Psychological predictors of treatment adherence among patients with diabetes (types I and II): Modified information-motivation-behavioural skills model

Application of the information-motivation-behavioral skills model to improve medication adherence among older adults with type 2 diabetes: findings from a quasi-experimental study in Kermanshah, Iran

INTRODUCTION

Medication adherence is crucial for effective blood sugar control in diabetes patients. However, older adults face a higher risk of non-adherence. This study aims to evaluate the effectiveness of a theory-based program designed to enhance medication adherence among older adults with type 2 diabetes.

METHODS

This quasi-experimental study involved 100 elderly individuals with type 2 diabetes in Kermanshah, Iran, in 2024. Participants were randomly assigned to an intervention (50) or control group (50). The intervention group attended six 40-minute sessions over six weeks, based on the Information-Motivation-Behavioral Skills (IMB) model. Data were collected via a questionnaire assessing demographics, IMB model components, and medication adherence. Data were analyzed using SPSS version 16, employing chi-square tests and t-tests for comparisons, moreover, effect sizes were determined using Cohen's d.

RESULTS

The intervention group showed significant improvements, especially in "Information," with a very large effect size of 1.3 and an average change of 3.84 (p < 0.001). In contrast, the control group had minimal changes. Other components like "Attitude" and "Self-efficacy" also had large effect sizes (0.65 and 0.67). However, "Subjective Norms" showed a small effect size (0.11) with no significant changes. Additionally, the intervention group showed a significant improvement in medication adherence (effect size 1.15), increasing scores from 16.92 to 19.76, (p < 0.001) while the control group had minimal changes.

CONCLUSION

The program based on the IMB model significantly improved medication adherence among elderly individuals with type 2 diabetes. We also identified the key theoretical methods of behavior change for each determinant of the IMB model and recommend utilizing them in the development of similar future interventions.

Relationships of Psychosocial Factors to Diabetes Self-efficacy: A Cross-sectional, Correlational Study

BACKGROUND

Self-care in people with diabetes is poor, which could be influenced by positive and negative psychosocial factors. Self-efficacy is an important factor affecting self-care, and depressive symptoms and diabetes distress may directly and indirectly affect self-efficacy.

OBJECTIVE

The aim of this study was to examine the relationships of depressive symptoms, diabetes distress, age, sex, self-compassion, resilience, self-esteem, and social support to diabetes self-efficacy and the mediating roles of diabetes distress and depressive symptoms in the relationships among people with diabetes.

METHODS

In this cross-sectional, correlational study, data on all the psychosocial and demographic factors were collected (N = 148; 57.6 years old) through Research Electronic Data Capture in 2023. The PROCESS macro for SPSS was used to address the purpose.

RESULTS

The mean score of diabetes self-efficacy was 28.6 (range, 8-40). In 1 model, depressive symptoms were directly and indirectly associated with diabetes self-efficacy through diabetes distress (direct effect, -3.524; t = -3.020, P = .003; indirect effect, -2.089; 95% bootstrap confidence interval, -3.494 to -0.911). In another model, diabetes distress was directly and indirectly associated with diabetes self-efficacy through depressive symptoms (direct effect, -3.778; t = -3.638, P < .001; indirect effect, -0.785; 95% bootstrap confidence interval, -1.868 to -0.089). In addition, self-esteem was associated with both depressive symptoms and diabetes distress. Resilience was associated with diabetes self-efficacy in 1 model.

CONCLUSIONS

Negative psychological factors were directly and indirectly associated with diabetes self-efficacy. Depressive symptoms, diabetes distress, self-esteem, and resilience can be important targets of interventions to improve diabetes self-efficacy.

Medication-Taking Trajectory and Its Correlates in Patients With Diabetes: Based on the Information-Motivation-Behavioral Skills Model

PURPOSE

The purpose was to identify trajectories of medication taking among patients with diabetes and investigate correlates of these trajectories using the information-motivation-behavioral skills (IMB) model.

METHODS

This study employed a descriptive correlational, longitudinal design using convenience sampling. The participants were 96 adults with diabetes from an outpatient diabetes clinic at a university-affiliated hospital. Medication taking was assessed at 3 time points: baseline, 6 months, and 12 months. At baseline, study variables based on the IMB model were measured: medication knowledge (information), motivational readiness and social support (motivation), and medication self-efficacy (behavioral skills). Group-based trajectory modeling was used to identify medication-taking trajectories, and multinomial logistic regression was used to assess factors associated with medication-taking trajectories.

RESULTS

Three distinct medication-taking trajectory groups were identified: "high medication taking," "increasing medication taking," and "low medication taking." Higher medication knowledge was associated with the high and increasing medication-taking trajectory groups. Motivational readiness was associated with the high and increasing medication-taking groups. In contrast, higher medication self-efficacy was associated only with the high medication-taking group, not with the increasing and low medication-taking groups.

CONCLUSIONS

The findings suggest that knowledge, motivational readiness, and self-efficacy are essential in IMB model-based intervention strategies across dynamic medication-taking patterns to enhance medication taking. Health care providers can help patients with diabetes improve medication taking by understanding their medication-taking trajectories and their correlates. Strategies that enhance medication self-efficacy are essential for patients in the increasing and low medication-taking groups.

The association between chronotype and social anxiety among Chinese university students: a moderated mediation analysis of loneliness and perceived social support

BACKGROUND

Social anxiety has been a burning problem among contemporary college students in China. Increasing evidence suggests that individual circadian typology-chronotype may play an important role in the development of social anxiety. However, little research has focused directly on examining the association between chronotype and social anxiety, and less is known about the mediating and moderating mechanisms underlying this relationship. The aim of the present study was to investigate the link between chronotype and social anxiety among Chinese college students, and to explore the mediating effect of loneliness and the moderating effect of perceived social support in the association between chronotype and social anxiety.

METHODS

A cross-sectional design was conducted among 1616 college students (16-29 years old) from several public universities in Northern China, including 1172 females (72.52%) and 444 males (27.48%), with an average age of 19.68 years old (SD = 1.49). All participants completed the standardized self-report questionnaires including the Social Avoidance and Distress Scale, Morningness-Eveningness Questionnaire, UCLA Loneliness Scale, and the Perceived Social Support Scale. Common method bias was performed using Harman's single-factor test. The mediation and moderation effects were analyzed using SPSS software and PROCESS macros.

RESULTS

Chronotype had a negative predictive effect on social anxiety in college students. Specifically, the greater the inclination of individuals' chronotypes toward evening preference, the more pronounced their symptoms of social anxiety would be. Loneliness served as a partial mediator in the relationship between chronotype and social anxiety, accounting for 30.0% of the total effect. In addition, perceived social support, particularly from friends and significant others, was found to play a moderating role in the process of loneliness affecting social anxiety among college students, while support from family did not. Interestingly, the perceived social support displayed a limited protective effect when college students suffered from higher levels of loneliness.

CONCLUSION

These findings deepened our understanding of how and when (or for "whom") chronotype is related to social anxiety, offering a theoretical foundation and practical insights for preventing and addressing social anxiety risk in young adult university students, particularly those with evening chronotypes.

Age-based challenges to type 1 diabetes management in the pediatric population

Type 1 diabetes is rising in the pediatric population, affecting approximately 1.2 million children and adolescents globally. Its complex pathogenesis involves the interaction between genetic predisposition and environmental factors, leading to T cell-mediated destruction of insulin-producing pancreatic beta-cells. This destruction results in insulin insufficiency and hyperglycemia. Hence, managing type 1 diabetes requires a comprehensive approach that includes various aspects such as blood glucose monitoring, insulin therapy, carbohydrate counting, caloric intake monitoring, considering family habits and food preferences, planning daily schedules, and incorporating physical activity. Children with type 1 diabetes encounter age-specific challenges in disease management that may exacerbate the risk of metabolic complications and adverse health outcomes. These risk factors may be neurological, physiological, behavioral, psychological, or social, complicate management and necessitate tailored approaches for effective care. Regardless of the age group, primary caregivers have a high responsibility to maintain optimal glycemic control, including monitoring diet, daily activity, and administering insulin. By reviewing research on the challenges faced by pediatric patients with type 1 diabetes, we summarized key insights aimed at developing targeted interventions and support systems that enhance diabetes management and improve health outcomes in this vulnerable population.

Relationships of multidimensional factors to self-management in patients with diabetes: A Cross-sectional, correlational study

Poor self-management in patients with diabetes is a consistent issue, leading to diabetes complications. The purpose of this study was to examine the relationships of demographic, cognitive, psychological, social, and physiological factors to self-management in patients with diabetes. In this cross-sectional, correlational study, data were collected from 98 patients through REDCap in 2023. Multiple regression analysis was used to address the study purpose. In the sample, adherence to adequate self-management was poor. Knowledge, self-efficacy, and body mass index (BMI) were associated with overall diabetes self-management. Self-efficacy and BMI were associated with diet and exercise. Knowledge and self-efficacy were associated with blood glucose testing. No factors were associated with smoking and foot care. In conclusion, different factors were associated with different types of self-management, but BMI and self-efficacy were associated with most types of self-management. Clinicians and researchers can target BMI, self-efficacy, and knowledge to improve self-management in patients with diabetes.

Sublingual immunotherapy adherence in patients with allergic rhinitis: Effects of an intervention based on the information-motivation-behavioral skills model

OBJECTIVE

This study aimed to confirm the efficacy of an intervention based on the information-motivation-behavior skills (IMB) model in improving the sublingual immunotherapy adherence score, medication beliefs score, self-efficacy score, and medication knowledge score of patients with allergic rhinitis.

METHODS

A total of 120 patients with allergic rhinitis from an otorhinolaryngology clinic were divided into the control group (n = 60) and experimental group (n = 60); the study was conducted from August 2021 to March 2022. The control group received routine intervention, whereas the experimental group received intervention based on the IMB model. The medication adherence, medication beliefs, self-efficacy, and medication knowledge levels of the two groups were evaluated at baseline, post-intervention, at 1-month follow-up, and at 3-month follow-up.

RESULTS

After intervention, a total of 116 patients completed the trial in the experimental and control groups (58 cases each). The results revealed differences in the scores of medication adherence, belief, self-efficacy, and knowledge between the two groups post-intervention, at 1-month follow-up, and at 3-month follow-up (P < 0.05). Further, the scores of the four indexes of the two groups were different with time, and better changes were noted among experimental group participants.

CONCLUSION

Implementing interventions based on the IMB model for people receiving sublingual immunotherapy for allergic rhinitis can effectively improve patients' medication beliefs, self-efficacy, and knowledge of medication, thereby improving their medication adherence, ensuring efficacy, and providing medication care for outpatients.

The role of self-compassion in diabetes management: A rapid review

Aim

This study aimed to assemble and critically reflect on previously acquired insights from investigations that have already been conducted into the role of self-compassion in diabetes and its management.

Methods

This study implemented a rapid review approach to assess the pre-existing knowledge in a time-sensitive manner. A rapid review involves the synthesis of existing knowledge using a simplified systematic review process.

Results

A total of 16 articles were identified for this rapid review. The main findings from these articles included that self-compassion is associated with improved outcomes (psychologically and medically), self-compassion can be improved through interventions, and that many extraneous factors influence levels of self-compassion.

Conclusion

It is apparent that self-compassion plays a rather significant role in the management of diabetes, and that interventions aimed at developing self-compassion showed success in improving health-related outcomes. It is suggested that future research should build on the possibility of using positive psychology interventions to improve the quality of life of those living with diabetes, and work to better understand the influence of aspects such as gender and diabetes duration on self-compassion.