Determinants Of Self-management Research Articles

Diabetes self-management and its related factors among Chinese young adults with type 2 diabetes mellitus.

To explore the status quo of self-management among young adults with type 2 diabetes mellitus (T2DM) and the determinants of self-management under the guidance of social cognitive theory. A cross-sectional study. In total, 227 young adults (18-44 years old) with T2DM at two hospitals in Beijing completed the questionnaires. The Summary of Diabetes Self-care Activities (SDSCA) was used, along with additional questionnaires about diabetes self-efficacy, attitude, diabetes distress, diabetes knowledge, coping styles and social support. Univariate analysis and multiple linear regression were used to explore the related factors of self-management among the young patients. The scores for the SDSCA in diet, exercise, blood-glucose testing, foot care and medication taking were (4.16 ± 1.51), (3.46 ± 2.50), (2.28 ± 2.24), (1.08 ± 1.84) and (6.09 ± 1.88), respectively. Stepwise multiple linear regression showed that fasting blood-glucose value was significantly associated with self-management behaviours of diet, exercise, blood-glucose testing and medication taking. Self-efficacy was significantly associated with self-management behaviours of diet, exercise and foot care. Diabetes distress, diabetes-related social activity, confrontation, education, duration of T2DM, treatment modalities and diabetes knowledge were associated with the one or two dimensions of SDSCA in the young adults with T2DM.

Exploring determinants of self-management in adults with severe mental illness: a qualitative evidence synthesis

AimsTo systematically review and synthesise qualitative evidence about determinants of self-management in adults with SMI. The goal is to use findings from this review to inform the design of effective self-management strategies for people with SMI and LTCs.BackgroundPeople living with serious mental illness (SMI) have a reduced life expectancy by around 15–20 years, mainly due to the high prevalence of long-term physical conditions such as diabetes and heart disease. People with SMI face many challenges when trying to manage their physical health. Little is known about the determinants of self-management – managing the emotional and practical issues – of long-term conditions (LTCs) for people with SMI.MethodSix databases, including CINAHL and MEDLINE, were searched to identify qualitative studies that explored people's perceptions about determinants of self-management in adults with SMI (with or without comorbid LTCs). Self-management was defined according to the American Association of Diabetes Educator's self-care behaviours (AADE7). Determinants were defined according to the Capabilities, Opportunity, Motivations and Behaviours (COM-B) framework. Eligible studies were purposively sampled for synthesis according to the richness of the data (assessed using Ames et al (2017)'s data richness scale), and thematically synthesised.ResultTwenty-six articles were included in the synthesis. Seven studies focused on self-management of LTCs, with the remaining articles exploring self-management of SMI. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the additional burden of SMI; living with comorbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; routine, structure and planning. Capabilities for self-management were linked to people's perceptions about the support they received for their SMI and LTC from healthcare professionals, family and friends. Opportunities for self-management were more commonly expressed in the context of social and environmental factors. Motivation for self-management was influenced by beliefs and attitudes, whilst being closely related to the burden of SMI.ConclusionThe themes identified from the synthesis suggest that capabilities, opportunities and motivations for self-management can be negatively influenced by the experience of SMI, whilst social and professional support, improved access to resources, and increased involvement in care, could promote self-management. Support programmes for people with SMI and LTCs need to account for these experiences and adapt to meet the unique needs of this population.

Self-management Determinants in Kidney Transplant Recipients according to the Health Belief Model

Introduction: Kidney transplant recipients, as chronic patients, need lifelong self-management. Therefore, identification of the effective factors is helpful in strengthening the individuals' adherence and planning self-management in the post-transplant period. However, the empirical research on this area is limited. The purpose of this study was "Explaining self-management determinants in kidney transplant recipients according to the health belief model".
 Methods: This qualitative content analysis was conducted in Kohgiluyeh and Boyer Ahmad province. The participants were included in the study by purposive and theoretical sampling methods until theoretical and classical saturations were achieved. The data were collected and analysed using 24 semi-structured interviews by 19 participants (14 transplant recipients, 4 family members, and a patient with a history of transplant rejection). The MAXQDA10 software was used to organize and manage the data.
 Results. After analysing the data, 264 primary conceptual codes were extracted. The findings were reported in 20 sub- categories and in accordance with six categories of the health belief model (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to actions).
 Conclusion. The findings of this qualitative study provided a profound understanding over the experiences of kidney transplant recipients and their family members about self-management determinants. The findings confirmed the health belief model constructs and its application in predicting these patients' self-management. In addition, the findings can be a guide for health planners and policy makers to select the suitable interventions and strategies to improve the adherence to recipients' self-management.

Self-Management and Self-Efficacy in Patients With Acute Spinal Cord Injuries: Protocol for a Longitudinal Cohort Study.

BackgroundPeople with recently acquired spinal cord injury (SCI) experience changes in physical, social and psychological aspects of their lives. In the last decades, attention has grown for aspects of self-management and self-efficacy in SCI research. However, we still do not know what the self-management and self-efficacy outcomes of first rehabilitation are and whether utilizing these skills may prevent secondary health conditions (SHCs) and increase participation and psychological adjustment early after SCI.ObjectiveTo describe the course and determinants of self-management and self-efficacy during and after first SCI rehabilitation; and to determine theory-based associations between self-management and self-efficacy with SHCs, participation and psychological adjustment.MethodsMulticenter prospective longitudinal cohort study. All people with a newly acquired SCI admitted to one of the 8 specialized SCI rehabilitation centers in the Netherlands will be considered for inclusion in this study. Main assessments will take place during the first and last week of admission and 3, 6 and 12 months after discharge. The target sample is 250 participants. The primary outcomes are self-management (knowledge and execution of self-care) and self-efficacy (confidence in the ability to manage the consequences of SCI and of self-care). Secondary outcome measures are SHCs, participation and psychological adjustment to SCI.ResultsThe first results with the complete set of data are expected in June 2019.ConclusionsThis protocol describes the SELF-SCI cohort study investigating self-management and self-efficacy of initial inpatient SCI rehabilitation. Second, associations will be investigated with SHCs, participation and psychological adjustment early after onset of SCI, until 1 year after discharge. The results will be used to test theories about motivation to perform health-promoting behaviors and adjustment to SCI.

Complex regional pain syndrome: Facilitating the use of self-management strategies

Aims: While several interventions are used to treat complex regional pain syndrome (CRPS), patient adherence to recommended care including self-management is challenging. To understand the barriers and facilitators to using self-management strategies among CRPS patients; to explore educational tools used to enable self-management; and to develop knowledge translation interventions to address potential barriers using intervention mapping. Methods: Semi-structured interviews of patients were conducted to identify the determinants of self-management. Findings informed the development of a tailored theory-based intervention to increase adherence. Result: Theoretical domains identified were: Social influence, Beliefs about capabilities, Beliefs about consequences, Environmental context and resources. Various educational tools were provided by treating clinicians. Interventions should consider increasing knowledge about treatment outcomes, identifying health antecedents and promoting self-monitoring. Conclusion: Online educational interventions focusing on patient advice, self-monitoring, and techniques to increase the quality of the clinician-patient relationship may successfully address patient barriers to using self-management strategies.

Development of a self-management program for employees with complaints of the arm, neck, and/or shoulder: an intervention mapping approach.

PurposeTo develop a self-management program with an additional eHealth module, using the six steps of the intervention mapping (IM) protocol, to help employees with complaints of the arm, neck, and/or shoulder (CANS) cope with their problems.MethodsIn Step 1 of the IM protocol, a needs assessment was performed consisting of a review of the Dutch multidisciplinary guidelines on CANS, and of focus group sessions with employees with CANS (n=15) and with relevant experts (n=17). After the needs assessment, the objectives of the intervention and the determinants of self-management at work were formulated (Step 2). Furthermore, theory-based intervention methods and practical strategies were selected (Step 3), and an intervention program (including the eHealth module) was developed (Step 4). Finally, plans for implementation and evaluation of the program were developed (Steps 5 and 6).ResultsStep 1 of the IM protocol revealed that employees with CANS should be stimulated to search for information about the cause of their complaints, about how to deal with their complaints, and in which manner they can influence their complaints themselves. In Step 2, the overall goal of the intervention was defined as “self-management behavior at work” with the aim to alleviate the perceived disability of the participants. Step 3 described how the intervention methods were translated into practical strategies, and goal setting was introduced as an important method for increasing self-efficacy. The product of Step 4 was the final program plan, consisting of 6-weekly group sessions of 2.5 hours each and an eHealth module. In Step 5, a recruitment plan and course materials were developed, a steering committee was set up, trainers were recruited, and the final program was tested. In Step 6, an evaluation plan was developed, which consists of a randomized controlled trial with a 12-month follow-up period and a qualitative evaluation (interviews) with some of the participants.ConclusionThis study resulted in a theory- and practice-based self-management program, based on behavioral change theories, guideline-related evidence, and practice-based knowledge that fits the needs of employees with CANS.

Social support systems as determinants of self-management and quality of life of people with diabetes across Europe: study protocol for an observational study

BackgroundLong-term conditions pose major challenges for healthcare systems. Optimizing self-management of people with long-term conditions is an important strategy to improve quality of life, health outcomes, patient experiences in healthcare, and the sustainability of healthcare systems. Much research on self-management focuses on individual competencies, while the social systems of support that facilitate self-management are underexplored. The presented study aims to explore the role of social systems of support for self-management and quality of life, focusing on the social networks of people with diabetes and community organisations that serve them.MethodsThe protocol concerns a cross-sectional study in 18 geographic areas in six European countries, involving a total of 1800 individuals with diabetes and 900 representatives of community organisations. In each country, we include a deprived rural area, a deprived urban area, and an affluent urban area. Individuals are recruited through healthcare practices in the targeted areas. A patient questionnaire comprises measures for quality of life, self-management behaviours, social network and social support, as well as individual characteristics. A community organisations’ survey maps out interconnections between community and voluntary organisations that support patients with chronic illness and documents the scope of work of the different types of organisations. We first explore the structure of social networks of individuals and of community organisations. Then linkages between these social networks, self-management and quality of life will be examined, taking deprivation and other factors into account.DiscussionThis study will provide insight into determinants of self-management and quality of life in individuals with diabetes, focusing on the role of social networks and community organisations.

Determinants of Self-Management Among Diabetic Patients

Diabetes self-management (DSM) is a complex behavior and various factors influence it. Despite continual recommendations to DSM, implementation of this behavior still remains a major health problem for diabetic patients. Identifying effective factors in DSM is useful to promote health in diabetic patients. The purpose of this study was to test the effects of individual and environmental factors on DSM. Path analysis was used to examine both one-way direct and indirect effects of 7 constructs and 3 demographic factors on DSM in this population (N = 396). Data were collected from a convenience sample of 104 (26.3%) males and 292 (73.7%) females with a median age 53 years. The final model provided a good fit to the data explaining 25% of the variance in DSM. Illness perception and provider-patient communication were the most effective factors in DSM. Knowledge and self-efficacy affected DSM indirectly via illness perception. The results of this study showed that effective DSM interventions should be designed to change illness perception and patient-provider communication, especially in patients with low duration of diabetes and low level of education.

Ethnic differences in outcomes of diabetes care and the role of self-management behavior

Objective Ethnic differences in outcomes of outpatient diabetic care and the role of self-management behavior and its determinants in explaining observed differences. Methods Face-to-face interviews were held with 102 Turkish or Moroccan, and 102 native Dutch diabetic patients to measure self-management behavior and determinants of self-management (as derived from the Attitudes-Social support self-Efficacy model, and Personal Models and Barriers). A medical record review was conducted to measure ethnic differences in outcomes of diabetes care. Data were analyzed using multiple linear regression. Results Outcomes differed significantly with ethnic minorities having higher levels of lipids (risk difference = RD = 0.7%; CI: 0.3–1.2) and HbA1c (RD = 0.9%; CI: 0.4–1.4) than native Dutch patients. Differences in self-management could not explain the ethnic differences in outcomes. Self-efficacy explained 18% of the ethnic differences in HbA1c. Beliefs about seriousness of diabetes and social support regarding diabetes management together explained 47% of the ethnic differences in lipids. Conclusion This study provides evidence for ethnic differences in outcomes of diabetes care. Self-efficacy is the most important determinant in explaining the differences in HbA1c. Practice implications For diabetes practice this suggests that strengthening patients’ self-efficacy may improve the control of HbA1c and may result in a decrease of ethnic differences. The relationship between behavioral determinants like seriousness and social support and outcomes of diabetes care was differential by ethnic group, implying that caution is required when applying behavioral models to different ethnic groups.

Contribution of Partner Support in Self-Management of Rheumatoid Arthritis Patients. An Application of the Theory of Planned Behavior

The aim of this exploratory study was to test the applicability of a model derived from the Theory of Planned Behavior on self-management. In this model social support from the partner, attitude and self-efficacy are determinants of intention, and intention and self-efficacy are determinants of self-management. We tested the model on rheumatoid arthritis patients who have a partner, using regression analyses and structural equation models. Partner support and attitude partly explained the variance in intention. Intention in turn partly explained the variance in self-management. Self-efficacy showed a tendency to positively affect intention and self-management. The present study provided moderate support for the use of the constructs and ideas derived from the Theory of Planned Behavior-attitude, social support, self-efficacy, and intention-in predicting and explaining self-management.

Biopsychosocial Determinants of Self-Management in Culturally Diverse South African Patients with Essential Hypertension

Associations between self-management and biopsychosocial variables in a group of Afrikaans- (n= 102) and Sotho-speaking (n= 94) patients with essential hypertension (EH) were investigated. Self-management in terms of predetermined criteria for medical and lifestyle prescriptions was achieved by only 30.6 per cent of the participants. Significant differences were found between self-managing and non self-managing participants regarding language and culture, doctor-patient fit, complexity of prescriptions, medication side-effects, aspects of health beliefs, illness behaviour and health locus of control. In addition, a first empirical indication was found that self-management is also linked with psychological wellbeing, as manifested in a sense of coherence. The significantly accurate prediction of self-management by various biopsychosocial variables endorses the relevance of a biopsychosocial perspective in the treatment of patients with EH.

Self-management of diabetes mellitus: A critical review.

Diabetes has no known cure and is a leading source of morbidity and mortality. Clinical management involves patients managing a complex and variable regimen. This article reviews the determinants of effective self-management and the methods of promoting better self-management. Trait variables (e.g., personality and demographics) have been presumed to affect self-management, but evidence suggests they have little impact. The important determinants of self-management are transient situational factors such as psychological stress and social pressure to eat. Interventions to promote better self-management have reported initial improvements in blood glucose control, but the long-term effects are unclear. We conclude that self-management has been inadequately assessed and that attempts to improve self-management have relied excessively on providing information. More research is needed to clarify determinants of self-management, and interventions to improve self-management will need to change these determinants.