Self-management Behaviors Research Articles

Habit Formation Intervention to Improve Type 2 Diabetes Self-Management Behaviors: A Feasibility Study.

Self-management of lifestyle behaviors is the recommended focus for interventions to address Type 2 diabetes. Habit formation is an effective approach to changing personal behaviors, but evidence of success for Type 2 diabetes is limited. To examine the feasibility and preliminary effectiveness of occupation-based habit formation interventions for improving diabetes self-management behaviors. Single-subject design with multiple participants providing 4 wk of baseline data followed by 10 wk of intervention data. Individual telehealth sessions. Eight adults (ages 29-75 yr) with Type 2 diabetes, who had access to a telephone and who were not involved in other diabetes-related education or interventions voluntarily, enrolled into the study. Participants engaged in 10 wk of habit formation intervention focused on four diabetes self-management domains: nutrition, blood glucose monitoring, medication management, and physical activity. Data gathered included findings on measures of diabetes self-care behaviors and habit formation. There was a significant change in self-care behaviors for 6 of the 8 participants (p < .05 for 1 participant, and p < .01 for 5 participants). Group changes were statistically significant (p < .001). Habit strength significantly improved for all areas of diabetes self-management (p < .001 for nutrition, blood glucose monitoring, and medication management and p = .001 for physical activity). Findings suggest that the occupation-based intervention was feasible and showed promise for developing self-management behaviors. What This Article Adds: Habits are considered foundational to occupations, yet application of the science of habit formation is often not well understood by occupational therapists. This study considered the theoretical components of habit formation that have been neglected by prior studies and demonstrates the feasibility and preliminary effect estimates of a habit formation intervention when used with people with Type 2 diabetes.

Hubungan Perilaku Self Management Dengan Kadar Gula Darah Pada Pasien Diabetes Melitus Tipe II Di Puskesmas Sekupang Kota Batam

Diabetes mellitus is a chronic disease but can be controlled or prevented with self-management. Self-management of diabetes aims to control blood glucose levels optimally and prevent complications that arise. Activities that can be done include diet, physical activity/exercise, blood glucose control, taking medication regularly and foot care. This research aims to determine the relationship between self-management behavior and blood sugar levels in type 2 diabetes mellitus patients. This type of research is a quantitative research method with a correlative descriptive design with a cross sectional approach. Data collection used a non-probability sampling technique in the form of accidental sampling with a sample size of 36 respondents, using the chi square test. Most respondents have sufficient self-management (69.4%). Apart from that, the majority of respondents had normal blood sugar levels (97.2%). The results of the analysis test were obtained with a P value = 0.004 (&lt;0.05). It is hoped that the UPTD BLUD Sekupang Community Health Center will create a diabetes self care management program with efforts to improve blood sugar control.

Improving Mild to Moderate Depression With an App-Based Self-Guided Intervention: Protocol for a Randomized Controlled Trial.

Depression is one of the most prevalent mental disorders and frequently co-occurs with other mental disorders. Despite the high direct and indirect costs to both individuals and society, more than 80% of those diagnosed with depression remain with their primary care physician and do not receive specialized treatment. Self-guided digital interventions have been shown to improve depression and, due to their scalability, have a large potential public health impact. Current digital interventions often focus on specific disorders, while recent research suggests that transdiagnostic approaches are more suitable. This paper presents the protocol for a study that aims to assess the efficacy of a self-guided transdiagnostic app-based self-management intervention in patients with mild or moderate depression with and without comorbid mental disorders. Specifically, we are investigating the impact of the intervention on symptoms of depression, quality of life, anxiety symptoms, and mental health-related patient empowerment and self-management skills. The intervention under investigation, MindDoc with Prescription, is a self-guided digital intervention aimed at supporting individuals with mild to moderate mental disorders from the internalizing spectrum, including depression. The app can be used as a low-threshold psychosocial intervention. Up to 570 adult patients will be randomized to either receive the intervention in addition to care as usual or only care as usual. We are including adults with a permanent residency in Germany and mild or moderate depression according to International Classification of Diseases, 10th Revision, criteria (F32.0, F32.1, F33.0, and F33.1). Clinical interviews will be conducted to confirm the diagnosis. Data will be collected at baseline as well as 8 weeks and 6 months after randomization. The primary outcome will be depression symptom severity after 8 weeks. Secondary outcomes will be quality of life, anxiety symptom severity, and patient empowerment and self-management behaviors. Data will be analyzed using multiple imputations, using the intention-to-treat principle, while sensitivity analyses will be based on additional imputation strategies and a per-protocol analysis. Recruitment for the trial started on February 7, 2023, and the first participant was randomized on February 14, 2023. As of September 5, 2023, 275 participants have been included in the trial and 176 have provided the primary outcome. The rate of missing values in the primary outcome is approximately 20%. Data from this efficacy trial will be used to establish whether access to the intervention is associated with an improvement in depression symptoms in individuals diagnosed with mild or moderate depression. The study will contribute to expanding the evidence base on transdiagnostic digital interventions. German Registry of Clinical Trials DRKS00030852; https://drks.de/search/de/trial/DRKS00030852. DERR1-10.2196/46651.

The Role of Family in Diabetes Management for Mexican American Adults.

Introduction: The purpose of this study was to characterize how family influences diabetes self-management in Mexican American adults. Methods: Data were analyzed from previously collected data that included 34 semi-structured interviews with Hispanic adults with diabetes and six focus groups with 37 adults with diabetes and family members. Themes related to family and diabetes management were identified and analyzed using a modified template approach. Results: Family-related facilitators to T2DM self-management were (1) provides support, (2) provides motivation, and (3) desire to protect family from diabetes. Family-related challenges were (1) lack of support, (2) family responsibilities, and (3) stress related to family. Diabetes education was shared with family members. Family member perspectives on T2DM included (1) not knowing how to help, (2) effect on emotional wellbeing, (3) diabetes affects the whole family, and (4) family provides support. Conclusion: Most participants with T2DM felt supported by family, but many desired more social support and support surrounding dietary changes from family. Many felt family did not understand what living with diabetes meant for them. Most family members wished to learn more about how to help. Future interventions should include family members and teach them supportive strategies to support beneficial diabetes self-management behaviors.

Systematic review and meta-analysis of stress management intervention studies in patients with metabolic syndrome combined with psychological symptoms.

Metabolic syndrome is affected by many factors, including lifestyle, mood, etc. Self-management of chronic diseases has attracted significant attention from researchers. Some studies have shown that patient self-management is a very important link, which can effectively alleviate the risk of further deterioration of the disease. However, so far, there has been no report on the basis of the summary of self-management intervention programs based on emotion management, which needs further in-depth discussion by researchers. The Medline (PubMed), Embase (Elsevier), PsycINFO (Ovid), CBM, CNKI and Wanfang databases were searched from the establishment of the databases to June 2022, and a total of 25 studies were traced. The inclusion criteria on stress management in patients of metabolic syndrome complicated with psychological symptoms uses meta-analysis. Two investigators independently assessed the risk of bias for each study using the Cochrane risk of bias tool.16 studies and 2687participants and relevant characteristics of studies. In the effects of intervention measures based on stress management on depression, fasting plasma glucose, 2hFPG, high-density cholesterol, self-management behavior and quality of life in patients with psychological symptoms (depression, anxiety, and schizophrenia) complicated with metabolic diseases, there are statistically significant differences between the intervention group and the control group (P < .05). Stress management intervention can effectively improve the health outcomes of patients. In all included analysis indicators, the results of the experimental group are better than those of the control group.

Self-management Behaviors and Associated Factors in Adult Cancer Survivors: An Integrative Review.

Despite numerous systematic reviews on self-management interventions for cancer survivors, little is known about survivors' daily self-management practices and the influencing factors. To identify self-management behaviors and related factors among cancer survivors. Six databases were searched for primary quantitative, qualitative, and mixed-methods studies on self-management behaviors in cancer survivors that were published in English-language, peer-reviewed journals between 2012 and July 2022. The methodological quality of the included studies was evaluated using the Mixed Methods Appraisal Tool. The data extracted using a predetermined form were analyzed using qualitative content analysis. A total of 22 articles were included in the review; the majority were qualitative research, and half had moderate to high quality of evidence. Nine domains of self-management behaviors were identified, namely, physical activity/exercise, diet, emotional management, complementary and alternative medicine, symptom management, religiosity/spirituality, attending regular follow-ups, adjustment of other lifestyles, and medication management. Four categories of factors were associated with self-management behaviors in cancer survivors: (1) personal factors (demographic and psychological), (2) health status, (3) family factors, and (4) healthcare system. However, the relationships between self-management behaviors and these factors were mainly identified from qualitative studies or addressed in single studies. Self-management behaviors in cancer survivors are multifaceted. There is an urgent need for quantitative exploration of factors associated with self-management in cancer survivors. This review provides nurses with a comprehensive basis for designing self-management support interventions for cancer survivors.

Analysis of The Reintegration into the Schools of Origin of Teenagers With Cancer In Romania

The present study aims to analyze the reintegration of adolescents with cancer in the schools of origin in Romania using the preparation scale for the reintegration of adolescents with cancer, which has 8 sub-scales and 71 items after the adolescents have completed the hospital school courses. It was necessary to use this scale because in Romania there is no reintegration scale for adolescents with long hospitalization experience. In June 2023, through a survey, 36 teenagers (15 girls, 21 boys), who lived a long-term experience in a hospital, answered the 71 items of the reintegration preparation scale (RRS) of pediatric oncology in Bucharest Romania, who were students in the hospital school and returned to the school of origin. The scale contains 8 subscales, namely: Self-management of behavior (10 items), Relationships between the student and others (10 items), Self-awareness (5 items), Self-confidence (5 items), Self-organization (12 items), Attitude (10 items ), Learning Skills (11 items), Reading Skills (8 items).The study emphasizes the importance of using the reintegration preparation scale (RRS) for adolescent patients in Romania, the results obtained being able to make the interventions of the psycho-educational reintegration team of adolescents with cancer more efficient.

Self-management skills in a UK sample of young people with chronic liver disease.

We aimed to assess self-management skills and adherence behaviors in young people post-liver transplant and compare these with those of young people with autoimmune liver disease and other forms of chronic liver disease. As part of our specialist multidisciplinary clinic, n = 156 young people (aged 16-25 years) completed the Liver Self-Management Questionnaire (an adaptation of the Developmentally Based Skills Checklist for adolescents post-liver transplant and modified for us across liver disease type and within the United Kingdom). Those taking medication (n = 128) also completed a service-designed questionnaire regarding adherence. The statistical significance of group differences was assessed with non-parametric analyses. Young people post-liver transplant were less likely to report managing their condition independently than those with autoimmune liver disease or those with other forms of chronic liver disease. They also reported higher adherence (93%) compared to those with autoimmune liver disease (77%) and those with other forms of chronic liver disease (85%). However, the vast majority of self-management and adherence behaviors were comparable between young people post-transplant and those with autoimmune liver disease/other forms of chronic liver disease. Our data are in line with existing data from US samples and also extend these findings to include those with other forms of chronic liver disease. These data highlight the importance of individualized care for young adults, regardless of condition type or healthcare setting, and of clinicians managing their expectations regarding what is considered appropriate condition management in early adulthood.

FRI084 The Impact Of COVID-19 On Comorbid Beliefs And Adherence To Self-Management Behaviors Among Breast Cancer Survivors With Type 2 Diabetes

Abstract Disclosure: S. Lambert: None. J.E. Itty: None. L. Guerra: None. M. Goel: None. J.J. Lin: None. Y.T. Harris: None. Introduction: During the first year of the Covid-19 pandemic, anxiety and depression rates increased substantially worldwide. Anxiety and depression can affect self-efficacy and health-related beliefs as well as diabetes self-management behaviors (DSMBs) such as diet, exercise, and medication adherence, which are crucial for glycemic control and preventing complications. Both Type 2 diabetes mellitus (T2DM) and breast cancer pose an increased risk of complications from Covid, which could exacerbate pandemic-related distress in patients with T2DM and a history of breast cancer. We compared diabetes beliefs and adherence to DSMBs in breast cancer survivors with T2DM, before Covid-19 versus during the first Covid-19 surge. Hypothesis: Patients will experience a change in diabetes beliefs and adherence to DSMBs in the setting of the Covid-19 pandemic. Methods: Eligible patients included women ≥ 55 years, diagnosed with Stage 0-IIIA breast cancer in the past 15 years, who had completed chemotherapy and/or were prescribed hormonal therapy, had pre-existing T2DM treated with ≥ 1 oral medication, and had been enrolled in an ongoing study of disease beliefs and cognition in breast cancer survivors with comorbid T2DM. We included patients with a baseline visit prior to Covid and a six-month follow up visit between March - September 2020. We assessed diabetes beliefs with the Illness Perception Questionnaire (IPQ) and DSMB adherence with the Summary of Diabetes Self Care Activities (SDSCA) questionnaire. Self-reported adherence to diabetes medication was assessed with the Medication Adherence Rating Scale (MARS). Signed rank tests were used to compare disease beliefs and DSMB adherence before versus during the first Covid-19 wave. Results: 26 patients completed baseline interviews prior to Covid and a six-month follow up visit during the first Covid-19 surge (mean age: 65 years; 27% White, 35% Black, 11% Asian/Pacific Islander, 27% unanswered). Diabetes beliefs did not differ significantly before versus during Covid (p &amp;gt; 0.05 for all IPQ scales), nor did adherence to DSMBs including diet (days/week following a healthful eating plan: p = 0.87), exercise (days participating in a specific exercise: p = 0.40), and glucose monitoring (days checking blood sugar the number of times recommended: p = 0.84). No significant differences were seen in medication adherence (p = 0.698). Conclusion: In this small sample of breast cancer survivors with T2DM there appears to be no change in diabetes beliefs or DSMB adherence during the first Covid surge compared to baseline. These findings raise the possibility that individual patient factors play a greater role in adherence and disease beliefs than pandemic-related distress. Future analyses will expand the sample size and explore whether the extent to which the Covid-19 pandemic impacted patients moderates their disease beliefs and self-management. Presentation: Friday, June 16, 2023

Exploring Disease Management Experiences of Individuals with Type 2 Diabetes During the COVID-19 Pandemic: A Qualitative Study.

The aim of this study was to investigate the impact of COVID-19 infection on disease management among individuals with type 2 diabetes and to explore their perspectives on COVID-19. This descriptive qualitative study included patients with diabetes, with a sample of 15 patients meeting the study criteria. The data were analyzed using code groups, which were then further categorized into main themes and subthemes. The main themes were: initial contact with the SARS-CoV-2 that is associated with COVID-19 illness changes in diabetes self-management behaviors; attempt at maintaining diabetes selfmanagement behaviors; and problems with accessing diabetes care. The study findings revealed several significant insights. Individuals with diabetes exhibited a fear of contracting SARS-CoV-2, which led to reduced levels of exercise and difficulties in managing blood sugar levels and insulin adjustments. Moreover, due to anxiety about COVID-19 infection, they postponed health check-ups, resulting in experiencing diabetes-related complications.

"The constant worry": Urinary incontinence self-management in rural women: A qualitative study.

Urinary incontinence (UI) is experienced by approximately 60% of women in the United States and has a negative impact on self-esteem, sexual function, social participation, and quality of life. Rural women, who are underrepresented in the UI literature, face many health disparities and unique barriers to accessing care. The purpose of this qualitative descriptive study was to explore UI self-management behaviors in rural women with UI, including the contextual factors that influence their approach to self-management. This study recruited rural women, ages 30-60 years, using purposive sampling via social media. Demographic information was collected. A semi-structured interview guide was used to conduct individual, in-depth interviews via Zoom. Interview data were analyzed using qualitative description. Sections of interview text were coded using a priori and emergent codes, grouped into categories, and distilled into themes. A total of 31 participants (mean age = 47.2 years) met inclusion/exclusion criteria, enrolled, and completed the study. Qualitative analysis revealed rural as a cross-cutting theme and five major themes: self-management behaviors, familial influence, medical encounters, talking about UI, and resource scarcity. Participants described the rural environment as having a substantial impact on their approach to UI self-management. Specifically, rural social enmeshment made seeking care for UI in rural communities challenging. Findings shed light on how the rural environment influences various aspects of UI self-management in midlife women. Diverse perspectives in UI self-management are needed to advance knowledge in this field.

An mHealth Text Messaging Program Providing Symptom Detection Training and Psychoeducation to Improve Hypoglycemia Self-Management: Intervention Development Study.

Hypoglycemia remains a challenge for roughly 25% of people with type 1 diabetes (T1D) despite using advanced technologies such as continuous glucose monitors (CGMs) or automated insulin delivery systems. Factors impacting hypoglycemia self-management behaviors (including reduced ability to detect hypoglycemia symptoms and unhelpful hypoglycemia beliefs) can lead to hypoglycemia development in people with T1D who use advanced diabetes technology. This study aims to develop a scalable, personalized mobile health (mHealth) behavioral intervention program to improve hypoglycemia self-management and ultimately reduce hypoglycemia in people with T1D who use advanced diabetes technology. We (a multidisciplinary team, including clinical and health psychologists, diabetes care and education specialists, endocrinologists, mHealth interventionists and computer engineers, qualitative researchers, and patient partners) jointly developed an mHealth text messaging hypoglycemia behavioral intervention program based on user-centered design principles. The following five iterative steps were taken: (1) conceptualization of hypoglycemia self-management processes and relevant interventions; (2) identification of text message themes and message content development; (3) message revision; (4) patient partner assessments for message readability, language acceptability, and trustworthiness; and (5) message finalization and integration with a CGM data-connected mHealth SMS text message delivery platform. An mHealth web-based SMS text message delivery platform that communicates with a CGM glucose information-sharing platform was also developed. The mHealth SMS text messaging hypoglycemia behavioral intervention program HypoPals, directed by patients' own CGM data, delivers personalized intervention messages to (1) improve hypoglycemia symptom detection and (2) elicit self-reflection, provide fact-based education, and suggest practical health behaviors to address unhelpful hypoglycemia beliefs and promote hypoglycemia self-management. The program is designed to message patients up to 4 times per day over a 10-week period. A rigorous conceptual framework, a multidisciplinary team (including patient partners), and behavior change techniques were incorporated to create a scalable, personalized mHealth SMS text messaging behavioral intervention. This program was systematically developed to improve hypoglycemia self-management in advanced diabetes technology users with T1D. A clinical trial is needed to evaluate the program's efficacy for future clinical implementation.

The impact of veteran support and resources for diabetes (iNSPiRED) on diabetes distress: Results from a randomized, parallel-group trial

ObjectiveThe primary objective of this research was to assess the impact of a novel, peer-directed intervention (iNSPiRED) on diabetes distress (DD) among veterans with type 2 diabetes and DD. Secondary objectives were to assess iNSPiRED's impact on anxiety, depression, and diabetes self-management behaviors. MethodA single-blinded, randomized, parallel-group trial was conducted. Participants (n = 218) were recruited through a Veterans Affairs medical center and community agencies in a major metropolitan area from September 2019 through January 2022. Certified mental health peer specialists delivered iNSPiRED, a three-month goal-setting and resource navigation intervention. Outcomes were assessed at baseline, postintervention, and month six. Multilevel random-intercept linear regression models with treatment x time interaction terms were used to assess treatment effects. ResultsFrequency of following a healthy eating plan was higher for iNSPiRED vs usual care at month three relative to baseline (B = 0.58; p = 0.03) after adjusting for race and socioeconomic status. No other treatment effects differed significantly from zero (ps ≥ 0.05). ConclusionPeer-directed interventions have the potential to deliver low-cost, highly scalable care. However, based on the largely negative findings of the current study, it is likely that more intense, multimodal interventions are needed to address DD.

Health locus of control and self-management behaviours among individuals with ischaemic heart disease: protocol for a scoping review

IntroductionIschaemic heart disease is a significant cause of morbidity and mortality worldwide. Self-management is a way to reduce the risk associated with ischaemic heart disease; however, some individuals may not...

WITHDRAWN: Effectiveness of continuous home wound care on wound healing, self-management behavior, and medical expenses of patients with diabetic foot ulcers

To explore the effectiveness of continuous home wound care on wound healing, self-management behavior, and medical expenses of patients with diabetic foot ulcers. Patients were grouped by the campuses they were hospitalized. One group received home wound care, and the other one received outpatient wound care after their discharge. Non-inferiority testing was performed to compare ulcer healing. Their Diabetes-related Foot Ulcer Self-Management Behavior Scale (DFUSMBS) scores and medical expenses were compared. Between October 2021 and December 2022, fifty-five patients in the home wound care group and fifty-two in the outpatient wound care group completed the study. The home wound care was non-inferior concerning ulcer complete healing rate in total or stratified by Wagner grade or baseline ulcer area. Concerning wound healing time, the home wound care group was inferior for Wagner Grade Ⅲ ulcers (hazard ratio=0.7772, 95% CI=0.2799-2.1581). In contrast, for ulcers with baseline area>5cm2, the home care group was non-inferior and even can be superior, although the superiority was not statistically significant (Log-rank X2=0.257, p=0.612). Moreover, the home wound care group showed significant improvement concerning timely wound treatment (t=23.045, p<0.001, Cohen's d=4.460, Effect Size=0.912) and wound care behavior (t=33.410, p<0.001, Cohen's d=6.454, Effect Size=0.955), while that of diabetes self-management was not statistically significant (t=-0.673, p=0.502, Cohen's d=0.128, Effect Size=0.064). The medium direct medical expense per capita of the patients in the outpatient care group was statistically significantly heavier than that of the home wound care group (Z=-6.877, p<0.001). The home wound care practice did not compromise ulcer healing, enhanced timely wound treatment and wound care behavior of the patients, and saved their medical expenses, hopefully providing a feasible wound care alternative with economic benefits for the physically and economically devastated patients.

Medication adherence to oral chemotherapeutic agents: a qualitative study of patients' and cancer care professionals' perspectives

Abstract Background: Adherence is increasingly understood as a complex concept and is affected by many factors. Among rural patients with cancer, adherence behavior can be affected by increased psychosocial and physical distress as well as economic burden. This study explored facilitators and barriers to medication adherence to oral chemotherapeutic agents (OCAs) from the perspective of both rural patients with cancer and their cancer care providers. Methods: This study was conducted in a regional Cancer Center in North Carolina. Data for the cancer care providers (N = 10) were collected (January-February 2016), and data for the patients with cancer (N = 25) were collected (March-June 2016). Qualitative interviews were conducted with patients with cancer currently taking OCAs, and interviews/focus groups were conducted with cancer care providers. Data analysis was conducted using the immersion crystallization approach. Results: The results of this qualitative study provide valuable insights into the attitudes of both cancer care providers and patients with cancer and their perceptions of adherence barriers and facilitators. The main barriers to adherence were costs associated with treatment, side effect management, comorbidities and concomitant treatments, limited health literacy, lack of social support, and patient-provider communication. Facilitators to adherence include education and follow-up, social support networks, and adherence strategies. Conclusion: Better communication, education/information, and social support were identified as facilitators of adherence in this study. It is critical to develop tailored strategies such as self-management behaviors, adherence strategies, and effective communication that can improve medication adherence and empower patients and their caregivers in their treatment management.

Influencing factors of self-management behavior in cancer patients based on a theoretical domain framework: a literature review.

To explore the factors that influence self-management behavior in cancer patients based on the theoretical domain framework. Studies in Chinese and English-language about factors influencing self-management behavior in cancer patients were searched from Wanfang DATA, CNKI, VIP, Sinomed, Pubmed, EMbase, CINAHL, Web of Science Core Collection, Cochrane library and Medline from inception to June 2022. Two investigators independently identified, extracted data, and collected characteristics and methodology of the studies. Factors were analyzed with Nvivo12, and theoretical domain framework was mapped to theoretical domain; then the secondary node was generalized by the theme analysis; finally, the specific influencing factors were summarized and analyzed. Thirty-four studies were included for analysis. A total of 194 factors were mapped to 13 theoretical domains, and 31 secondary nodes were summarized. The top three factors were mapped to the three theoretical domains, which were environmental context and resources, social/professional role and identity, and beliefs about consequences. Knowledge, age, self-efficacy, social support gender, economic status and physical status were the most influential factors for self-management in cancer patients. The influencing factors of self-management of cancer patients involve most of the theoretical domains, and are intersectional, multi-source and complex. It is important to further explore the key factors to provide the basis for the intervention of self-management behavior in cancer patients.

Patient factors and health outcomes associated with illness perceptions in people with gout.

Illness perceptions are views and beliefs formed in response to a health threat, and they may influence self-management behaviours and chronic disease outcomes. Despite effective medication, sub-optimal outcomes in gout are common. This study aimed to quantitatively investigate illness perceptions in gout to examine how illness perceptions relate to health outcomes. Data were obtained from a randomized controlled trial in which people with gout (n = 493) completed surveys measuring illness perceptions [Brief Illness Perception Questionnaire (B-IPQ)], gout flares, medication adherence, health-related quality of life, health-care utilization, and productivity, alongside serum urate blood tests at baseline, and at 6- and 12-month follow-ups. Multivariable linear regression identified patient factors independently associated with each B-IPQ item score. Logistic and linear regression, adjusted for age and sex, determined whether baseline B-IPQ items could predict current and future health outcomes. Younger individuals and those with severe gout were more likely to experience pessimistic illness perceptions at baseline. Optimistic illness perceptions were associated with lower odds of having had at least one flare in the preceding 6 months. Every 1-point increase in B-IPQ treatment control, indicating an increasingly optimistic view that gout is treatable, decreased the odds of a recent flare prior to baseline by 33% [odds ratio (OR): 0.67; 95% CI: 0.53, 0.85; P < 0.001] and prior to the 12-month follow-up by 15% (OR: 0.85; 95% CI: 0.76,0.96; P = 0.01). Pessimistic illness perceptions also predicted poorer medication adherence, health-related quality of life, and productivity, but not serum urate levels. Modifying pessimistic illness perceptions, including, but not limited to, patient education, may promote prudent self-management behaviours and better outcomes in gout. Australian New Zealand Clinical Trials Registry; https://www.anzctr.org.au/, ACTRN12616000455460.

Underlying mechanisms of diabetes knowledge influencing diabetes self-management behaviors among patients with type II diabetes in rural China: Based on health belief model

To investigate the association between diabetes knowledge and diabetes self-management (DSM) behaviors and to explore the influence mechanism between them among patients with type 2 diabetes mellitus (T2DM) based on health belief model in rural China. This cross-sectional study included 483 participants with T2DM from 8 villages of 3 townships in Jiangsu Province. All participants completed a structured questionnaire, including demographic information, diabetes knowledge, DSM behaviors, health beliefs, and cognitive function. Multiple linear regression and mediation analysis were performed to analyze the association between diabetes knowledge and DSM behaviors, furthermore the mechanism between them. Diabetes knowledge and self-efficacy positively influenced DSM behaviors. Health beliefs multiply mediated the association between diabetes knowledge and DSM behaviors. Perceived behavioral barriers mediated the relationship between diabetes knowledge and DSM behaviors, where a suppression effect existed. A chain-mediated effect was found: diabetes knowledge affected perceived benefits, followed by self-efficacy, and finally DSM behaviors. Diabetes knowledge acquisition played an important role in improving DSM behaviors, and health beliefs multiply mediated the relationship between them. When designing interventions, health systems and health providers should refocus on diabetes knowledge, emphasize the benefits of self-management, and consider the barriers that patients may encounter.

Opening the Black Box of an mHealth Patient-Reported Outcome Tool for Diabetes Self-Management: Interview Study Among Patients With Type 2 Diabetes.

Mobile health (mHealth) tools are used to collect data on patient-reported outcomes (PROs) and facilitate the assessment of patients' self-management behaviors outside the clinic environment. Despite the high availability of mHealth diabetes tools, there is a lack of understanding regarding the underlying reasons why these mHealth PRO tools succeed or fail in terms of changing patients' self-management behaviors. This study aims to identify the factors that drive engagement with an mHealth PRO tool and facilitate patients' adoption of self-management behaviors, as well as elicit suggestions for improvement. This qualitative study was conducted within the context of a randomized controlled trial designed to evaluate the efficacy of an mHealth PRO tool (known as i-Matter) versus usual care regarding reduction in glycated hemoglobin (HbA1c) levels and adherence to self-management behaviors at 12 months among patients with uncontrolled type 2 diabetes. Patients randomized to i-Matter participated in semistructured interviews about their experiences at the 3-, 6-, 9-, and 12-month study visits. A qualitative analysis of the interviews was conducted by 2 experienced qualitative researchers using conventional qualitative content analysis. The sample comprised 71 patients, of whom 67 (94%) completed at least one interview (n=48, 72% female patients; n=25, 37% identified as African American or Black; mean age 56.65 [SD 9.79] years). We identified 4 overarching themes and 6 subthemes. Theme 1 showed that the patients' reasons for engagement with i-Matter were multifactorial. Patients were driven by internal motivating factors that bolstered their engagement and helped them feel accountable for their diabetes (subtheme 1) and external motivating factors that helped to serve as reminders to be consistent with their self-management behaviors (subtheme 2). Theme 2 revealed that the use of i-Matter changed patients' attitudes toward their disease and their health behaviors in 2 ways: patients developed more positive attitudes about their condition and their ability to effectively self-manage it (subtheme 3), and they also developed a better awareness of their current behaviors, which motivated them to adopt healthier lifestyle behaviors (subtheme 4). Theme 3 showed that patients felt more committed to their health as a result of using i-Matter. Theme 4 highlighted the limitations of i-Matter, which included its technical design (subtheme 5) and the need for more resources to support the PRO data collected and shared through the tool (subtheme 6). This study isolated internal and external factors that prompted patients to change their views about their diabetes, become more engaged with the intervention and their health, and adopt healthy behaviors. These behavioral mechanisms provide important insights to drive future development of mHealth interventions that could lead to sustained behavior change.