The impact of a stage-matched intervention to promote exercise behavior in participants with type 2 diabetes

The effect of nurse-led motivational interviewing based on the trans-theoretical model on promoting physical activity in healthy older adults: A randomized controlled trial

AIM

The aim of this study was to evaluate the effect of motivational interviewing based on the trans-theoretical model promoting physical activity in older adults.

METHODS

A randomized controlled trial study was conducted with 117 older adults (intervention group: 58, and control group: 59) between April and November 2019. The data were collected via a questionnaire, trans-theoretical model scales, the Physical Activity Scale for the Elderly, the Katz Activities of Daily Living scale and a pedometer. The 24-week intervention consisted of regular motivational interviewing. The control group received usual care at the family health centre.

RESULTS

Following the intervention, the Intervention Group showed significant improvements Exercise Processes of Change Scale, Exercise Self-Efficacy Scale and Perceived Benefits of the Decisional Balance Scale for Exercise. There was a significant difference between the groups in terms of stages of change. In the Intervention Group, 81.5% were in the contemplation stage in the pre-test, while in the post-test, 70.4% had transitioned to the action stage. In contrast, in the control group, 62.5% were in the contemplation stage initially, but in the post-test, only 9.3% had reached the action stage. The mean number of step counts increased significantly in favour of the Intervention Group, as did the Physical Activity Scale for the Elderly total score.

CONCLUSION

The trial indicated that after the trans-theoretical model-based motivational interviewing, the stages of change among the older adults improved, as did their exercise behaviours. It is recommended that the trans-theoretical model and motivational interviewing be used by nurses to improve healthy lifestyle stage behaviours in older adults.

Prospective association of eHealth literacy and health literacy with physical activity among Chinese college students: a multiple mediation analysis

Background

The COVID-19 pandemic has decreased physical activity (PA) while increasing demand for electronic health resources. eHealth literacy (EHL) is expected to aid eHealth use and health promotion. EHL was raised on the grounds of health literacy (HL). This study explored the associations among EHL, HL, and PA in Chinese college students and identified mediating mechanisms in the EHL/HL-PA relationship.

Methods

An integrated social-cognitive model was proposed. A total of 947 Chinese college students (52.8% women, age = 19.87 ± 1.68 years) completed the three-wave data collection. Path analysis was performed.

Results

An adequate good-to-fit model was indicated. Perceived EHL (PEHL) was significantly associated with perceived HL (PHL) and HL performance (HLP); PHL was negatively related to HLP; PEHL was significantly associated with self-efficacy (SE) and social support (SS); PHL had a significant effect on SS but not SE; HLP significantly affected SS but not SE; SS and SE positively predicted intention (INT), which then predicted PA. SS mediated PEHL/PHL-INT links; SE mediated the PEHL-INT link; SS and INT jointly mediated PEHL/PHL/HLP-PA; SE and INT jointly mediated PEHL-PA.

Conclusion

Relationships among EHL, HL, and PA were explored with multiple mediating mechanisms identified. Differential SE and SS roles in EHL/HL-PA links suggest new mechanisms to inform EHL/HL intervention development.

Psychosocial determinants of consistent condom use among university students in Sudan: findings from a study using the Integrated Change Model

Unprotected sex is common among university students in Sudan, thus increasing risks for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). As little is known about the psychosocial determinants of consistent condom use among this population, this study was designed to identify them. The Integrated Change Model (ICM) was applied in a cross-sectional design to identify in 218 students (aged 18-25 years) from Khartoum which items distinguish condom users from non-condom users. Condom users differed significantly from non-condom users in having more HIV and condom use-related knowledge, higher perception of susceptibility to HIV, reporting more exposure to condom use cues, having a less negative attitude towards condom use (attitude cons), experiencing social support and norms favouring condom use and having higher condom use self-efficacy. Binary logistic regression showed that peer norms favouring condom use in addition to HIV-related knowledge, condom use cues, negative attitude and self-efficacy were the factors uniquely associated with consistent condom use among university students in Sudan. Interventions seeking to promote consistent condom use among sexually active students could benefit from increasing knowledge about HIV transmission and prevention, raising HIV-risk perception, using condom use cues, addressing perceived condom disadvantages and enhancing students` self-efficacy to avoid unprotected sex. Moreover, such interventions should raise students` perceptions of their peers` beliefs and behaviours favouring condom use and seek health care professionals` and religious scholars` support for condom use.

Masticatory Behavior Change with a Wearable Chewing Counter: A Randomized Controlled Trial

Because a relationship has been reported between masticatory behavior, obesity, and postprandial blood glucose, it is recommended to chew well and take a longer time to eat. The purpose of this study was to examine the possibility of changing masticatory behavior using a small ear-hung wearable chewing counter, which can monitor masticatory behavior without disturbing daily meals. In total, 235 healthy volunteers participated in a 4-wk randomized controlled trial and were divided into 3 groups. All participants were instructed about the importance of mastication at the first visit. During the intervention, group B used the chewing counter without an algorithm during each meal (notification of the number of chews after meal), and group C used the chewing counter with a masticatory behavior change algorithm (setting a target value and displaying the number of chews in real time). Group A was set as the control group. The number of chews and the meal time when consuming 1 rice ball (100 g) were measured before and after the intervention using the chewing counter, and the rate of change in these values was evaluated. Participants also provided a subjective evaluation of their changes in masticatory behavior. The number of chews and the meal time of 1 rice ball increased significantly in groups B and C compared with before the intervention, and the rate of change was significantly higher in group C than in group A and group B. In addition, the subjective evaluation of the change in the number of chews was highest in group C. Self-monitoring of masticatory behavior by providing a target value and the degree of achievement for the number of chews using a wearable chewing counter with a behavioral change algorithm could promote effective change in masticatory behavior and lead to an increased number of chews. (Trial ID: UMIN000034476).

Effect of the SNS-Based Physical Activity-Related Psychological Intervention on Physical Activity and Psychological Constructs among Inactive University Students

Background/Objective

The current study investigated the effects of the physical activity-related psychological intervention via social network service (SNS) on physical activity and psychological constructs in inactive university students.

Method

Thirty inactive university students participated in the 12-week intervention and received the physical activity-related psychological strategy via SNS. The physical activity levels, stages of physical activity, self-efficacy, pros, and cons were measured at the three time points (baseline, after 6 weeks, and after 12 weeks). Data analyses included frequency analysis, McNemar chi-square (χ²) test, and a repeated measures ANOVA were conducted.

Results

Results indicated that the number of inactive university students gradually decreased across the three different time points, and that a total physical activity of inactive university students significantly increased over the 12-week intervention. In addition, pros and self-efficacy significantly increased but cons gradually decreased over the intervention.

Conclusions

The current study suggests that the SNS-based physical activity-related psychological strategies have positive effects on promoting physical activity and its related psychological constructs for inactive university students.

Psychometric Properties of the Korean Version of the Perceived Therapeutic Efficacy Scale for Physical Activity in Adults With Type 2 Diabetes

PURPOSE

The purpose of this study is to translate the Perceived Therapeutic Efficacy Scale (PTES) into Korean and investigate its validity and reliability.

METHODS

The authors conducted a cross-sectional survey using baseline data from a randomized controlled study to psychometrically validate the PTES-Korean (PTES-K) among 108 adults with type 2 diabetes from an outpatient clinic at a university-affiliated hospital in Korea. The original PTES was forward-translated and back-translated to ensure translation equivalence of the PTES-K. Structured questionnaires were used for psychometric evaluation; exploratory and confirmatory factor analysis assessed validity, and Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were used for reliability.

RESULTS

The interitem correlation analyses revealed that 5 items were redundant; thus, the scale was reduced to 5 items. A 1-factor model explained 76.85% of the variance; confirmatory factor analysis showed that this model adequately fit the data. The ICC for test-retest reliability was .78; Cronbach's alpha was .92. The PTES-K showed significant associations with the scores of diabetes self-care activities for physical activity, quality of life, and depressive symptoms. Participants with good glycemic control and regular physical activity tended to have a higher score on the PTES-K than their counterparts, demonstrating known-groups validity.

CONCLUSIONS

The cross-cultural applicability, reliability, and validity of the PTES-K were confirmed. The PTES-K may be used in clinical settings to examine the potential role of perceived therapeutic efficacy for physical activity in enhanced glycemic control among patients with diabetes.

Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review

BACKGROUND

For people with diabetes mellitus to achieve optimal glycaemic control, motivation to perform self-management is important. The research team wanted to determine whether or not psychological interventions are clinically effective and cost-effective in increasing self-management and improving glycaemic control.

OBJECTIVES

The first objective was to determine the clinical effectiveness of psychological interventions for people with type 1 diabetes mellitus and people with type 2 diabetes mellitus so that they have improved (1) glycated haemoglobin levels, (2) diabetes self-management and (3) quality of life, and fewer depressive symptoms. The second objective was to determine the cost-effectiveness of psychological interventions.

DATA SOURCES

The following databases were accessed (searches took place between 2003 and 2016): MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsycINFO, EMBASE, Cochrane Controlled Trials Register, Web of Science, and Dissertation Abstracts International. Diabetes conference abstracts, reference lists of included studies and Clinicaltrials.gov trial registry were also searched.

REVIEW METHODS

Systematic review, aggregate meta-analysis, network meta-analysis, individual patient data meta-analysis and cost-effectiveness modelling were all used. Risk of bias of randomised and non-randomised controlled trials was assessed using the Cochrane Handbook (Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928).

DESIGN

Systematic review, meta-analysis, cost-effectiveness analysis and patient and public consultation were all used.

SETTING

Settings in primary or secondary care were included.

PARTICIPANTS

Adolescents and children with type 1 diabetes mellitus and adults with types 1 and 2 diabetes mellitus were included.

INTERVENTIONS

The interventions used were psychological treatments, including and not restricted to cognitive-behavioural therapy, counselling, family therapy and psychotherapy.

MAIN OUTCOME MEASURES

Glycated haemoglobin levels, self-management behaviours, body mass index, blood pressure levels, depressive symptoms and quality of life were all used as outcome measures.

RESULTS

A total of 96 studies were included in the systematic review (n = 18,659 participants). In random-effects meta-analysis, data on glycated haemoglobin levels were available for seven studies conducted in adults with type 1 diabetes mellitus (n = 851 participants) that demonstrated a pooled mean difference of -0.13 (95% confidence interval -0.33 to 0.07), a non-significant decrease in favour of psychological treatment; 18 studies conducted in adolescents/children with type 1 diabetes mellitus (n = 2583 participants) that demonstrated a pooled mean difference of 0.00 (95% confidence interval -0.18 to 0.18), indicating no change; and 49 studies conducted in adults with type 2 diabetes mellitus (n = 12,009 participants) that demonstrated a pooled mean difference of -0.21 (95% confidence interval -0.31 to -0.10), equivalent to reduction in glycated haemoglobin levels of -0.33% or ≈3.5 mmol/mol. For type 2 diabetes mellitus, there was evidence that psychological interventions improved dietary behaviour and quality of life but not blood pressure, body mass index or depressive symptoms. The results of the network meta-analysis, which considers direct and indirect effects of multiple treatment comparisons, suggest that, for adults with type 1 diabetes mellitus (7 studies; 968 participants), attention control and cognitive-behavioural therapy are clinically effective and cognitive-behavioural therapy is cost-effective. For adults with type 2 diabetes mellitus (49 studies; 12,409 participants), cognitive-behavioural therapy and counselling are effective and cognitive-behavioural therapy is potentially cost-effective. The results of the individual patient data meta-analysis for adolescents/children with type 1 diabetes mellitus (9 studies; 1392 participants) suggest that there were main effects for age and diabetes duration. For adults with type 2 diabetes mellitus (19 studies; 3639 participants), baseline glycated haemoglobin levels moderated treatment outcome.

LIMITATIONS

Aggregate meta-analysis was limited to glycaemic control for type 1 diabetes mellitus. It was not possible to model cost-effectiveness for adolescents/children with type 1 diabetes mellitus and modelling for type 2 diabetes mellitus involved substantial uncertainty. The individual patient data meta-analysis included only 40-50% of studies.

CONCLUSIONS

This review suggests that psychological treatments offer minimal clinical benefit in improving glycated haemoglobin levels for adults with type 2 diabetes mellitus. However, there was no evidence of benefit compared with control interventions in improving glycated haemoglobin levels for people with type 1 diabetes mellitus.

FUTURE WORK

Future work should consider the competency of the interventionists delivering a therapy and psychological approaches that are matched to a person and their life course.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42016033619.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 28. See the NIHR Journals Library website for further project information.

Affective Variables and Cognitive Performances During Exercise in a Group of Adults With Type 2 Diabetes Mellitus

Previous research has documented that type 2 diabetes mellitus (T2DM) is associated with cognitive impairment. Psychological variables were repeatedly investigated to understand why T2DM patients are poorly active, despite standards of medical care recommends performing aerobic and resistance exercise regularly and reducing the amount of time spent sitting. This exploratory study aims to investigate how affective variables as thoughts, feelings, and individuals’ stage of exercise adoption can modulate low cognitive performances during an experimental procedure based on exercise. The Exercise Thoughts Questionnaire (ETQ), Exercise-Induced Feeling Scale (EFI), and Physical Activity Stage of Change were administered to a sample of 12 T2DM patients. The Bivalent Shape Task (BST) alone (BST), BST with exercise [control exercise recovery (CER) + BST], and BST with metaboreflex [post-exercise muscle ischemia (PEMI) + BST] were used as mental task, and response time to congruent, incongruent, and neutral stimuli was recorded. Concomitant cerebral oxygenation (COX) was evaluated by near-infrared spectroscopy (NIRS). As expected, T2DM patients performed significantly better when the stimulus was presented in congruent trials (followed by neutral and incongruent). In the CER + BST session, T2DM patients showed longer reaction time to incongruent trials than in the PEMI + BST and BST alone sessions. Positive feelings toward exercise seem to modulate cognitive performances in high challenging task only if T2DM patients were conscious to play exercise. These results could provide some insights for health intervention targeting exercise for patients with T2DM in order to enhance cognitive performances.

Willingness of Patients Prescribed Medications for Lifestyle-Related Diseases to Use Personal Health Records: Questionnaire Study

Background

Personal health record (PHR) systems let individuals utilize their own health information to maintain and improve quality of life. Using PHRs is expected to support self-management in patients with lifestyle-related diseases.

Objective

The aim of this study was to identify predictors of the willingness to use PHRs among patients who are prescribed medications for lifestyle-related diseases.

Methods

We recruited pharmacy patrons, aged 20 years or older, who had received at least one medication indicated for hypertension, dyslipidemia, or diabetes. Participants completed self-administered questionnaires regarding their previous diseases, awareness of health care, experience in using PHRs, willingness to use PHRs, and barriers to using PHRs. Data were analyzed using multivariate logistic regression models.

Results

Of the 3708 subjects meeting eligibility criteria, 2307 replies (62.22%) were collected. While only 174 (7.54%) participants had previous PHR experience, 853 (36.97%) expressed willingness to use PHRs. In the multivariate analysis, considering exercise to be important for health management (odds ratio [OR] 1.57, 95% CI 1.12-2.21; P=.009), obtaining medical information from books or magazines (OR 1.23, 95% CI 0.96-1.59; P=.10), and obtaining medical information from the internet (OR 1.45, 95% CI 1.13-1.87; P=.004) were newly identified predictors. These were in addition to known predictors, such as being employed, owning information terminals, and previous PHR experience.

Conclusions

Patients who have an active and positive attitude toward health seem to be more willing to use PHRs. Investigating willingness should contribute to the development of more useful PHRs for self-management among patients prescribed medications for lifestyle-related diseases.

Association of glucose control and stages of change for multiple self-management behaviors in patients with diabetes: A latent profile analysis

OBJECTIVE

To determine whether the joint use of the transtheoretical model and latent profile analysis could help us better understand the shared characteristics of patients with diabetes and explore the association of patients' latent classes and glucose control.

METHODS

Five hundred twenty-three (523) patients with diabetes were included in the study. The questionnaire evaluated patients' stages of change for medication-taking, diet control, exercise, and glucose-monitoring. Latent profile analysis was performed based on the four indicators.

RESULTS

Patients were classified into four latent groups and defined as follows: good medication-taking/good lifestyle (GM/GL, 41.7%), poor medication-taking/poor lifestyle (PM/PL, 27.7%), good medication-taking/poor lifestyle (GM/PL, 21.6%), and poor medication-taking/good lifestyle (PM/GL, 9.0%). Patients in the PM/PL group were generally younger and better educated while those in the GM/GL group exhibited the opposite pattern. Compared with patients in the PM/PL group, those in the PM/GL and GM/GL groups had significantly lower HbA1c values (PM/GL: standardized β = -0.694, P =  0.007; GM/GL: standardized β = -0.499, P =  0.003).

CONCLUSION

With the help of the transtheoretical model and latent profile analysis, future study could cluster homogeneous patients before the initiation of intervention and provide tailored instructions to different types of patients accordingly.

PRACTICE IMPLICATIONS

A combination of the transtheoretical model and latent profile analysis could shed some light into future diabetic interventions.

The influence of pre-motivational factors on behavior via motivational factors: a test of the I-Change model

Background

The I-Change Model for explaining motivational and behavioral change postulates that an awareness phase precedes the motivation phase of a person, and that effects of pre-motivational factors on behavior are partially mediated by motivational factors. This study tests this assumption with regard to physical activity.

Methods

Observational longitudinal survey study (baseline, three months, six months) amongst Dutch adults (N = 2434). Structural equation modelling was used to investigate whether the influence of (1) knowledge, (2) cognizance, (3) cues, and (4) risk perception separately on intention and physical activity were mediated by motivational factors (i.e. attitudes, self-efficacy and social influence). Subsequently, a comprehensive model including all pre-motivational factors was estimated to test the same assumption for all pre-motivational factors simultaneously.

Results

The results indicate that the associations of cognizance, risk perception and cues with behavior were fully mediated by motivational factors when tested separately. When tested simultaneously only the effect of cognizance remained. Cognizance was most strongly associated with positive attitudes β = .13, p < .01, self-efficacy β = .13, p < .01, and intention β = .14, p < .01. No direct link with behavior was found.

Conclusion

The results suggest that pre-motivational factors are important to form a motivation; however, they do not directly influence behavior. The inclusion of factors such as risk perception and cognizance would help to get a better understanding of motivation formation and behavior.

Integrative Review on Adherence in Haitians With Diabetes

In light of a marked increase in the incidence and prevalence of diabetes in the United States in recent years with associated health costs totaling $245 billion for 2012, diabetes has become a major health and fiscal concern. Haitian Americans as a cultural group have unique obstacles to effective treatment and management of diabetes. This paper analyzes recent studies relevant to these challenges in anticipation of new research pertaining to this population. Although medication compliance is generally referred to as adherence, it is a complex concept and key challenge in diabetes care. Accordingly, this paper will further define adherence by describing its relevance in effective treatment and management. It will also analyze key theoretical perspectives in diabetes care, summarize recent research, and make recommendations for effective future research on the impact of diabetes education in Haitian Americans.

Social Cognitive and Planned Behavior Variables Associated With Stages of Change for Physical Activity in Spinal Cord Injury: A Multivariate Analysis

Purpose:To apply the constructs of social cognitive theory (SCT) and the theory of planned behavior (TPB) to understand the stages of change (SOC) for physical activities among individuals with a spinal cord injury (SCI).

Method:Ex post facto design using multivariate analysis of variance (MANOVA). The participants were 144 individuals with SCI who completed an online SCT, TPB, and SOC for physical activities survey.

Results:Participants in the preintender, intender, and actor groups differed significantly in functional disability, secondary health conditions, exercise self-efficacy, perceived benefits and barriers, intention, and physical health.

Conclusion:Findings support the concept of stage-matching exercise and physical activity cognitive behavioral interventions for people with SCI.

Applying the transtheoretical model to promote functional fitness of community older adults participating in elastic band exercises

AIMS

The transtheoretical model was applied to promote behavioural change and test the effects of a group senior elastic band exercise programme on the functional fitness of community older adults in the contemplation and preparation stages of behavioural change.

BACKGROUND

Forming regular exercise habits is challenging for older adults. The transtheoretical model emphasizes using different strategies in various stages to facilitate behavioural changes.

DESIGN

Quasi-experimental design with pre-test and post-tests on two groups.

METHODS

Six senior activity centres were randomly assigned to either the experimental or control group. The data were collected during 2011. A total of 199 participants were recruited and 169 participants completed the study (experimental group n = 84, control group n = 85). The elastic band exercises were performed for 40 minutes, three times per week for 6 months. The functional fitness of the participants was evaluated at baseline and at the third and sixth month of the intervention. Statistical analyses included a two-way mixed design analysis of variance, one-way repeated measures analysis of variance and an analysis of covariance.

RESULTS

All of the functional fitness indicators had significant changes at post-tests from pre-test in the experimental group. The experimental group had better performances than the control group in all of the functional fitness indicators after three months and 6 months of the senior elastic band exercises.

CONCLUSION

The exercise programme provided older adults with appropriate strategies for maintaining functional fitness, which improved significantly after the participants exercising regularly for 6 months.

Association of BID SNPs (rs8190315 and rs2072392) and clinical features of benign prostate hyperplasia in Korean population

Exercise has beneficial effect on cancer apoptosis and benign prostatic hyperplasia (BPH). The BH3 interacting domain death agonist (BID) gene expression is associated with apoptosis or cell proliferation. In this study, we investigated the association between BID single nucleotide polymorphisms (SNPs) and the development, prostate volume, and international prostate symptom score (IPSS) of BPH. In 222 BPH males and 214 controls, two SNPs in BID [rs8190315 (Ser56Gly), and rs2072392 (Asp106Asp)] were genotyped and analyzed using multiple logistic regression models. In the result, the genotype and allele frequencies of rs8190315 and rs2072392 were not associated with BPH development or IPSS, however, the allele frequencies [odd ratio (OR)= 1.90, 95% confidence interval (CI)= 1.07–3.41, P= 0.03] and genotype frequencies (in dominant model, OR= 1.94, 95% CI= 1.01–3.74, P= 0.42) of rs8190315, and the genotype frequencies of rs2072392 (in dominant model, OR= 1.94, 95% CI= 1.01–3.74, P= 0.42) were associated with increased prostate volume. We propose that rs8190315 and rs2072392 of BID may contribute to the disease severity of BPH.

Type 2 diabetes mellitus, physical activity, exercise self-efficacy, and body satisfaction. An application of the transtheoretical model in older adults

Physical activity (PA) is a relevant component of the treatment of Type 2 diabetes mellitus (T2DM). However, to prevent its related morbidities, PA requires an immediate and lasting change of lifestyle. Exercise self-efficacy and body satisfaction were used in a sample of older adults with T2DM, classified in different stages of change, to predict levels of PA. Results show that exercise self-efficacy increases linearly from precontemplation to maintenance stage, while body satisfaction shows an inverted U shape. However, only stages of change, other than exercise self-efficacy, add a significant and noticeable contribution to prediction of levels of PA. This evidence claims a tailored approach to PA in older adults with T2DM and advises behavioural health interventions based on exercise self-efficacy.

Effects of a dietary modification on 2 h postprandial blood glucose in Thai population at risk of type 2 diabetes: An application of the Stages of Change Model

The purpose of this study was to investigate the effect of a dietary modification intervention programme by applying the Stages of Change Model in 2 h postprandial capillary glucose reduction among Thai population. A randomized control trial was conducted for people at risk of type 2 diabetes for a period of 8 weeks. The intervention programme consisted of evaluating an individual's stage of change after being provided dietary information regarding kind of food and portions, discussion with a role model, and keeping a food diary record. By the end of the intervention programme, most participants in the experimental group were in the action stage (n = 36), whereas those in the control group were in the preparation stage (n = 32). Body mass index, blood pressure, food consumption behaviour and the 2 h postprandial blood glucose (PPG) in the experimental group had improved (P < 0.05). When performing regression analysis, intervention participation and the 2 h PPG at the baseline accounted for approximately 54% of total variance in predicting the 2 h PPG. This study yielded evidence for the benefits of using the Stages of Change Model as a framework in a dietary modification programme among people at risk of type 2 diabetes.

Targeting educational therapy for type 2 diabetes: identification of predictors of therapeutic success

Patient education is a key component of diabetes care. Limits in resources often prevent the participation of many patients with type 2 diabetes to structured education programs. The identification of predictors of response to group education could help in selecting those patients in whom the intervention is more cost-effective. A structured interactive group program was proposed to a consecutive series of 150 type 2 diabetes patients, who were then followed prospectively in 24 months, with measurements of HbA1c, BMI, quality of life, eating habits. For comparison, another consecutive series of 113 patients who had received no intervention was also observed for 12 months. A significant reduction in HbA1c was observed in the intervention group at 12 and 24 months (from 7.5 ± 1.4 to 6.9 ± 1.2 and 6.6 ± 1.1% at 12 and 24 months, respectively, both P < 0.01), with no variation in BMI and quality of life. A sustained reduction in total energy, protein, and fat intake was observed after education. The proportion of success (HbA1c < 7% and/or HbA1c reduction from baseline > 1%) in the intervention group was 60.7% (vs. 38.1% in controls) and 63.3% at 12 and 24 months, respectively. In the intervention group, patients with success at 12 months showed lower baseline HbA1c, BMI, duration of diabetes, protein, and cholesterol intake. Patients with a lower duration of diabetes appear to have a greater response to structured group education, whereas age is not a predictor of response. Therefore, educational intervention should be planned in the earlier phases of the disease.

'Small changes' to diet and physical activity behaviors for weight management

Obesity is associated with numerous short- and long-term health consequences. Low levels of physical activity and poor dietary habits are consistent with an increased risk of obesity in an obesogenic environment. Relatively little research has investigated associations between eating and activity behaviors by using a systems biology approach and by considering the dynamics of the energy balance concept. A significant body of research indicates that a small positive energy balance over time is sufficient to cause weight gain in many individuals. In contrast, small changes in nutrition and physical activity behaviors can prevent weight gain. In the context of weight management, it may be more feasible for most people to make small compared to large short-term changes in diet and activity. This paper presents a case for the use of small and incremental changes in diet and physical activity for improved weight management in the context of a toxic obesogenic environment.

Psychosocial predictors of four health-promoting behaviors for cancer prevention using the stage of change of Transtheoretical Model

OBJECTIVES

The present study aimed to examine whether demographic as well as psychosocial variables related to the five stages of change of the Transtheoretical Model can predict non-clinical adults' cancer preventive and health-promoting behaviors. This study specifically focused on cancer, one of the major chronic diseases, which is a serious threat of national health.

METHODS

A total of 1530 adults participated in the study and completed questionnaires. Collected data were analyzed by using multinominal logistic regression.

RESULTS

The significant predictors of later stages varied among the types of health-promoting behaviors. Certain cancer preventive health-promoting behaviors such as well-balanced diet and exercise were significantly associated with psychosocial variables including cancer prevention-related self-efficacy, personality traits, psychosocial stress, and social support. On the other hand, smoking cessation and moderate or abstinence from drinking were more likely to be predicted by demographic variables including sex and age.

CONCLUSIONS

The present study found that in addition to self-efficacy-a relatively well-studied psychological variable-other personality traits and psychological factors including introversion, neuroticism, psychosocial stress, and social support also significantly predicted later stages of change with respect to cancer preventive health-promoting behaviors. The implications of this study are also discussed.

Effects of targeted interventions on lifestyle modifications of chronic kidney disease patients: randomized controlled trial

Targeting interventions to an individual's readiness to modify lifestyle factors, specifically diet and exercise behaviors, may delay chronic kidney disease (CKD) progression. This study examined the effects of a targeted Lifestyle Modification Program based on the readiness to change health-promotion lifestyle behaviors, renal protection knowledge, and physical indicators of patients with early CKD. A repeated-measures design randomized 160 CKD patients from four southern Taiwan outpatient nephrology clinics into control and intervention groups. Data were collected five times over a year with a participant retention rate of 64.4%. The intervention group demonstrated significant improvement with regard to diet behavior modifications. Compared with the control group, the intervention group showed a significant improving trend of renal function protection knowledge, stress management, and interpersonal relations. Targeted interventions for patients in the early phases of CKD promotes adherence to proper diet, exercise behavior, and positive lifestyle modifications.

Development and formative evaluation of a web-based self-management exercise and diet intervention program with tailored motivation and action planning for cancer survivors

Background

Most dietary and exercise interventions developed to date for cancer survivors have employed intensive clinic-based face-to-face counseling sessions. However, when the clinic-based face-to-face intervention ends, the participants cannot receive feedback from the experts, and the motivation for regular exercise and diet practices decreases. One way to overcome the shortcomings of clinic-based face-to-face intervention is to employ the Internet to this end. To maximize effectiveness when providing Web-based interventions, action planning should be able to start at the right time, education should be tailored to motivational readiness, and self-efficacy should be enhanced at appropriate intervals.

Objective

The aim of this study was to develop a Web-based self-management diet and exercise intervention program with the aid of the transtheoretical model (TTM) and to conduct formative evaluations.

Methods

The Web-based self-management exercise and diet intervention program was developed employing a 5-phase system development life-cycle (SDLC) method. The 5 phases were 1) identification of user requirements, 2) system design, 3) system development, 4) system evaluation, and 5) system application. An expert group composed of 3 content experts, a Web developer, and 2 Web designers, evaluated the usability and accuracy of the content. The program was evaluated by 30 breast cancer survivors for perceived ease of use.

Results

The Web-based self-managed exercise and diet intervention program contained 5 components differing in screen layout. These components are introduction, assessment, education (tailored information provision), action planning (goal setting, scheduling, keeping a diary), and automatic feedback. Education, action planning, and automatic feedback were tailored to each participant through the assessment. The processes of change, self-efficacy, and decisional balance, which are the principal strategies encouraging behavioral change according to the TTM theory, were reflected in the education, and self-efficacy was also reflected in the automatic feedback. After iterative testing by experts on problems that arose in terms of usability and content accuracy during system operation, the perceived ease of use of the program was evaluated by 29 breast cancer survivors. The end users rated the program as being easy to understand and use (a total usability score of 81.3 points). In addition, program feasibility was evaluated using the percentage of patients (27/30, 90%) who consistently used the program.

Conclusions

The use of Internet technology allowed immediate and easy access to interventions, real-time monitoring of progress, online education, tailored action planning, and tailored short message services using mobile phones.

Changing physical activity behavior in type 2 diabetes: a systematic review and meta-analysis of behavioral interventions

OBJECTIVE

Behavioral interventions targeting "free-living" physical activity (PA) and exercise that produce long-term glycemic control in adults with type 2 diabetes are warranted. However, little is known about how clinical teams should support adults with type 2 diabetes to achieve and sustain a physically active lifestyle.

RESEARCH DESIGN AND METHODS

We conducted a systematic review of randomized controlled trials (RCTs) (published up to January 2012) to establish the effect of behavioral interventions (compared with usual care) on free-living PA/exercise, HbA(1c), and BMI in adults with type 2 diabetes. Study characteristics, methodological quality, practical strategies for increasing PA/exercise (taxonomy of behavior change techniques), and treatment fidelity strategies were captured using a data extraction form.

RESULTS

Seventeen RCTs fulfilled the review criteria. Behavioural interventions showed statistically significant increases in objective (standardized mean difference [SMD] 0.45, 95% CI 0.21-0.68) and self-reported PA/exercise (SMD 0.79, 95% CI 0.59-0.98) including clinically significant improvements in HbA(1c) (weighted mean difference [WMD] -0.32%, 95% CI -0.44% to -0.21%) and BMI (WMD -1.05 kg/m(2), 95% CI -1.31 to -0.80). Few studies provided details of treatment fidelity strategies to monitor/improve provider training. Intervention features (e.g., specific behavior change techniques, interventions underpinned by behavior change theories/models, and use of ≥10 behaviour change techniques) moderated effectiveness of behavioral interventions.

CONCLUSIONS

Behavioral interventions increased free-living PA/exercise and produced clinically significant improvements in long-term glucose control. Future studies should consider use of theory and multiple behavior change techniques associated with clinically significant improvements in HbA(1c), including structured training for care providers on the delivery of behavioural interventions.

Changing physical activity behavior in type 2 diabetes: a systematic review and meta-analysis of behavioral interventions

OBJECTIVE

Behavioral interventions targeting "free-living" physical activity (PA) and exercise that produce long-term glycemic control in adults with type 2 diabetes are warranted. However, little is known about how clinical teams should support adults with type 2 diabetes to achieve and sustain a physically active lifestyle.

RESEARCH DESIGN AND METHODS

We conducted a systematic review of randomized controlled trials (RCTs) (published up to January 2012) to establish the effect of behavioral interventions (compared with usual care) on free-living PA/exercise, HbA(1c), and BMI in adults with type 2 diabetes. Study characteristics, methodological quality, practical strategies for increasing PA/exercise (taxonomy of behavior change techniques), and treatment fidelity strategies were captured using a data extraction form.

RESULTS

Seventeen RCTs fulfilled the review criteria. Behavioural interventions showed statistically significant increases in objective (standardized mean difference [SMD] 0.45, 95% CI 0.21-0.68) and self-reported PA/exercise (SMD 0.79, 95% CI 0.59-0.98) including clinically significant improvements in HbA(1c) (weighted mean difference [WMD] -0.32%, 95% CI -0.44% to -0.21%) and BMI (WMD -1.05 kg/m(2), 95% CI -1.31 to -0.80). Few studies provided details of treatment fidelity strategies to monitor/improve provider training. Intervention features (e.g., specific behavior change techniques, interventions underpinned by behavior change theories/models, and use of ≥10 behaviour change techniques) moderated effectiveness of behavioral interventions.

CONCLUSIONS

Behavioral interventions increased free-living PA/exercise and produced clinically significant improvements in long-term glucose control. Future studies should consider use of theory and multiple behavior change techniques associated with clinically significant improvements in HbA(1c), including structured training for care providers on the delivery of behavioural interventions.

Effect of a Group Adherence Intervention for Mexican-American Older Adults With Type 2 Diabetes

OBJECTIVE. I evaluated the effect of a culturally tailored, peer-led support group intervention on improvement in adherence behaviors of Mexican-American older adults with type 2 diabetes mellitus and obtained feedback on the cultural relevance of the manual that structured the intervention.

METHOD. The one-group pretest–posttest design used five self-report questionnaires and blood testing to measure change among 4 men and 12 women, ages 60–85.

RESULTS. Empowerment, self-efficacy, and attitude were highly significant at 2-, 4-, and 6-mo posttests. Glycosylated hemoglobin test results were significant at p &lt; .05 between pretest and 2-mo posttest with a stabilizing effect on the 6-mo posttest.

CONCLUSION. Mexican-American older adults’ adherence may improve with a culturally sensitive, structured peer-led program with indirect consultation from an occupational therapist.

Increasing physical activity in Belgian type 2 diabetes patients: a three-arm randomized controlled trial

BACKGROUND

Pedometer-based physical activity programs have been typically delivered in a group format by a behavioral expert. An alternative strategy that builds on existing interactions is delivery through individual consultation by a general practitioner (GP). These two delivery strategies have not been directly compared.

PURPOSE

To compare effectiveness of a 12-week physical activity (PA) intervention for type 2 diabetes patients delivered by a trained GP via an individual consultation or as group delivery by a behavioral expert.

METHOD

Sixty-seven primary care participants (mean age = 67.4 years, 70% male) from three Belgian general practices were randomized into three different treatment arms: (1) individual consultation (n = 22) with three PA contacts with the patient's GP; (2) group counseling (n = 21) with three PA group sessions delivered by a behavioral expert; and (3) a control arm (n = 24) receiving no intervention. Participant inclusion criteria were ≤80 years; 25-35 kg/m²; ≤12% HbA1c and reporting no PA limitations. Outcome measures were pedometer-determined steps/day, self-reported PA, and health parameters (weight, body mass index, waist circumference, total cholesterol, fasting glucose, and HbA1c).

RESULTS

Group counseling participants increased 1,706 steps/day over baseline significantly (p ≤ 0.05) more than other treatment arms. Moreover, they increased their self-reported PA (+82 min/day), while control arm participants showed a decrease in PA (p ≤ 0.05). Participants of the individual consultation had a decrease in waist circumference (-1.4 cm) and HbA1c (-0.32%) and a lower increase in total cholesterol (+7.2 mg/dl) compared to the other treatment arms (all p ≤ 0.05).

CONCLUSION

Group counseling in type 2 diabetes patients improved PA, whereas individual consultations had an impact on some health outcomes on the short-term.

A culturally sensitive diabetes peer support for older Mexican-Americans

The purpose of this study was to determine if a peer-led diabetes support group intervention could improve adherence to recommendations for self-management in 42 Mexican-American elders with type 2 diabetes. This mixed-method pilot study occurred at a community-based diabetes education centre in Texas. The 10-week intervention programme was compared to usual care on five self-reported questionnaires and blood tests during four collection periods. Participants displayed statistically significant improvements in blood sugar, self-efficacy, transformational change and personal resources. Qualitative themes were derived from 30 focus group meetings, which were as follows: do not trust the system, choice + control = power and the social cost of diabetes. The results suggested a consultation role for occupational therapists in training peer leaders to learn to lead and manage community-based diabetes self-management programmes. Limitations were the sample size of the convenience sample, and the lack of qualitative analysis of the control group discussions. Future research should involve a study of expanded community-based social networks using experimental design.

A cross-sectional survey of self-perceived health status and metabolic control values in patients with type 2 diabetes

BACKGROUND

The prevalence of diabetes is increasing worldwide. Diabetes and other chronic disorders play an important role in how patients perceive their health status, this perception being an important component of general health.

OBJECTIVES

The purpose of this study is to determine self-perceived health status and metabolic control in patients with type 2 diabetes and to understand the relationship between perceived health status and metabolic control in diabetic participants.

DESIGN

This is a cross-sectional survey.

SETTING

The research population was diabetes sufferers registered with the Turkish Diabetes Society in Denizli Province, Turkey.

PARTICIPANTS

A convenience sample composed of 110 patients with type 2 diabetes mellitus.

METHODS

The research data were collected using three tools. The first of these was a "Socio-demographic Data Form" to gather information on the diabetes patients. The second was a survey on the patients' self-perceived health (how do rate your state of health in general) in which the patients were asked to rate their own health in one of five categories: very good, good, fair, bad and very bad. For the statistical analysis, the study group was divided into two groups: "good", consisting of those who classified their health as either very good or good; and "poor", those who gave other responses. The third type of data was collected by measuring metabolic control outcomes [glycosylated hemoglobin (HbA(1C)), fasting blood sugar (FBS), non-fasting blood sugar, total cholesterol, high-density lipoproteins (HDL) and triglycerides] for each participant.

RESULTS

Approximately half of the diabetic participants surveyed have poor self-perceived health. In terms of the values of HbA(1C), an important indicator of metabolic control levels, it was found that only 24.5% of the participants surveyed had good metabolic control. There was found to be a statistically significant difference between self-perceived health and levels of HbA(1C); 68% of participants who had high HbA(1C) values evaluated their health as good, whereas 63.9% of those who had poor HbA(1C) values evaluated their health as bad. Age, level of education, mode of treatment, adherence to treatment and level of exercise were factors that were found to have statistically significant differences from, and therefore an influence on, self-reported health.

CONCLUSION

When working with diabetes patients, as soon as the diagnosis has been made, it is recommended that information both on subjective perceptions of health and on perceptions of the illness (health perceptions, health beliefs related to the illness) are evaluated and objective data (metabolic control values) are gathered.

The effect of an internet-based, stage-matched message intervention on young Taiwanese women's physical activity

A web-based, stage-matched message intervention was designed in order to see the effect on the physical activity of young Taiwanese women with regard to several variables. The intervention was guided by the Transtheoretical Model (TTM) and was evaluated using a pre-post-test control group design. One hundred thirty female freshmen, enrolled in a nursing class in a university in Taipei, completed the survey at three different points in time. They were assigned to three groups: an experimental group with stage-matched messages on the website, a generic group with non-stage-matched messages on the website, and a control group that was given only lectures but had no access to the website. Results indicated that the subjects in the stage-matched group improved most in terms of stage-of-exercise and amount of physical activity, followed by the generic group at immediate post-test; meanwhile, the control group had a tendency toward downward change. The effect did not persist, however, for the first two groups. A significantly higher level of exercise self-efficacy was found in the stage-matched group than in the other two groups immediately after the intervention. The results suggested that a website conveying theory-based messages can serve as a useful tool for improving young females' physical activity and exercise self-efficacy. Additionally, we need research that explores different degrees and dimensions of tailoring in order to find the optimal degree of audience segmentation.

A randomized trial investigating the 12-month changes in physical activity and health outcomes following a physical activity consultation delivered by a person or in written form in Type 2 diabetes: Time2Act

BACKGROUND AND AIMS

Physical activity is a cornerstone of Type 2 diabetes management but is underutilized. Physical activity consultations increase physical activity in people with Type 2 diabetes but resources are often limited. Time2Act is a randomized control trial to study the 12-month effectiveness of a physical activity consultation delivered by a person or in written form, in contrast to standard care, for people with Type 2 diabetes.

METHODS

A total of 134 inactive people with Type 2 diabetes in a contemplation or preparation stage were randomized to either intervention or standard care. Objective (accelerometer) and subjective (7-day recall) physical activity levels were measured over 1 week, along with physiological [blood pressure, body mass index (BMI), waist circumference] and biochemical [glycated haemoglobin (HbA(1c)), total and high-density lipoprotein (HDL) cholesterol] measures at baseline, 6 and 12 months.

RESULTS

Neither a physical activity consultation delivered by a person nor in written form was better than standard care at increasing physical activity levels or improving health outcomes in the full study cohort. Total and HDL cholesterol, waist circumference and both systolic and diastolic blood pressure improved over 12 months in all groups, whilst HbA(1c) improved over 6 months. In a subgroup (baseline pedometer steps < 5000/day), the physical activity consultation delivered by a person significantly increased physical activity over 12 months and the standard care group significantly decreased.

CONCLUSIONS

More research is needed which not only investigates the most economical and effective methods to promote physical activity, but also the best setting to conduct physical activity consultations and the participant factors affecting uptake of physical activity in Type 2 diabetes.

A stage-matched intervention for exercise behavior change based on the transtheoretical model

The effectiveness of a stage-matched intervention for enhancing exercise behavior was investigated with related Transtheoretical Model constructs among young Korean adults. 265 university students (147 men, 118 women; M age=24.1 yr., SD=3.5) enrolled in Seoul National University of Technology voluntarily participated in an 8-wk. intervention study. In order to measure exercise behavior and its related psychological constructs, the Stages of Readiness for Exercise Behavior Scale, Decision Balance Scale for Exercise, Exercise Self-efficacy Scale, Processes of Change Scale, and Leisure Time Exercise Questionnaire were used. Results indicated that the participants' exercise readiness was significantly changed in a positive way after the 8-wk. intervention. There was a significant main effect of testing time and an interaction between testing time and exercise readiness stage at baseline. There were significant interactions between testing times and groups for all Transtheoretical Model measures, implying that the stage-matched intervention can be an effective tool for increasing exercise readiness and related psychological variables. The present study provides a starting point for stage-matched interventions aimed at increasing exercise levels, and a baseline level from which to evaluate interventions.

Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups

BACKGROUND

Ethnic minority groups in upper-middle and high income countries tend to be socio-economically disadvantaged and to have higher prevalence of type 2 diabetes than the majority population.

OBJECTIVES

To assess the effectiveness of culturally appropriate diabetes health education on important outcome measures in type 2 diabetes.

SEARCH STRATEGY

We searched the The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, ERIC, SIGLE and reference lists of articles. We also contacted authors in the field and handsearched commonly encountered journals.

SELECTION CRITERIA

RCTs of culturally appropriate diabetes health education for people over 16 years with type 2 diabetes mellitus from named ethnic minority groups resident in upper-middle or high income countries.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trial quality and extracted data. Where there were disagreements in selection of papers for inclusion, all four authors discussed the studies. We contacted study authors for additional information when data appeared to be missing or needed clarification.

MAIN RESULTS

Eleven trials involving 1603 people were included, with ten trials providing suitable data for entry into meta-analysis. Glycaemic control (HbA1c), showed an improvement following culturally appropriate health education at three months (weight mean difference (WMD) - 0.3%, 95% CI -0.6 to -0.01), and at six months (WMD -0.6%, 95% CI -0.9 to -0.4), compared with control groups who received 'usual care'. This effect was not significant at 12 months post intervention (WMD -0.1%, 95% CI -0.4 to 0.2). Knowledge scores also improved in the intervention groups at three months (standardised mean difference (SMD) 0.6, 95% CI 0.4 to 0.7), six months (SMD 0.5, 95% CI 0.3 to 0.7) and twelve months (SMD 0.4, 95% CI 0.1 to 0.6) post intervention. Other outcome measures both clinical (such as lipid levels, and blood pressure) and patient centred (quality of life measures, attitude scores and measures of patient empowerment and self-efficacy) showed no significant improvement compared with control groups.

AUTHORS' CONCLUSIONS

Culturally appropriate diabetes health education appears to have short term effects on glycaemic control and knowledge of diabetes and healthy lifestyles. None of the studies were long-term, and so clinically important long-term outcomes could not be studied. No studies included an economic analysis. The heterogeneity of studies made subgroup comparisons difficult to interpret with confidence. There is a need for long-term, standardised multi-centre RCTs that compare different types and intensities of culturally appropriate health education within defined ethnic minority groups.

Physical Activity Behavior Change Interventions Based on the Transtheoretical Model: A Systematic Review

This review critically examines Transtheoretical Model (TTM)—based interventions for physical activity (PA) behavior change. It has been suggested that the TTM may not be the most appropriate theoretical model for applications to PA behavior change. However, previous reviews have paid little or no attention to how accurately each intervention represents the TTM. Findings comprise two sections: sample characteristics of each intervention reviewed and a summary outlining the use of the TTM to develop the interventions. Results reveal numerous inconsistencies regarding the development and implementation/application of TTM-based interventions. Specifically, the majority of interventions reported to be based on the TTM fail to accurately represent all dimensions of the model. Therefore, until interventions are developed to accurately represent the TTM, the efficacy of these approaches and the appropriateness of the underpinning theoretical model cannot be determined.

Does the Transtheoretical Model (TTM) explain exercise behavior in a community-based sample of older women?

OBJECTIVE

To determine whether patterns of exercise adoption by older women would conform to the Transtheoretical Model (TTM) of behavior change.

METHODS

Participants were randomized into an exercise group (walk 30 minutes per day, 5 days per week, plus balance exercises twice per week) or attention control (health education on topics other than exercise). The intervention was conducted over 28 weeks with 1-year follow-up.

RESULTS

Participants included 272 sedentary women aged 70 and above. Exercise adoption was higher in the intervention group (83% vs. 17% among controls). After 1 year, 60% of the intervention group was in action or maintenance, compared to 16% of the control group. Self-efficacy following the intervention predicted long-term exercise adherence.

DISCUSSION

Few studies have addressed longitudinal analysis of the TTM for exercise adoption. Most constructs from the TTM were useful in explaining exercise adoption in older sedentary women.

Interventions for being active among individuals with diabetes: a systematic review of the literature

PURPOSE

The purpose of this systematic review is to assess and summarize evidence and gaps in the literature regarding the intervention for being active (exercise) among individuals with diabetes.

METHODS

Twelve electronic databases were searched. Publications eligible for inclusion specifically studied learning, behavioral, clinical, and humanistic outcomes for exercise interventions in adult patients with type 1 and type 2 diabetes.

RESULTS

Seven reviews (2 systematic reviews, 3 meta-analyses, 2 technical reviews) and 34 individual, nonreview studies (18 randomized controlled trials, 16 nonrandomized trials) met inclusion criteria. For type 2 diabetes, findings suggested that exercise had a positive effect on glycemic control and decreased cardiovascular risk, but the impact of exercise on behavioral and humanistic outcomes was unclear; long-term outcomes and adherence to exercise interventions is unknown because most studies were of short duration. The overall impact of varied types of exercise in type 1 diabetes was unclear, especially regarding glycemic control. Potential benefits of exercise in type 1 may include improved cardiovascular health.

CONCLUSION

The review did not identify specific successful intervention details because of the heterogeneity of studies, subjects, and research gaps. General findings suggest that physical activity is better than no exercise at all; intensive regimens, if tolerated by patients, achieved better clinical outcomes than less intensive regimens. Reviewed studies using structured exercise regimens exhibited a more significant impact on outcomes. Substantial gaps in the literature include studies measuring direct effects of exercise in the US minority populations most affected by type 2 diabetes and economic evaluations of exercise interventions. Interventions must be tailored to individual patient needs to succeed.

Physical activity consultation for people with Type 2 diabetes: evidence and guidelines

Physical activity is an important, but often underused, therapeutic strategy within diabetes care. To date, little is known about the best way to promote physical activity in diabetes care. Physical activity consultation is an intervention designed to promote physical activity behaviour change. This article provides guidelines on how to conduct a physical activity consultation with people who have Type 2 diabetes, and reviews the evidence surrounding the effectiveness of this intervention in this population. The trans-theoretical model is the underlying theory of behaviour change for the physical activity consultation intervention. The review identifies research which supports the use of this model for understanding physical activity behaviour in people with Type 2 diabetes. The review outlines a number of modifiable variables associated with physical activity behaviour change in this population. How each of these variables is addressed within the guidelines for conducting a physical activity consultation is identified. Finally, limited but consistent research highlights the effectiveness of physical activity consultation for promoting physical activity in people with Type 2 diabetes.

Validity and reliability study of the Turkish version of Health Belief Model Scale in diabetic patients

BACKGROUND

Diabetes mellitus (DM) is an important health problem that leads to severe complications, is the cause of early death, and is showing an increase in frequency. The development of positive health behaviors is extremely important in the treatment of diabetic patients. There are various models that examine the health behaviors of individuals. One of these is the Health Belief Model. This model is very beneficial in explaining factors that affect patients' compliance with their disease.

PURPOSE

This research was planned to measure the validity and reliability of the Health Belief Model Scale in diabetic patients in the Turkish population.

DESIGN

Questionnaire Survey.

SETTINGS

The research population was all of the diabetic patients (4,125) registered with the Turkish Diabetes Society, Denizli Province, Turkey.

PARTICIPANTS

A convenience sample was composed of 352 patients with Type 2 DM.

METHODS

The research data were collected with three tools, a "sociodemographic data form" related to the diabetic patients, the "Health Belief Model Scale in Diabetic Patients," and the "Diabetes Management Self-Efficacy Scale."For validity studies: language validity, content validity, concurrent validity and construct validity were examined. For reliability studies: the tool's internal consistency reliability, Cronbach alpha reliability coefficient, test-retest reliability were examined.

RESULTS

The tool's internal consistency reliability subscales' Cronbach alpha coefficient values ranged from 0.73 to 0.86. For the total tool a Cronbach alpha value of 0.89 was found. In the tool's internal consistency reliability total item correlation the three items that were below 0.30 were removed and the 36 items were reduced to 33 items. The tool's test-retest reliability was 0.90. According to factor analysis the tool contains five subscales of perceived susceptibility, perceived severity, perceived benefits, perceived barriers and recommended healthy behaviors.

CONCLUSION

The Health Belief Model Scale in diabetic patients was determined to be valid and reliable for use in the Turkish population.

Factors influencing disease self-management among veterans with diabetes and poor glycemic control

SPECIFIC AIM

Although the Department of Veterans Affairs (VA) has made significant organizational changes to improve diabetes care, diabetes self-management has received limited attention. The purpose of this study is to assess factors influencing diabetes self-management among veterans with poorly controlled diabetes.

METHODS

Surveys were mailed to patients with type 2 diabetes and a HbA1c of 8% or greater who attended 1 of 2 VA Medical Centers in Washington State (n = 1,286). Validated survey instruments assessed readiness to change, self-efficacy, provider advice, and diabetes self-care practices.

RESULTS

Our response rate was 56% (n = 717). Most respondents reported appropriate advice from physicians regarding physical activity, nutrition, and glucose monitoring (73%, 92%, and 98%, respectively), but many were not ready to change self-management behaviors. Forty-five percent reported non-adherence to medications, 42% ate a high-fat diet, and only 28% obtained either moderate or vigorous physical activity. The mean self-efficacy score for diabetes self-care was low and half of the sample reported readiness to change nutrition (52%) or physical activity (51%). Individuals with higher self-efficacy scores were more likely to adhere to medications, follow a diabetic meal plan, eat a lower fat diet, have higher levels of physical activity, and monitor their blood sugars (P < .001 for all).

CONCLUSIONS

Although veterans with poor diabetes control receive appropriate medical advice, many were not sufficiently confident or motivated to make and maintain self-management changes. Targeted patient-centered interventions may need to emphasize increasing self-efficacy and readiness to change to further improve VA diabetes outcomes.

Strategies to enhance compliance to physical activity for patients with insulin resistance

The evidence that physical activity is an effective therapeutic tool in the management of insulin resistance and type 2 diabetes is well documented. Limited research has addressed how best to promote and maintain physical activity in these individuals. This paper explores strategies to enhance compliance to physical activity for patients with insulin resistance. Several evidence-based guidelines and reviews recommend that physical activity interventions are based on a valid theoretical framework. However, there is no evidence-based consensus on the best theory or the combination of theories to use. Motivational tools such as pedometers, wearable sensors measuring energy expenditure, and point of choice prompts appear to be effective at stimulating short-term substantial increases in physical activity, but further strategies to maintain physical activity behaviour change are required. Physical activity consultation has demonstrated effective physical activity promotion over periods of up to 2 years in people with type 2 diabetes. Future research should identify the longer term effects of this intervention and the effectiveness of different methods of delivery. Overall, there needs to be a lot more focus on this area of research. Without this, the abundance of research investigating the effects of physical activity on people with insulin resistance and type 2 diabetes is essentially redundant.