Mediating role diet self-efficacy plays in the relationship between social support and diet self-management for patients with type 2 diabetes

Associations between disease acceptance and dietary adherence in patients with type 2 diabetes mellitus in China: a cross-sectional study

Studies on the correlation between dietary adherence in patients with Type 2 diabetes mellitus (T2DM) have focused on self-management, efficacy, and exercise. Limited empirical research on the impact of disease acceptance on dietary adherence. However, previous studies had shown that disease acceptance was an important factor influencing patients' self-management behavior, of which dietary management was a key component. Therefore, it is of great significance to explore the relationship between disease acceptance and dietary adherence for the later development of relevant measures to improve dietary adherence.

AIMS

The aim of this study was to investigate and report disease acceptance and diet adherence, as well as the factors that influenced diet adherence in patients with T2DM in China.

METHODS

A descriptive study including 230 patients with T2DM was conducted in China. General socio-demographic data questionnaires, the Acceptance of Illness Scale (AIS), and the Dietary Adherence Scale (DAS) were used to explore the disease acceptance, dietary adherence. Correlation analyses were performed to determine the relationship between disease acceptance and dietary adherence, and logistic regression analyses were performed to determine the factors that contributed to dietary adherence in patients with T2DM.

RESULTS

The mean score of disease acceptance was found to be (24.50 ± 7.34), and the mean score of dietary adherence was (78.79 ± 13.32). Correlation analysis indicated that disease acceptance was significantly and positively correlated with dietary adherence (r = 0.235, p ≤ 0.05). Further, regression analysis revealed that disease acceptance, gender, current treatment, and occupation were predictive of dietary adherence in patients with T2DM (R2 = 0.124, F = 16.233).

CONCLUSION

A greater acceptance of illness correlated with increased dietary adherence in patients with T2DM. Influences on dietary adherence were found to be multifaceted, encompassing socio-demographic data, disease-related factors, and disease acceptance. As such, targeted interventions may be enacted to enhance disease acceptance, thus improving the dietary adherence in patients with T2DM.

Factors influencing health-related quality of life among people with uncontrolled type II diabetes mellitus in Wenzhou, China: A cross-sectional study

Background

China has a high prevalence of Type 2 Diabetes Mellitus (T2DM), and more than half of the population has uncontrolled blood sugar levels. As a result, this leads to a reduction in health-related quality of life (HRQOL). Therefore, identifying the factors that influence HRQOL in individuals with uncontrolled T2DM is a clinical priority.

Objectives

This study aimed to describe the level of HRQOL among people with uncontrolled T2DM in Wenzhou, China, and to examine the predictive factors, including social support, diabetes distress, self-efficacy, and health literacy, in relation to HRQOL among these individuals.

Methods

This predictive correlational study used a simple random sampling technique to recruit 107 adults with uncontrolled T2DM from the Endocrinology outpatient department at the First Affiliated Hospital of Wenzhou Medical University in Wenzhou, China, between August and September 2024. Data were collected through questionnaires and standardized tools to assess the correlation between HRQOL, social support, health literacy, self-efficacy, and diabetes distress. Data were analyzed using descriptive statistics and multiple regression analysis.

Results

The HRQOL in this study was moderate (Mean = 3.34, SD = 0.31). Significant factors associated with HRQOL were health literacy (r = 0.819, p <0.01), self-efficacy (r = 0.825, p <0.01), and social support (r = 0.477, p <0.01). All predictor variables in the regression model collectively explained 79.8% of the variance in HRQOL among individuals with uncontrolled T2DM. Furthermore, health literacy (β = 0.426, p <0.001), self-efficacy (β = 0.463, p <0.001), and social support (β = 0.130, p = 0.009) were significant predictors of HRQOL.

Conclusion

Enhancing health literacy, self-efficacy, and social support is crucial for improving HRQOL. Healthcare professionals and nurses should develop and implement intervention programs that help individuals and families enhance their critical thinking abilities and adopt lifestyles that support disease management and improve HRQOL.

The Mediating Role of Patient Activation on the Relationship Between Social Support and Health-Promoting Behavior in Patients with Thyroid Cancer: A Cross-Sectional Study

Purpose

This study aimed to explore social support on health promotion behavior among patient with thyroid cancer and to investigate the mediating effect of patient activation in this relationship.

Participants and Methods

This study used a cross-sectional correlational design. A convenience sample of 618 thyroid cancer patients from two hospitals in Hunan Province, China, was included in the study. Data were collected from April to November 2023. The survey tools include: the General Information Questionnaire, Patient Activation Scale, Health Promoting Lifestyle Scale Chinese Revised Version, Social Support Rating Scale. Structural equation modeling and bootstrapping were used to analyze the mediating effect of patient activation on social support and health promotion behavior.

Results

Social support was positively correlated with health promotion behavior (r= 0.360, P<0.001), social support was positively correlated with patient activation (r=0.293, P<0.001), patient activation was positively correlated with health promotion behavior (r=0.541, P<0.001). Patient activation partially mediated the impact of social support and health promotion behavior, accounting for 33.03% of the total effect.

Conclusion

Thyroid cancer patients' health behavior need to be improved. Medical professionals ought to devise an intervention strategy based on pathways that influence health promotion behaviors among thyroid cancer patients. This approach aims to improve social support and patient activation, in order to promote the improvement of health promotion behavior, ultimately reducing the burden of medical care.

Enhancing self-care management among women with type 2 diabetes mellitus

Effective self-care management is essential for optimizing blood glucose control and preventing complications in patients with Type 2 Diabetes Mellitus (T2DM). This study explores the mediating roles of self-efficacy and illness perception in the relationship between social support and health literacy, with self-care management among women with T2DM. A cross-sectional study was conducted among 330 female patients recruited through multistage sampling from nine health clinics in Malaysia. Structural equation modeling (SEM) was used to analyze the relationships between these factors. The results showed that self-efficacy and illness perception significantly enhanced the influence of social support and health literacy on diabetes self-care management. During analysis, SEM model demonstrated a good fit (c2/df = 3.447, CFI = 0.932, TLI = 0.913, RMSEA = 0.086). Illness perception had the strongest direct effect on self-care management (standardized regression value = 0.69), followed by self-efficacy (standardized regression value = 0.31). These findings emphasize the need for targeted interventions in diabetes self-management programs, such as cognitive and behavioral strategies to improve self-efficacy; and patient-centered education to reshape illness perceptions. Integrating psychosocial support into diabetes care policies can also enhance self-care behaviors and improve health outcomes for women with T2DM, emphasizing the importance of a holistic approach in diabetes management.

Predicting dietary management intention of patients with chronic kidney disease using protection motivation theory

BACKGROUND

Psychological determinants underlying the dietary management intention (DMI) of Chinese patients with chronic kidney disease (CKD) are not well understood. This hinders the development of theory-informed dietary interventions targeting this population. The aim of this study was to identify factors influencing DMI of Chinese patients with CKD through the lens of Protection Motivation Theory (PMT).

METHODS

500 patients with CKD from a nephrology ward of a large teaching hospital in China completed a survey including measures of PMT constructs (i.e., perceived vulnerability, perceived severity, intrinsic and extrinsic rewards, self-efficacy, response efficacy, and response cost) using validated scales adapted from previous studies. Data were analyzed using confirmatory factor analysis and multiple linear regression.

RESULTS

Three PMT constructs, namely perceived severity [B = 0.198, P < 0.001], response efficacy [B = 0.331, P  < 0.001], and self-efficacy [B = 0.325, P  < 0.001], two demographic variables, namely single status [B = -0.180, P = 0.028] and education level [B = 0.080, P = 0.007], and a disease-related variable, namely CKD stage [B = .056, P = 0.001], predicted 39.3% of the variance of the CKD DMI. No significant effect on CKD DMI was observed for other predictor variables (P > 0.05).

CONCLUSIONS

Applying the PMT, significant predictors of DMI in Chinese patients with CKD were identified, which should be targeted in behavior change initiatives aimed at promoting dietary management.

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.

Mediating effect of dietary self-efficacy in the relationship between health literacy and nutrition label use among coronary heart disease patients

Nutrition label use among patients with coronary heart disease (CHD) is limited. This study aims to investigate the mediating effect of dietary self-efficacy on the relationship between health literacy and nutrition label use in CHD patients. This cross-sectional study recruited 350 CHD patients using convenience sampling from two hospitals in Changsha City. Data were collected using a general information questionnaire, the Newest Vital Sign Scale, the Cardiac Diet Self-efficacy Scale, and the Nutrition Label Use Questionnaire. SPSS 25.0 was used for Pearson correlation analysis and multiple linear regression analysis, while Model 4 in the SPSS macro program PROCESS was applied for mediation effect analysis. The results indicated health literacy and dietary self-efficacy were positively and significantly correlated with nutrition label use in CHD patients (P < 0.001). Bootstrap test results demonstrated that dietary self-efficacy partially mediated the relationship between health literacy and nutrition label use, with a mediation effect of 0.184 (95% CI: 0.144-0.225), accounting for 55.42% of the total effect. In conclusion, dietary self-efficacy mediates the relationship between health literacy and nutrition label use in CHD patients. Targeted interventions that address both health literacy and dietary self-efficacy are crucial for improving nutrition label use among CHD patients.

How to facilitate peer support - learnings from the development of a peer support program for people with T2DM via instant messaging service to improve diabetes self-management

This study explores the use of Instant Messaging Services (IMS) for peer support among individuals with Type 2 Diabetes Mellitus (T2DM). Leveraging the popularity of IMS within the affected age group, the DiabPeerS study implemented a peer support intervention aimed at improving long-term blood glucose levels (HbA1c) in a randomized controlled trial (RCT). This article describes the development and acceptance of the IMS intervention used in the DiabPeerS study. The intervention included a communication strategy and content designed for lay moderators to facilitate group interaction among people with Type 2 Diabetes mellitus (PWT2D). The intervention's acceptance was determined by conducting participant interviews, moderator meetings, and analysis of IMS chat protocols. Results indicate that the intervention was well-received, with participants engaging in meaningful exchange about diabetes self-management (DSM). However, those less familiar with online communication may benefit from preparational training and initial face-to-face meetings could enhance group cohesion. This research offers insights into the practical application of IMS for diabetes peer support, highlighting both its benefits and room for improvement.

Contribution of Disease-Specific Distress, Social Support, and Self-Efficacy to Diabetes Self-Management Behaviors in Saudi Adults: A Path Analysis

Purpose

Disease-specific distress, social support, and self-efficacy have noticeable impacts on diabetes self-management. Although these three concepts are connected, their interplay and subsequent influence on diabetes self-management warrants further research.

Patients and Methods

A total of 154 individuals with type 2 diabetes mellitus were recruited to complete a survey, which included questions related to social support, diabetes self-efficacy, diabetes self-management behaviors, and disease-specific stress. The variables were examined with path analysis using Analysis of Moment Structures (AMOS) software.

Results

In the final model, diabetes self-efficacy was a significant predictor of increased diabetes self-management behaviors. Lower levels of disease-specific distress were associated with higher levels of self-efficacy. Path analysis indicated that the direct effect of social support on diabetes self-management behaviors was significant, and social support indirectly affected diabetes self-management behaviors through the mediating effect of diabetes self-efficacy. Overall, the study findings indicate that social support can exert an impact on diabetes self-management behaviors through the mediating effect of diabetes self-efficacy.

Conclusion

The study's findings support the use of Individual and Family Self-Management Theory to improve diabetes self-management. Further research is needed to better understand how factors related to the family support system influence diabetes self-management behaviors.

Examining the Relationship Between Social Support, Self-Efficacy, Diabetes Self-Management, and Quality of Life Among Rural Individuals With Type 2 Diabetes in Eastern China: Path Analytical Approach

BACKGROUND

Patients with type 2 diabetes (T2D) in rural China frequently exhibit inadequate diabetes self-management (DSM) and a reduced quality of life (QoL). Social support and self-efficacy are known to influence DSM and QoL. However, the pathways through which social support and self-efficacy impact DSM and QoL among patients with T2D in rural China has yet to be fully elucidated.

OBJECTIVE

This study offers a foundation for developing policies in rural chronic disease management, thereby, contributing to the improvement of T2D prevention and control in China and other transitional countries.

METHODS

This study used a cross-sectional design, collecting data from a survey conducted between May and July 2021 on DSM and QoL among rural patients diagnosed with T2D in 2 townships in East China. All patients with T2D were enrolled through cluster sampling from the township health center database, and a questionnaire survey was administered by investigators. Structural equation modeling and multiple regression analyses were used to explore the pathways through which social support influences DSM and QoL, as well as the mediating role of self-efficacy.

RESULTS

It was found that the DSM score (mean 37.42, SD 7.70) was less than half of the maximum theoretical score. The QoL score (mean 48.92, SD 8.88) accounted for 36% of the maximum theoretical score. Social support directly and positively affected the DSM and QoL of Chinese rural patients with T2D (P<.01); an increase of 1 unit in social support was associated with a direct increment of 0.339 units in DSM and 0.397 units in QoL. Self-efficacy played a positive mediating role (P<.01), further increasing DSM and QoL by 0.147 and 0.159 units, respectively. The mediating effect of self-efficacy accounted for 30.2% and 28.6% of the total effect of social support on DSM and QoL. Furthermore, the family and friend dimension of social support, along with the symptom and disease management dimensions of self-efficacy, were significantly associated with DSM or QoL (P<.01).

CONCLUSIONS

The study confirmed the direct and indirect influences of social support on DSM and QoL and elucidated the mediating effect of self-efficacy among rural patients with T2D in eastern China. Interventions should be developed to enhance both social support and self-efficacy, creating a positive cycle of mutual reinforcement to improve DSM and QoL among this group.

Unraveling the role of social support in eating behavior among children and adolescents in Shanghai, China: exploring the mediating role of self-efficacy and the moderating influence of BMI and weight concern

Objective

This study explores the intricate relationship between social support and eating behaviors in children and adolescents, considering the mediating role of eating self-efficacy and the moderating effects of body mass index (BMI) and weight concern.

Methods

Data from 1986 primary and secondary school students aged 8 to 17 in Shanghai, China, were analyzed using moderated mediation analysis.

Results

The results demonstrate a robust positive association between social support and eating self-efficacy, particularly prominent among individuals with low BMI (effect = 0.506, 95% CI [0.376, 0.636]). Moreover, the study highlights that eating behavior is influenced not only by eating self-control (β = -0.054, 95% CI [-0.062, -0.046]) but also by the interaction term between individuals' perceptions of their body weight (β = -0.0008, 95% CI [-0.0015, -0.0001]).

Conclusion

Eating self-efficacy serves as a mediator in the relationship between social support and eating behavior, modulated by BMI and weight concern. Importantly, high weight concern significantly strengthens the mediating effect of eating self-efficacy on the relationship between social support and eating behavior, regardless of BMI.

Predictors of Diabetes Self-Management Behaviour Among Type 2 Diabetics in Saudi Arabia: A Cross-Sectional Study

Background

Type 2 Diabetes Mellitus (T2DM) requires effective self-care behaviors and social support to manage the condition and prevent complications. This study aimed to examine the influence of demographic characteristics and perceived social support on diabetes self-management behaviors in individuals with T2DM.

Methods

An analytical cross-sectional design was employed to collect data from 300 T2DM patients using validated questionnaires from April to May 2023. Self-care behaviors were assessed using a Summary of Diabetes Self-Care Activities-Arabic (SDSCA-Arabic), while perceived social support was measured using a Diabetes Care Profile (DCP) using an Arabic Social Support subscale. Descriptive statistics, correlation analysis, and regression analysis were performed to examine the relationships and predictors of self-care behaviors.

Results

Patients exhibited varying levels of self-care behaviors, with exercise and blood sugar testing being the most frequently reported activities. Additionally, the findings revealed that health education on self-examining regarding the feet, exercising, comorbidities, perceived social support, medical insurance, and gender were significant predictors of diabetes self-management behaviors. These factors collectively accounted for 21.2% of the variance in self-management behavior levels. Specifically, health education on self-examining regarding the feet (β = -0.286, p = 0.001) and exercising (β = -0.175, p = 0.001) showed a negative association, while perceived social support (β = 0.235, p = 0.001) demonstrated a positive association with self-management behaviors.

Conclusion

The study highlights the importance of comprehensive health education programs that address multiple aspects of diabetes management and the role of social support in fostering better self-management behaviors. It also emphasizes the influence of demographic factors on self-management, with individuals with higher comorbidities exhibiting better self-management behaviors and those with medical insurance showing poorer self-management behaviors. These findings have implications for nursing practice, suggesting the need for tailored interventions, effective education, and support networks to enhance self-management behaviors in T2DM patients.

The mediating role of diabetes stigma and self-efficacy in relieving diabetes distress among patients with type 2 diabetes mellitus: a multicenter cross-sectional study

Background

Patients with diabetes mellitus often suffer from diabetes distress. Social support and certain psychological factors potentially influence diabetes distress, but studies exploring the mechanisms underlying these relationships are scarce.

Objectives

To reveal the associations between social support, diabetes stigma, diabetes self-efficacy, and diabetes distress among patients with type 2 diabetes and the underlying mechanisms linking these variables.

Design and methods

A multicenter cross-sectional study was adopted and a sample of 431 patients with type 2 diabetes was investigated. Social support, diabetes stigma, diabetes self-efficacy, and diabetes distress were surveyed with the Perceived Social Support Scale, Type 2 Diabetes Stigma Assessment Scale, Self-Efficacy for Diabetes Scale, and Diabetes Distress Scale, respectively. The hypothesized model was verified using structural equation modeling.

Results

Social support and diabetes stigma had direct associations with diabetes distress. Diabetes stigma mediated the association between social support and diabetes distress, and the association between diabetes self-efficacy and diabetes distress. Diabetes stigma and self-efficacy exerted a chain mediation effect on the association between social support and diabetes distress.

Conclusion

Social support and diabetes stigma were significant predictors of diabetes distress. Diabetes stigma and self-efficacy play essential mediating roles in relieving diabetes distress. This can provide guidance for the development of evidence- and theory-based interventions. Culturally sensitive interventions that aim to provide ongoing social support, decrease diabetes stigma, and enhance self-efficacy have the potential to relieve diabetes distress.

Effect of solution-focused approach on anxiety and depression in patients with rheumatoid arthritis: A quasi-experimental study

Introduction

Anxiety and depression are common psychological problems in rheumatoid arthritis (RA) patients. However, few effective nursing intervention models have been designed specifically to improve anxiety and depression in RA patients. Solution-focused approach (SFA) is an effective intervention method for psychosocial issues. There have been no studies involving SFA yet in RA patients. This study investigated the effects of SFA-based nursing intervention on anxiety and depression in RA patients.

Methods

A quasi-experimental study using a convenience sampling of RA patients was conducted. The 48 RA patients were divided into the control group (n = 24) and the experimental group (n = 24). The control group received routine nursing intervention, while the experimental group received SFA-based nursing intervention. The scores on the self-rating anxiety scale (SAS), self-rating depression scale (SDS), arthritis self-efficacy scale-8 (ASES-8), and questionnaire on patient satisfaction with nursing care were collected before and after nursing interventions.

Results

Between-Group Comparison: Before the nursing intervention, there was no statistically significant difference in the SDS, SAS, and ASES-8 scores between the two groups (p > 0.05). However, after the nursing intervention, the SDS and SAS scores of the experimental group were statistically significantly lower than those of the control group (p < 0.05). In contrast, the ASES-8 score of the experimental group was statistically significantly higher than that of the control group (p < 0.05). In addition, patient satisfaction with nursing care of the experimental group was better than that of the control group (p > 0.05). Within-Group Comparison: There was no statistically significant difference in the SDS, SAS, and ASES-8 scores in the control group before and after routine nursing intervention (p > 0.05). However, in the experimental group, the SDS and SAS scores before SFA-based nursing intervention were statistically significantly higher than those after SFA nursing intervention (p < 0.05), and the ASES-8 score before SFA-based nursing intervention was considerably lower than that after SFA nursing intervention (p < 0.05).

Discussion

SFA-based nursing intervention can effectively improve anxiety, depression, and arthritis self-efficacy of RA patients. This study broadens clinical psychological nursing intervention models for RA patients. SFA may be an effective nursing model for various psychosocial problems in the current medical context.

Patients' and family members' knowledge, attitudes and perceived family support for SMBG in type 2 diabetes: a fuzzy-set qualitative comparative analysis

AIMS AND OBJECTIVES

To examine the combined effects of the patient's and family members' knowledge, attitudes and perceived family support on self-monitoring of blood glucose (SMBG) behaviour of patients with type 2 diabetes.

DESIGN

A cross-sectional design using the framework of knowledge-attitude-behaviour (KAB) combined with family support.

SETTING

Shanghai, China.

PARTICIPANTS

Seventy type 2 diabetes patient-family member dyads recruited from 26 residential committees in Shanghai were investigated. Twenty-three health providers were interviewed.

PRIMARY OUTCOME MEASURES

The knowledge, attitudes and perceived family support of patients' and their family members' data were measured through scales. Combined effects were analysed by a fuzzy-set qualitative comparative analysis (fsQCA) using fsQCA V.3.0. Other analyses and calculations were performed by STATA V.14.0.

RESULTS

SMBG was very poor (20%), and behaviour was characterised by 'multiple complications,' and 'all paths lead to the same destination' for patients. There were two solution paths toward patients' SMBG (solution coverage=0.4239, solution consistency=0.7604). One path was the combination of 'patients with low risk perception, the patients' and family members' perceived negative support', the other was the combination of 'patients with high risk perception, the patients' perceived negative support'. In both paths, basic knowledge serves as an auxiliary condition.

CONCLUSION

The study revealed that for patients with high and low risk perceptions that are relatively difficult to change, we could strengthen family support to achieve the desired SMBG behaviour. Knowledge is not a prerequisite to achieving SMBG. Moreover, negative family support plays a crucial role. Perceived family support by patients is more important than perceived family support by family members, which suggests that family members should improve support for patients so that the patients can perceive more family support.

Perceived facilitators and barriers to healthy dietary behaviour in adults with type 2 diabetes mellitus in Kenya: A qualitative study

OBJECTIVE

This study aimed to explore the facilitators and barriers to healthy dietary behaviour in adults with type 2 diabetes mellitus (T2DM) in Kenya.

DESIGN

A qualitative descriptive design using telephone interviews was applied. An interview guide was developed through a modified theoretical framework.

SETTING

This study was conducted in selected hospitals in Nakuru County, located in west-central Kenya.

PARTICIPANTS

A two-step sampling strategy was used to select hospitals and study participants. Adult participants aged 30 to 85 years old, with T2DM from six hospitals were selected based on their ability to openly elaborate on the theme of dietary behaviour.

RESULTS

Thirty respondents were interviewed (mean age 62 years; 43.3% females). The average duration of the interviews was 32:02 minutes (SD 17.07). The highest-ranking internal facilitators of healthy dietary behaviour were knowledge of healthy food choices, gardening, self-efficacy, food preparation skills and eating at home. External facilitators included inaccurate beliefs and information on food and diet, education by healthcare workers, food availability, proximity to food selling points and family support. Internal barriers included tastes and preferences, health conditions barring intake of certain foods, and random eating of unhealthy foods. External barriers included socioeconomic factors, seasonal unavailability of fruits and food safety concerns.

CONCLUSIONS

Facilitators and barriers to healthy dietary behaviour among Kenyan adults with T2DM are related to food literacy and include selection, preparation and eating. Interventions to enhance healthy dietary behaviour should target context-specific knowledge, skills and self-efficacy.

Effects of sociodemographic and health factors on the self-management of non-communicable diseases among Chilean adults during the Covid-19 pandemic

Individuals with non-communicable diseases (NCDs) are potentially at increased vulnerability during the Covid-19 pandemic and require additional help to reduce risk. Self-management is one effective strategy and this study investigated the effect of sociodemographic and health factors on the self-management of some non-communicable diseases, namely hypertension, type 2 diabetes mellitus and dyslipidemia, among Chilean adults during the Covid-19 pandemic. A cross-sectional telephone survey was carried out on 910 participants with NCDs, from Santiago, Chile. An adapted and validated version of the "Partners in Health" scale was used to measure self-management. Exploratory Factor analysis yielded five dimensions of this scale: Disease Knowledge, Healthcare Team Relationship, General Self-Management and Daily Routines, Drug Access and Intake, and Monitoring and Decision-Making. The average of these dimensions was calculated to create a new variable Self-Management Mean, which was used as a dependent variable together with the five separate dimensions. Independent variables included age, gender, years of schooling, number of diseases, the percentage of Multidimensional Poverty Index in the commune of residence, and self-rated health status. Beta regressions and ANOVA for the Beta regression residuals were utilized for analyses. Beta regression model explained 8.1% of the variance in Self-Management Mean. Age, years of schooling, number of diseases and self-rated health status were statistically associated with Self-Management Mean and dimensions related to daily routines and health decision making, such as Disease Knowledge, General Self-Management and Daily Routines, and Monitoring and Decision-Making. Gender and the percentage of Multidimensional Poverty Index in the commune of residence were insignificant. Strategies for self-management of NCDs during a crisis should consider age, years of schooling, number of diseases, and self-rated health status in their design.

Health Action Process Approach (HAPA) as a Framework to Understand Compliance Issues With Health Protocols Among People Undergoing Isolation at Emergency Hospital for COVID-19 Wisma Atlet Kemayoran and RSCM Kiara Ultimate Jakarta Indonesia

INTRODUCTION

This study aims to identify the psychosocial determinants and examine the mediation mechanisms of the compliance with COVID-19 health protocols among people undergoing isolation in health facilities that specifically treat COVID-19 cases in Jakarta, Indonesia.

METHODS

This is a cross-sectional study which used socio-cognitive approach, known as the Health Action Process Approach (HAPA), to understand the complexity of issues related to compliance with health protocols. A total of 1,584 subjects participated in this study, including 865 men and 719 women over the age of 18 years old during the data collection period (October 19-26, 2020). The data were collected using questionnaire that was developed by a team of experts from the Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, and survivors. The data that has been collected were then analyzed using Structural Equation Modeling, a multivariate data analysis technique.

RESULTS

The final research model in this study fulfills the criteria for a good model fit. This study found that individuals who have strong self-efficacy regarding their ability to implement behaviors and overcome obstacles will have stronger intent to comply in the future. The study also found that stronger intent will lead to stronger planning, and planning was found mediating intention and compliance with health protocols.

CONCLUSION

This research model is comprehensive and useful in understanding compliance with health protocols among people undergoing isolation in health facilities for COVID-19 (Wisma Atlet and RSCM Kiara Ultimate). Having intent (related to the risk perception, outcome expectancies, and self-efficacy) and having a plan can positively influence the behavior of people undergoing isolation, resulting in better compliance to health protocols. The understanding gained from this study can be used to improve strategies related to compliance with health protocols against COVID-19 in the communities.

Discriminating Low to High Adherent Type 2 Patients with Diabetes by Glycosylated Hemoglobin A1c, Eating Self-Efficacy and Other Psychosocial Determinants: Difference Between Patient and Physician Adherence Models

OBJECTIVE

Develop individual discriminant models using clinical and psychosocial variables for physicians and patients with diabetes based on their perceptions of patient adherence.

METHODS

This was a cross-sectional research design utilizing a discriminant analysis approach. Type 2 patients on treatment for diabetes for at least 2 years prior to research were selected. Clinical data were obtained from patient records, and psychosocial variables were collected by survey instruments filled out by patients. A final sample of 200 patients was recruited.

RESULTS

We found a positive correlation between patient and physician assessment of patient adherence behaviors. Greater adherence efforts were associated with lower HbA1c. Better quality of the patient-physician relationship was linked to better patient adherence. Increased HbA1c, longer therapy duration and higher BMI described low patient adherence for physicians. Lower HbA1c, female gender and fewer difficulties in marital adjustment characterized high adherence for patients. Dietary self-efficacy as well as emotional and social isolation discriminated mid-level adherers in both models.

CONCLUSION

This research confirmed that patients and physicians perceived and judged patients' adherence behaviors differently. Physicians and patients associated different clinical and psychological factors with low and high adherence. Further research is recommended to clarify how the quality of the physician-patient as well as the patient-spouse relationship affect dietary efficacy and patient adherence. A randomized, controlled clinical trial approach is recommended to establish the effectiveness of interventions aiming to improve dietary self-efficacy on adherence outcomes.

Exploring the Role of Social Support between Discharge Teaching and Readiness for Discharge in Ocular Fundus Disease Patients: A Cross-Sectional Study

Background

This study aims to evaluate the quality of discharge teaching and readiness for discharge of fundus disease patients treated with day surgery and understand the role of social support between them.

Methods

This was a cross-sectional descriptive correlational survey. Through convenient sampling, fundus disease patients treated with day surgery from Zhongshan Ophthalmic Center, China, were recruited. Data were collected using demographic and disease-related information, quality of discharge teaching scale, readiness for hospital discharge scale, and social support scale.

Results

255 fundus disease patients treated with day surgery were recruited at last. The mean total score of readiness for discharge, quality of discharge teaching, and social support in patients with fundus disease were 157.91 (SD = 26.68), 122.97 (SD = 21.55), and 36.32 (SD = 7.60), respectively. Participants with stronger social support had better discharge teaching and then had higher readiness for discharge. Social support played a partial mediator role in the relationship between discharge teaching and readiness for discharge. The mediation effect ratio was 5.5%.

Conclusions

The quality of discharge teaching and social support among fundus disease patients who underwent day surgery was relatively high, and readiness for discharge was good. Social support is essential for the quality of discharge teaching and the improvement of discharge readiness. Clinical nurses need to provide appropriate guidelines to help patients seek effective support and improve quality of discharge teaching to enhance the readiness for discharge of fundus disease patients treated with day surgery.