A theory of planned behavior-enhanced intervention to promote health literacy and self-care behaviors of type 2 diabetic patients

Evaluation of a Family-Based, Health Literacy-Adapted Educational Intervention Program in Patients With Type 2 Diabetes Mellitus

Background Glycemic goals are linked to both health literacy (HL) and self-efficacy (SE) in type 2 diabetes mellitus (T2DM) management. This study aims to investigate the effectiveness of an HL-adapted educational intervention for patients with type T2DM at home in achieving glycemic control goals and improving HL and SE. Method This randomized controlled trial involved an intervention group and a control group, comprising random samples of 60 patients with T2DM monitored at the diabetes clinic and home care department of the Hospital of Drama, Drama, Greece. The intervention group participated in a structured home education program, while the control group continued to receive standard care during routine visits. All participants completed the following two scales at baseline, immediately post-intervention, and three months after intervention: the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) to measure HL and the Diabetes Management Self-Efficacy Scale (DMSES) to measure SE. Demographic characteristics, BMI, medical history, and glycemic control metrics, including HbA1c (A1C), fasting plasma glucose (FPG), and postprandial plasma glucose (PPG) were recorded. Results We approached 130 T2DM patients, of whom 120 participated (92.3% response rate), evenly split between intervention and control groups. The groups had similar baseline characteristics. Three months post-intervention, the intervention group showed significant improvements in glycemic control (A1C, FPG, PPG), weight, HL, and SE. The proportion of patients achieving glycemic goals increased substantially in the intervention group. SE fully mediated the relationship between HL and A1C immediately after the intervention. Overall, the intervention group demonstrated superior outcomes compared to the control group. Conclusion The findings confirm that family-based and HL-adapted intervention programs can effectively support the management of T2DM. Such interventions can help patients achieve glycemic control goals while enhancing HL and SE.

Knowledge, attitudes, and practices among patients with diabetes mellitus and hyperuricemia toward disease self-management

Background

This study aimed to assess the knowledge, attitudes and practices (KAP) among patients with diabetes mellitus and hyperuricemia toward disease self-management.

Methods

This web-based cross-sectional study was conducted between June 2023 and January 2024 at Heilongjiang Provincial Hospital. A self-designed questionnaire was developed to collect demographic information of patients with diabetes mellitus and hyperuricemia, and assess their knowledge, attitudes and practices toward disease self-management.

Results

A total of 482 participants were enrolled in this study, among them, 364 (75.52%) were male, 235 (48.76%) were aged between 40 and 59 years, 226 (46.89%) had a body mass index (BMI) ranging from 24 to 28 kg/m2, 337 (69.92%) had received a diagnosis of diabetes for a duration of 2 years or more, while 245 (50.83%) had been diagnosed with hyperuricemia for a similar duration. Their median (range) knowledge, attitude and practice scores were 10.00 (9.00, 11.00) (possible range: 0-12), 38.00 (36.00, 40.00) (possible range: 9-45), and 30.00 (26.00, 34.75) (possible range: 10-50), respectively. The path analysis demonstrated that knowledge had direct effects on attitude (β = 0.508, p < 0.001), and attitude had direct effects on practice (β = 0.448, p < 0.001). Additionally, there was an indirect effect of knowledge on practice mediated through attitude, with a path coefficient of 0.228 (p < 0.001).

Conclusion

This study demonstrates that patients with diabetes mellitus and hyperuricemia exhibit relatively proficient responses to certain items within the KAP dimensions. However, it also exposes a certain degree of inadequacy in the KAP level toward disease management. Interventions should focus on improving patients' understanding of their conditions while fostering positive attitudes, ultimately translating into better self-management practices.

Advances in stem cell therapy for diabetic foot

Diabetic Foot Ulcers (DFU) represent a grave complication often encountered in the advanced stages of diabetes mellitus. They frequently lead to recurrent hospitalizations and, in severe cases, can result in life-threatening conditions such as infections, gangrene, and even amputation Diabetic foot ulcers (DFU), as a serious complication in the late stage of diabetes mellitus, are prone to lead to repeated hospitalization, and in severe cases, infection, gangrene, and even amputation. Although there are many methods for treating diabetic foot, there is no clear and effective method to reduce the amputation rate of diabetic foot patients. In recent years, advancements in the understanding of stem cell therapy for the treatment of DFU have shed light on its potential as a novel therapeutic approach. In recent years, as the research on stem cell therapy for diabetic foot is gradually deepening, stem cells are expected to become a new therapeutic method for treating DFU in the future. Their therapeutic effects are through promoting angiogenesis, secreting paracrine factors, controlling inflammation, promoting collagen deposition, and regulating immunity, etc. Despite numerous studies confirming the efficacy of stem cell therapy in treating DFU, there is still a need for the establishment of standardized treatment protocols. Although numerous studies have shown that stem cell therapy for DFU is real and effective, there has not yet been a standardized treatment protocol. This article reviews studies related to stem cell therapy for DFU, looking at the mechanism of action, types of stem cells, and modes of administration.

The mediating effect of traditional Chinese medicine (TCM) health literacy between TCM culture promotion and residents' health status

Background

Traditional Chinese medicine (TCM) is a medical system with a long history and unique theories and techniques, playing a crucial role in maintaining and promoting human health. Disseminating TCM cultural knowledge is essential for enhancing the TCM health literacy and health status of people. This study aimed to investigate how TCM health literacy mediated the relationship between the TCM cultural ambiance and people's health status.

Methods

A multi-stage random sampling method was employed to select 22,125 permanent residents in Jiangsu Province for a survey aimed at examining the popularization of TCM culture. The survey categorized the intensity of TCM cultural ambiance into four grades (0-3) based on the promotion activities in various settings, including street/community, medical service institutions, and educational/work institutions. Furthermore, the survey evaluated TCM health literacy, overall health status, and prevalence of chronic diseases using the 2017 Chinese Citizens TCM Health Literacy Survey Questionnaire. The regression analysis was used to examine the correlation between the TCM cultural ambiance and TCM health literacy and health status. Also, a mediation model was applied to explore the mediating effect of TCM health literacy on the TCM cultural ambiance and the public's self-assessment of health and reporting of chronic diseases.

Results

The rate of popularization of TCM culture was 79.3% in Jiangsu Province, with a TCM health literacy level of 14.76%. The average score for public self-assessment of health was 37.80 ± 9.70, and the prevalence of chronic diseases was reported at 32.66%. A positive correlation was observed between cultural promotion ambiance and TCM health literacy. The impact of the cultural promotion ambiance on health literacy also increased with the increase in promotion grade (P < 0.001). The correlation analysis showed no statistically significant correlation of promotion grade 1 [β = 0.21, 95% confidence interval (CI): -0.26 to 0.67] with the health status of residents, whereas promotion grades 2 (β = 1.47, 95% CI: 1.12-1.83) and 3 (β = 4.61, 95% CI: 4.19-5.04) were positively correlated with self-health evaluation. TCM health literacy was positively correlated with self-health evaluation (β = 2.10, 95% CI: 1.72-2.48) and negatively correlated with the risk of chronic diseases (odds ratio = 0.53, 95% CI: 0.48-0.58). The analysis of the mediating effect revealed that the TCM cultural ambiance directly impacted self-health evaluation and the prevalence of chronic diseases, with coefficients of 1.131 and -0.027 (P < 0.001), respectively. TCM health literacy had a significant mediating effect on the relationship between the cultural promotion ambiance and self-health evaluation, as well as with the prevalence of chronic diseases (P < 0.001). The mediating effect accounted for 17.8% and 42.2% of the total effect, respectively.

Conclusions

TCM health literacy served as a mediating factor in the positive relationship between the TCM cultural ambiance and health status. Theoretically, it can improve the overall health of residents by intensifying the dissemination of TCM culture and enhancing their health literacy.

The effect of educational intervention based on the behavioral reasoning theory on self-management behaviors in type 2 diabetes patients: a randomized controlled trial

BACKGROUND

Diabetes self-management education is necessary to improve patient outcomes and reduce diabetes-related complications. According to the theory of behavioral reasoning, the likelihood of performing a behavior is predicted by the link between beliefs, motivation, intention, and behavior. This study aimed to investigate the effect of an educational intervention based on the Behavioral Reasoning Theory (BRT) on self-management behaviors in patients with Type 2 Diabetes.

METHODS

A randomized controlled trial based on BRT was conducted on 113 patients with type 2 diabetes, with a control group and an intervention group followed for 3and 6 months. Data were collected using a researcher-made demographic questionnaire based on the constructs of BRT and behaviors related to self-management in patients with type 2 diabetes. In the intervention group were provided, 8 sessions of diabetes self-management education based on BRT. The control group only received the usual training of the center. Data was analyzed using SPSS26 software.

RESULTS

After the educational interventions in the intervention group, there were statistically significant changes observed in the mean scores of all constructs, fasting blood sugar, and glycosylated hemoglobin. On the other hand, no statistically significant change was observed in the mean grades of the control group. All the observed changes were significant at the 0.05 level.

CONCLUSIONS

The results of this study were in favor of the effectiveness of an educational intervention that promotes diabetes self-management behaviors, using the principles of the behavioral reasoning theory. Which can be used in the design of health promotion programs for patients with diabetes.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT), IRCT20131014015015N21.

Effects of a Theory-Based Educational Program on Health Behaviors and Cardiovascular Health Outcomes Among Overweight Postmenopausal Women: A Randomized Controlled Trial

BACKGROUND

With the natural cessation of estrogen, after menopause, women, especially those who are overweight, are at a high risk for cardiovascular disease. Diet control and adequate physical activity (PA) are recommended as the essence of promoting cardiovascular health for women after menopause.

OBJECTIVE

The aim of this study was to examine the effects of a theory-based educational program on health behaviors and cardiovascular health outcomes among overweight postmenopausal Chinese women compared with conventional didactic education.

METHODS

In this randomized controlled trial, 288 participants were randomly allocated to intervention (n = 144) or control (n = 144) groups. The control group received conventional didactic education. The intervention group received a 3-month theory-based educational program. Primary outcomes were PA and dietary behavior. Secondary outcomes included cardiovascular health knowledge, self-efficacy in PA and diet, and cardiovascular health outcomes. Data were collected at baseline (T0), 3 months (T1), 6 months (T2), and 12 months (T3).

RESULTS

The intervention group demonstrated significantly greater improvements in PA, dietary behavior, self-efficacy in PA and diet, and several cardiovascular health outcomes (body weight, body mass index, waist circumference, blood pressure, and Framingham risk score [body mass index]) at postintervention compared with the control group (all P s < .05). These significant effects maintained at T2, and the effects on self-efficacy in PA and diet also were maintained at T3.

CONCLUSIONS

A theory-based educational program may be an effective strategy for improving PA, dietary behavior, self-efficacy in PA and diet, and several cardiovascular health outcomes for overweight postmenopausal Chinese women. However, further strategies are needed to enhance the sustainability of the positive changes.

Adherence to Self - Care Practice Among Type 2 Diabetes Mellitus Patients Using the Theory of Planned Behavior and Health Belief Model at Comprehensive Specialized Hospitals of Amhara Region, Ethiopia: Mixed Method

Background

Diabetes mellitus is one of the major public health problems that requires appropriate self-care practices to reduce complications. The current study assessed adherence to self-care practices and associated factors using the theory of planned behavior and the health belief model among type 2 diabetes mellitus patients.

Methods

A facility-based, sequential explanatory mixed-method was undertaken at comprehensive specialized hospitals in the Amhara region of Ethiopia. A single population proportion formula was used to calculate sample size. Proportional allocation to the three study settings and systematic random sampling techniques were used to select 846 study participants. Logistic regression analysis was used to identify associated factors. Variables with a P-value less than 0.05 were declared statistically significant. For the qualitative study, purposive sampling was used to select sixteen key informants, and thematic analysis was performed.

Results

About 42.4% of the study participants had good adherence to self-care practices. Being a member of a diabetes association (AOR = 2.57, 95% CI: 1.51, 4.38), having a home glucometer (AOR = 2.52, 95% CI: 1.59, 4.02), having good glycemic control (AOR = 4.07, 95% CI: 2.53, 6.53), having low perceived barriers (AOR = 8.65, 95% CI: 4.65, 16.07), and having middle perceived barriers (AOR = 3.26, 95% CI: 1.88, 5.66) were significantly associated with good adherence to self-care practice. On the other hand, poor wealth index (AOR = 0.27, 95% CI: 0.16, 0.46), poor behavioral control (AOR = 0.59, 95% CI: 0.36, 0.97), poor behavioral intention (AOR = 0.36, 95% CI: 0.21, 0.64), low perceived benefits (AOR = 0.20, 95% CI: 0.08, 0.51), and middle perceived benefits (AOR = 0.57, 95% CI: 0.31, 0.83) were significantly associated with poor adherence to self-care practice. The key informants explored the influence of patients' beliefs, self-efficacy, social support, and barriers on their self-care practices.

Conclusion

Less than half of type 2 diabetes mellitus patients had good adherence to self-care practices. This was more evident for patients who are members of a diabetes association, having a high wealth index, having a home glucometer, good behavioral control, good behavioral intentions, high perceived benefit, and poor perceived barriers. Appropriate intervention should be designed based on the aforementioned factors.

Factors affecting T2DM patients' behaviors associated with integrated treatment and prevention services in China

OBJECTIVE

To explore the relationship between type 2 diabetes mellitus (T2DM) patients' attitude, subjective norms (SN), perceived behavioral control (PBC), behavioral intention (BI) and behavior associated with integrated treatment and preventive (ITP) services.

METHODS

A convenient sampling method was employed at a community health center in Nanjing, China between January and July 2022. The collected data were processed using Epidata 3.1, SPSS 26.0, and AMOS 24.0. Descriptive statistics and a structural equation model based on the theory of planned behavior (TPB) were used to explore the correlation between the study variables.

RESULTS

430 participants were eventually included, with a response rate of 98.6%. The mean age was 72.50 ± 5.69 years. The TPB model proved to be suitable and explained 41% of the variance in the BI. Attitude (β = 0.289, P < 0.001), SN (β = 0.314, P < 0.001) and PBC (β = 0.261, P < 0.001) were the main predictors of BI, and the SN was the strongest. BI (β = 0.452, P < 0.001) and PBC (β = 0.452, P < 0.001) had similar direct effects on patients' behavior.

CONCLUSION

The TPB model explained the behavioral variations associated with ITP services and provided a framework for developing targeted interventions and improving community-based ITP services for T2DM. To encourage patients to engage in desirable behaviors, interventions should focus on modifying patients' SN towards behavior associated with ITP services by promoting peer pressure and increasing the family's emphasis on health.

Mesenchymal stem cell therapy for non-healing diabetic foot ulcer infection: New insight

Diabetic foot ulcer (DFU) is considered the most catastrophic complication of diabetes mellitus (DM), leading to repeated hospitalizations, infection, gangrene, and finally amputation of the limb. In patients suffering from diabetes mellitus, the wound-healing process is impaired due to various factors such as endothelial dysfunction and synthesis of advanced glycation end-products, hence, conventional therapeutic interventions might not be effective. With increasing therapeutic applications of mesenchymal stem cells (MSCs) in recent years, their potential as a method for improving the wound-healing process has gained remarkable attention. In this field, mesenchymal stem cells exert their beneficial effects through immunomodulation, differentiation into the essential cells at the site of ulcers, and promoting angiogenesis, among others. In this article, we review cellular and molecular pathways through which mesenchymal stem cell therapy reinforces the healing process in non-healing Diabetic foot ulcers.

The Effect of Health Literacy Intervention on Patients with Diabetes: A Systematic Review and Meta-Analysis

Relevant studies published between January 2010 and June 2021 were identified through relevant databases, including the Science Citation Index Expanded (SCIE) database of Web of Science, PubMed, and Embase, in order to assess the effect of health literacy (HL) intervention on patients with diabetes. A total of 21 articles were eligible. The results showed that: (1) this review involved different HL assessment tools, most of which were self-designed scales and assessment tools focused on measuring functional HL. (2) The differences in glycosylated hemoglobin (HbA1c) (weighted mean difference [WMD] = -0.78, 95% confidence interval [CI]: -0.94, -0.62) and medication adherence (standardized mean difference [SMD] = 1.85, 95% CI: 0.19, 3.52) between the HL intervention group and the usual care group were statistically significant. There was no significant improvement in systolic blood pressure (SMD = -0.05, 95% CI: -0.34, 0.25). Furthermore, this review reported that self-efficacy (SMD = 0.85, 95% CI: 0.65, 1.04) was increased, and the level of HL was improved. In the assessments of risk of bias, 90% of the studies were classified as medium. The quality of the evidence of medication adherence was very low, and the reliability of the conclusions was not enough to confirm the effect of HL.