisal of Diabetes Scale as a first-line clinical screening tool.

Supportive and nonsupportive family behaviors: relationships to adherence and metabolic control in persons with type I diabetes.

The Diabetes Family Behavior Checklist (DFBC) was administered to 54 adults and 18 adolescents (less than 19 yr of age) with insulin-dependent diabetes mellitus (IDDM). Subjects and family members completed parallel forms of the DFBC at initial and 6-mo follow-up home interviews. During each of these periods, adherence was assessed via self-report, 1 wk of self-monitoring, and 24-h dietary recalls. The results showed reliable differences between adolescents and adults. More negative interactions with family members were reported by adolescents and their family members, and adolescents were in poorer metabolic control. For adults but not adolescents, negative DFBC scores were prospectively predictive of poorer regimen adherence over the 6-mo interval for measures of glucose testing, insulin injection, and dietary adherence. In addition, higher negative DFBC scores for adults were marginally associated with higher HbA1 levels (P less than 0.10). We conclude that the DFBC is a promising measure of family interaction related specifically to the IDDM regimen and that, for adults, higher levels of nonsupportive family behaviors may be related to reduced regimen adherence and poor control.