Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy?

Non-adherence to diabetes microvascular complications follow-up screening in the primary care population: Predictors, associated barriers, and facilitators

AIMS

We determined the rates, predictors, and barriers/facilitators of non-adherence to annual follow-up screenings for Diabetic Retinopathy (DR), nephropathy (DN) and foot complications (DFC) screening in primary care patients with type 2 diabetes.

METHODS

This prospective, mixed-method, clinical study, included 934 patients (mean ± SD age 60.4 ± 9.4 years, 46.9 % women) who underwent DR/DN/DFC screenings (N = 2012 appointments). Logistic regression analysis determined the baseline predictors of non-adherence to follow-up screening (failure to attend annual follow-up screening within ± 4 months). Qualitative interviews on barriers/facilitators of screening adherence were conducted with 36/24 non-adherent/adherent patients and 9 healthcare professionals (HCPs).

RESULTS

Non-adherence rates to DR, DFC and DN follow-up screening were 27.6 % (n = 186), 29.8 % (n = 225) and 12.7 % (n = 74), respectively. Predictors included higher total cholesterol (DR); poor self-rated Diabetes Control (DN); and higher satisfaction with diabetes support (DFC and DN). Better self-efficacy was protective (DFC). Poor HCP-patient communication and long waiting times were patient-reported barriers to adherence, while knowledge about benefits of diabetes complications screening was a facilitator. Time constraints prevented HCPs from reinforcing the importance of screening to patients.

CONCLUSIONS

Non-adherence to diabetic microvascular complications follow-up screening was suboptimal in Singapore and driven by multi-faceted predictors and barriers. Targeted interventions are needed to improve follow-up screening adherence.

Psychosocial predictors of diabetes self-efficacy in young adults with youth-onset type 2 diabetes

The aim of this study was to identify psychosocial factors associated with, and predictive of, diabetes self-efficacy (DSE) in young adults with youth-onset type 2 diabetes (T2D), a vulnerable, understudied group. In this observational, longitudinal study (T1 = baseline, T2 = 1 year later), 348 participants in the TODAY2 multi-center study of youth-onset T2D, completed valid measures of: diabetes self-efficacy, beliefs about medicines, depression and anxiety symptoms, diabetes distress, attitudes, self-management support, and need insecurities. Multivariable logistic regression models evaluated independent associations of each psychosocial factor with the likelihood of being in the high/low DSE tertile groups. Multivariable linear regression models assessed associations with DSE as a continuous variable. Participants' mean age was 26 years, 67.9% were women, mean diabetes duration was 12.4 years, with mean of 2.5 diabetes-related complications. Greater self-care support increased the odds of high DSE at T2. Beliefs that medicines are overused, moderate-to-severe depressive or anxiety symptoms, and unmet material needs, decreased the odds of high DSE at T2. More support, fewer depressive and anxiety symptoms, and fewer unmet material needs at T1 predicted T2 DSE scores. Cognitions (beliefs that medicines are overused), emotions (depressive/anxiety symptoms), and social factors (self-management support, unmet material needs), were significant longitudinal predictors of DSE in young adults with youth-onset T2D. These potentially modifiable factors should be considered when screening for, and designing, interventions to enhance DSE, to improve health behaviors and forestall the development of complications in this at-risk group.

Psychological Flexibility and Diabetes Self-Management: The Mediating Roles of Depressive Symptoms and Self-Efficacy

BACKGROUND

Psychological flexibility is the concept and focus of Acceptance and Commitment Therapy. It has been demonstrated to benefit self-efficacy and depressive symptoms. However, its role in diabetes self-management (DSM) and the potential mechanisms remain unknown.

PURPOSE

This study aimed to investigate the association between psychological flexibility and self-management and to explore the mediating effect of depressive symptoms and self-efficacy among people with diabetes in China.

METHODS

Using a cross-sectional study design, 249 people with type 2 diabetes in China were recruited from February 1, 2024, to April 30, 2024, and completed a structured online questionnaire.

RESULTS

Psychological flexibility and DSM showed a moderate correlation (r = 0.45, P < .001). Path analysis showed significant associations between the 3 subscales of psychological flexibility and depressive symptoms and self-efficacy. In addition, depressive symptoms partially mediated the relationship between the valued action subscale of psychological flexibility and DSM, while the mediation role of self-efficacy was not significant.

CONCLUSIONS

The findings highlight the potential mechanisms of how higher levels of psychological flexibility may affect depressive symptoms reduction and self-management promotion. Acceptance and Commitment Therapy that particularly aims to enhance valued action may be effective for alleviating depressive symptoms and enhancing self-management.

Understanding the Roles of Fatalism and Self-Efficacy on Clinical and Behavioral Outcomes for African American with Type 2 Diabetes: A Systematic Review

PURPOSE OF REVIEW

To evaluate the evidence on the relationship between fatalism, self-efficacy, and clinical and behavioral diabetes outcomes among African American adults with type 2 diabetes and to recommend areas for future work.

RECENT FINDINGS

Evidence suggests that psychosocial factors including fatalism and self-efficacy are essential for optimizing diabetes outcomes and may be important considerations for reducing health disparities in type 2 diabetes. A reproducible search using OVID Medline, PubMed, and EBSCOHost was conducted from database creation up to February 2025. Medical Subject Heading terms and key words representing fatalism, self-efficacy, and diabetes were used. Outcomes included: hemoglobin A1c, LDL, Blood Pressure, Self-Care, and Quality of Life. A total of 17 studies were identified, 5 examining fatalism and 12 examining self-efficacy. All 5 fatalism studies demonstrated that fatalism is statistically significantly related to self-care behaviors and HbA1c, however this relationship may be impacted by other psychosocial and social risk factors. Among the self-efficacy studies, 11 demonstrated statistically significant relationships between self-efficacy and one or more clinical and behavioral outcomes including HbA1c, diet, physical activity, medication adherence, blood glucose testing, and quality of life. All studies were cross-sectional analyses. Given the small number of studies focused on fatalism and the largely correlational results for self-efficacy, there is a need for more targeted research to understand contributors to and moderators of the influence of the factors on outcomes.

Assessment of self-efficacy, quality of life, and well-being of patients with diabetes mellitus in Alqunfudah, Saudi Arabia

BACKGROUND

Patients with diabetes mellitus (DM) often experience psychological challenges, such as feelings of loss of control, self-care stress, and fear of complications. This study aimed to assess the prevalence of uncontrolled DM, self-efficacy, quality of life (QoL), and well-being among patients with DM in Alqunfudah, Saudi Arabia, and to investigate the associations between these factors and diabetes control.

METHODS

A cross-sectional study employing an online questionnaire was conducted among adults with DM. The questionnaire assessed demographic characteristics, diabetes-related history, and glycemic control based on glycated hemoglobin A1c (HbA1c) level. Self-efficacy was evaluated using the validated Arabic version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale, and the Arabic version of the World Health Organization Quality of Life Brief Version was utilized to assess QoL. Well-being was measured using the Arabic version of the World Health Organization-Five Well-being Index (WHO-5).

RESULTS

Four hundred patients with diabetes were included with a mean age of 49.3 ± 14.6 years, 40.8% were males, and 49.25% had uncontrolled DM. Compared to the controlled group, the uncontrolled group had a lower percentage of patients living in urban areas (16.8% vs. 25.6%, p = 0.037), a larger proportion of participants having DM for > 10 years (42.6% vs. 26.6%, p < 0.001), lower median (interquartile [IQR]) self-efficacy score [39.0 (30.0-46.0) vs. 47.0 (34.0-54.0), p < 0.001], lower physical QoL [75.0(60.7-85.7) vs. 67.8 (50.0-82.1), p < 0.001], and lower environmental QoL [(78.1(62.5-87.5) vs. 68.7(59.3-84.3), p = 0.005]. Predictors of glycemic control included the physical domain of QoL [adjusted odd ratio (aOR) = 1.02 (95% CI: 1.01-1.03), p < 0.001] duration of DM for 1-2 years [aOR = 2.53 (95% CI: 1.08-5.91), p= 0.032], 3-5 years [aOR = 3.76 (95% CI: 1.90-7.43), p< 0.001 ], and 6-10 years [aOR = 1.85 (95% CI: 1.04-3.32), p = 0.036], and urban residence [aOR = 1.88 (95% CI: 1.11-3.18), p = 0.017].

CONCLUSIONS

A large sector of patients with diabetes had uncontrolled blood sugar with greater affection of QoL and self-efficacy compared to the controlled group. Physical QoL, duration of DM, and residence were the key factors to be targeted for improved diabetes management.

Beyond Compliance: The Role of Self-Efficacy in Foot Care and Self-Management Among Patients With Type 1 Diabetes

Background: Effective self-management behaviors are crucial for diabetes management. This study examines the mediating role of self-efficacy in the relationship between compliance dimensions and self-management activities in patients with Type 1 diabetes. Methods: The current study explores a baseline analysis from a randomized controlled trial but the intervention's effectiveness is not reported here; the analysis focuses on elucidating potential mediating factors at baseline. The study investigated the relationships between seven compliance dimensions (treatment effort, intention, adaptability, integration, adherence, commitment, and indecisiveness) and six self-management activities (diet, exercise, smoking cessation, blood sugar monitoring, and foot care) through the potential mechanism of self-efficacy. Results: The analysis revealed an indirect association between three compliance dimensions (treatment effort, intention, and commitment) and foot care behavior, mediated by self-efficacy. Additionally, self-efficacy was identified as an indirect mechanism influencing the association between commitment and adaptability with dietary behaviors. Conclusions: This study highlights the importance of self-efficacy in promoting self-management behaviors in chronic conditions. By targeting specific compliance dimensions that influence self-efficacy, healthcare professionals can potentially improve patient self-management. Trial Registration: Iranian Registry of Clinical Trials number: IRCT20221029056335N1.

Health literacy and medication adherence in adults from ethnic minority backgrounds with Type 2 Diabetes Mellitus: a systematic review

BACKGROUND

For people living with Type 2 Diabetes Mellitus (T2DM), achieving optimal health outcomes requires optimal self-management and adherence to medical treatment. While some studies suggest an association between poor medication adherence and lower levels of health literacy, the evidence for this association remains inconclusive. This systematic review aimed to synthesise the evidence on the association between health literacy and medication adherence among adults from ethnic minority backgrounds living with T2DM.

METHODS

Medline (Ovid), The Cochrane Library, Embase (Ovid), PsycInfo (EBSCO), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO) were searched systematically for peer-reviewed literature, published until January 2024. Studies were included in this review if they assessed health literacy and medication adherence among ethnic minority people with T2DM. Two reviewers independently screened and selected the studies, extracted data from the included articles, and assessed the methodological quality of the studies. The methodological quality and bias in designing, conducting, and analysis of each study were evaluated using a standardised JBI critical appraisal tool.

RESULTS

Of the total 6,318 identified studies, seven studies were included in the review. The total participant sample sizes across these studies varied from 53 to 408 participants. All included studies incorporated cross-sectional design for the research, with the majority conducted in the USA. Of the seven unique studies, only one study observed a significant association between health literacy and medication adherence among people from an ethnic minority background.

CONCLUSIONS

Evidence on the association between health literacy and medication adherence in ethnic minority adults with T2DM is weak and inconsistent. To understand this association more clearly in ethnic minority populations and to address the disparities in cultural and linguistic considerations, well-designed studies are required.

TRIAL REGISTRATION

This review is registered with PROSPERO (CRD42022328346).

Behavioral and Psychosocial Dynamics in Diabetes Management: A Path Analysis to Examine the Influence of Acculturation in Arab Immigrant Communities

BACKGROUND

Type 2 diabetes mellitus (T2DM) prevalence is rising globally. Arab immigrants with T2DM, one of the least studied ethnic minorities, have a higher diabetes prevalence and more prominent management-related challenges compared with mainstream host societies. Acculturation's impact on self-care activities and diabetes distress (DD) is understudied globally.

PURPOSE

To examine how acculturation affects self-care practices and DD in first-generation Arab immigrants with T2DM and how health literacy, illness perceptions, and self-efficacy mediate these associations.

METHODS

This multicenter cross-sectional study was conducted in Victoria, Australia. Eligible patients were invited while waiting for their appointments. The questionnaire included validated tools to assess DD, self-care activities, health literacy, self-efficacy, and acculturation. We tested mediation hypothesis using path analysis, with a maximum likelihood estimation to calculate total, direct, and indirect effects and bias-corrected accelerated 95% CI.

RESULTS

Overall, 382 Arab immigrants with T2DM participated, with an average age of 57.9 years (SD = 8.0). Half were males, most had low education, and were married. Participants lived in Australia for a mean of 19.1 years (SD = 8.3) and had diabetes for 7.1 years (SD =4.7). Higher acculturation was directly associated with decreased DD. Illness perceptions (p = .002) and self-efficacy (p = .001) mediated the association of acculturation with self-care activities, while health literacy did not. Additionally, self-efficacy fully mediated the relationship between acculturation and DD (p = .001).

CONCLUSIONS

This research provided valuable insights into the complex interplay between acculturation, diabetes management, and psychosocial factors. Interventions targeting self-efficacy and illness perceptions may improve self-care activities and reduce DD among Arab immigrants with T2DM.

Bridging health self-efficacy and patient engagement with patient-centered culturally sensitive health care for Black American adults

This study investigates whether systems-level interventions, specifically patient-centered culturally sensitive health care (PC-CSHC) from healthcare providers, office staff, and the clinic environment, moderate the relationship between health self-efficacy and patient engagement among Black American adults. An online survey was completed by 198 Black American adults. PC-CSHC from healthcare providers, office staff, and the clinic environment did not mitigate the adverse effects of low health self-efficacy on patient engagement. However, PC-CSHC from healthcare providers (b = 0.38) was as significant as health self-efficacy (b = 0.37) in predicting patient engagement, R2 = 0.47, F(9, 177) = 19.61, p < 0.001. Provider-delivered PC-CSHC can enhance patient engagement among Black American adults. This systems-level approach has the potential to reach more patients than intrapersonal interventions alone and alleviates the undue burden placed on Black Americans to leverage intrapersonal strengths in the face of health disparities rooted in structural racism.

Impacts of Diabetes Self-Management Education and Support Programs in Hispanic Church Settings: A Cluster-Randomized Trial Comparing Faith-Based and Faith-Placed Approaches

Background/Objectives: This study aimed to adapt evidence-based diabetes self-management education and support (DSMES) into a faith-based (FB) context for Hispanic communities and compare its effectiveness to a faith-placed (FP) approach using the church as a venue for DSMES delivery. Methods: A cluster-randomized trial was conducted among adults with type 2 diabetes from predominantly Hispanic churches. The churches were assigned to either the FB Group (nine churches, n = 146) or the FP Group (seven churches, n = 125). The FB Group, led by trained lay health leaders, received a health sermon, a six-session DSMES program, and a seven-session Healthy Bible Study. The FP Group, led by outside health professionals, received the same six-session DSMES and a seven-session partial attention control curriculum. Key outcomes, including hemoglobin A1c (HbA1c), waist circumference (WC), diabetes distress, self-care activities, and self-efficacy, were assessed at baseline, 6, 9, and 12 months. Results: The FB Group had lower HbA1c levels than the FP Group at 6 months (-0.3%, p < 0.01), with no within-group differences post-intervention. No significant between-group differences were found for other outcomes. Within-group comparisons from baseline showed that both groups reduced WC at 9 and 12 months. Both groups showed reductions in diabetes distress and increased self-efficacy at all time points post-intervention (p < 0.05). The FB Group increased self-care scores at all time points post-intervention, while the FP Group increased at 9 and 12 months. Conclusions: DSMES can be effectively delivered in church settings by trained lay leaders or health professionals in Hispanic communities. Adding a spiritual dimension to DSMES may enhance outcomes.

Evaluation of the mediating role of physical activity self-efficacy in the relationship between knowledge, social support, and physical activity in pregnant women with a high risk for gestational diabetes

OBJECTIVE

This study aimed to examine the associations between knowledge, social support, and physical activity and explore the mediating role of physical activity self-efficacy in pregnant women with a high risk for gestational diabetes mellitus (GDM).

METHODS

A cross-sectional study was conducted in Guangzhou, China, from July 2022 to May 2023. Five hundred thirty-seven pregnant women with a high risk for GDM completed the Pregnancy Physical Activity Questionnaire, Pregnancy Physical Activity Self-Efficacy Scale, Pregnancy Physical Activity Knowledge Scale, Physical Activity Social Support Scale, and a socio-demographic data sheet. The mediation effect was tested using structural equation modeling (SEM) and the bootstrap method.

RESULTS

42.5% of pregnant women did not meet the current physical activity guidelines. Physical activity self-efficacy (β, 0.16; P<0.001), knowledge (β, 0.15; P = 0.001), social support (β, 0.10; P = 0.019), education, and type of conception were predictors of physical activity. The SEM results found that physical activity self-efficacy mediated the association between physical activity and knowledge (β, 0.24; 95% CI, 0.17 to 0.32) and social support (β, 0.30; 95% CI, 0.20 to 0.39). The data fit of the model (RMSEA = 0.067, CFI = 0.851, TLI = 0.828, χ2/df = 3.440) was acceptable.

CONCLUSION

This study found that the prevalence of being physically inactive was high in pregnant women with a high risk for GDM. The present study's findings suggested that healthcare providers should try to enhance physical activity self-efficacy, knowledge, and social support of pregnant women with a high risk for GDM to improve their physical activity with a focus on physical activity self-efficacy.

An Examination of the Self-Efficacy and Factors Influencing Foot Care Behaviors in Individuals with Type 2 Diabetes Mellitus

The present descriptive study investigates the general and foot-care self-efficacy and the level of foot-care knowledge of 151 participants who presented to the internal medicine ward and diabetes nursing unit of a training and research hospital in Türkiye. The mean Diabetes Management Self-Efficacy Scale score of the participants was 69.0 ± 15.0 (min: 20, max: 100), the mean Diabetic Foot Care Self-Efficacy Scale score was 56.2 ± 23.1 (min: 9, max: 90) and the mean Diabetes Foot Self-Care Behavior Scale score was 51.5 ± 13.6 (min: 15, max: 75). The total Diabetes Management Self-Efficacy Scale, Diabetic Foot Care Self-Efficacy Scale and Diabetes Foot Self-Care Behavior Scale scores were noted to be higher in the participants who underwent regular health check-ups and used their medication regularly than in those who did not (p < 0.05). People with diabetes should be provided with counseling on the benefits of developing positive behaviors related to self-efficacy and foot self-care, and the prevention of wound development through education, support and the effective self-management of their condition.

A short tool to screen self-care preparedness: cross-sectional study in general practice

BACKGROUND

Self-care is crucial in the prevention and treatment of chronic diseases. It is important to identify patients who need support with self-care.

OBJECTIVES

This study introduces a self-care preparedness index (SCPI) and examines its associations with health-related quality of life (HRQoL) and other outcomes.

METHODS

A cross-sectional study of adults (n = 301) with hypertension, coronary artery disease, or diabetes in primary health care. Based on the self-care questionnaire, SCPI was formed. A higher SCPI value indicated better self-care preparedness. We examined correlations and a hypothesis of linearity between SCPI and HRQoL (15D), depressive symptoms (BDI), patient activation (PAM), and health-related outcomes (self-rated health, life satisfaction, physical activity, body mass index [BMI], waist, low-density lipoprotein). Exploratory factor analysis was used to test the construct validity of SCPI.

RESULTS

A total of 293 patients with a mean age of 68 (54.3% women) were included in the analysis. BDI, BMI, and waist had a negative linear trend with SCPI. Self-rated health, physical activity, patient activity, and life satisfaction had a positive linear trend with SCPI. SCPI correlated with HRQoL (r = 0.31 [95% CI: 0.20 to 0.41]). Exploratory factor analysis of the SCPI scores revealed 3 factors explaining 82% of the total variance.

CONCLUSIONS

SCPI seems to identify individuals with different levels of preparedness in self-care. This provides means for health care providers to individualize the levels of support and counselling. SCPI seems to be a promising tool in primary health care but needs further validation before use in large scale trials or clinical practice.

Culturally Congruent Latino-Adapted Telemonitoring of Underrepresented Adults With Type 2 Diabetes: The CULTURA-DM2 Trial

This study reports on the development and testing of a comprehensive diabetes telemonitoring program tailored to meet the needs of underserved Hispanic/Latino patients with diabetes. Individuals participating in the culturally tailored program had significantly better 6-month outcomes than those receiving comprehensive outpatient management for A1C, blood pressure, and diabetes self-efficacy, with no differences between groups in quality of life, medication adherence, emotional functioning, patient activation, or unscheduled physician visits. These findings suggest that culturally congruent diabetes telemonitoring may be effective for this underserved population.

Factors affecting the quality of life in pregnant women with diabetes: the mediating effect of illnesses acceptance

INTRODUCTION

Gestational diabetes, as a disorder of carbohydrate metabolism, is considered one of the most common metabolic complications in pregnancy. The diagnosis of diabetes in pregnancy leads to changes in lifestyle, and the treatments employed can affect various aspects of pregnant women's lives, including their quality of life. The present study aimed to investigate the relationship between self-efficacy and the mediating effect of illness acceptance on the quality of life in pregnant women diagnosed with diabetes during pregnancy.

MATERIALS AND METHODS

This cross-sectional study was conducted on 240 pregnant women diagnosed with diabetes who were selected by convenience sampling method. Quality of life tools (SF12), the Acceptance of Illness Scale (AIS), and the Sherer self-efficacy scale were used to collect data.

RESULTS

The mean (SD) of quality of life, self-efficacy, and disease acceptance were 57.36 (6.63), 51.75 (7.44), and 29.07 (7.69), respectively. In the single-variable regression analysis, self-efficacy and disease acceptance variables could predict 20.6% (β = 0.457, P < 0.001) and 14.4% (β = 0.385, P < 0.001) of the variations in quality of life, respectively. In the multiple regression model, by entering the two main variables (self-efficacy and Acceptance of Illness), demographic characteristics, three disease knowledge variables, health status from an individual perspective, and type of treatment, the variables could explain 25% of the changes of the quality of life (R2adj 0.25, P < 0.001=). Income status and self-efficacy had the highest impact among the variables. According to the results of path analysis, the total effect of self-efficacy on the quality of life of pregnant women with diabetes was 0.711.

CONCLUSION

The overall quality of life in women with diabetes was moderate, and self-efficacy, illness acceptance, and income status were predictors of overall quality of life. Self-efficacy can influence the quality of life by affecting disease acceptance. The findings highlight the importance of designing educational programs and providing midwifery services to increase self-efficacy and illness acceptance to improve the quality of life of pregnant women with diabetes.

Effectiveness of a health literacy intervention to improve diabetes outcomes in rural family medicine clinics: a randomized pragmatic trial

Background

Adults with diabetes mellitus (DM) living in rural areas often face limited access to medical and specialist care, minimal exposure to diabetes education, and transportation challenges. Rural residents also tend to be older, poorer, less educated, under-insured and have lower health literacy compared to their urban counterparts.

Aims

We tested the effectiveness of the American College of Physicians (ACP) diabetes health literacy intervention in rural community clinics to improve a range of diabetes-related patient outcomes and determine whether the intervention reduces disparities by health literacy.

Methods

We recruited 756 English-speaking adults with uncontrolled Type 2 DM from rural clinics in Arkansas. Trained health coaches reviewed the ACP Diabetes Guide and conducted counseling and action-planning monthly to participants randomized to the intervention. The enhanced usual care (EUC) arm received an American Diabetes Association workbook and was followed as usual. Interviews were conducted at baseline, 3 and 6 months, and clinical outcomes, including hemoglobin A1C and blood pressure values, were extracted from charts through 12 months post-baseline. Health literacy was measured at baseline using the Newest Vital Sign (NVS). Our primary outcome was A1C at 6 months, with other clinical values and self-reported diabetes-related knowledge, self-efficacy, distress, and self-care behaviors examined as secondary outcomes.

Results

Participants had a mean age of 55.8 (SD=11.7), 68% were female, two-thirds had an annual household income <$15,000, and 52% had limited health literacy. Overall, the intervention had little effect on outcomes at 6 and 12 months, including our primary outcome of A1C at 6 months (Intervention Least Squared Means (LSM) 8.28, 95% CI 8.11, 8.46; EUC LSM 8.44, 95% CI 8.26, 8.61). Diabetes knowledge was greater in those with adequate (LSM 9.46, 95% CI 9.25, 9.67) compared to those with limited health literacy (LSM 8.11, 95% CI 7.91, 8.23, p<0.001) at baseline. This disparity remained in the EUC arm after 6 months but disparities were mitigated in the intervention arm (interaction p<0.001).

Discussion

Our intensive intervention was well received, but insufficient to improve outcomes. Strategies may need to attend to other barriers faced by rural patients beyond health literacy to improve health behaviors and outcomes.

Self-efficacy of PLHIV for self-management at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: a cross-sectional study

BACKGROUND

Self-efficacy is the ability to execute, and it is a critical predictor of health-related outcomes among people living with human immunodeficiency virus (PLHIV). Self-efficacy directly determines treatment outcome. However, there is no evidence on the self-efficacy of PLHIV for self-management in Ethiopia. Currently, HIV is considered a manageable chronic disease. However, the burden remains high despite all the taken measures.

OBJECTIVES

This study aimed to assess the self-efficacy of PLHIV for self-management at the University of Gondar Comprehensive Specialized Hospital (UOGCSH), northwest Ethiopia, 2022.

METHODS

A cross-sectional study was conducted on PLHIV selected by a systematic random sampling technique using an interviewer-administered questionnaire at the UOGCSH from August 10 to September 30, 2022. The data was entered and analyzed using the Statically Package for Social Science version 25.0. Categorical variables were summarized as frequency (percentage) of the total. Both descriptive and inferential statistics, such as the Kruskal-Wallis H test and Mann-Whitney U test were performed to detect difference. P-value < 0.05 was considered to indicate statistically significance.

RESULTS

Overall, 405 PLHIV participated in the study, giving a 96% response rate. The overall median (Interquartile range) self-efficacy score of PLHIV for self-management was 22 (4) and 67.4% of the PLHIV self-efficacy score was above the median. A statistically significant difference was detected between the social support groups (χ2 (2) = 37.17, p < 0.0001), education background (U = 10,347, Z = 2.279, P = 0.023, r = 0.113), living conditions (U = 12,338, Z = 2.457, P = 0.014, r = 0.122) and medication adherence (U = 9516.5, Z = 3.699, P < 0.0001, r = 0.184).

CONCLUSION

Most participants' self-efficacy score was above the median. Statistically significant differences in self-efficacy were observed based on individual, environmental, and clinical factors. We suggest training and workshops for healthcare workers and the hospital and adherence support groups should work to improve the self-efficacy of PLHIV.

Living with type 2 diabetes: A social cognitive perspective on adherence

OBJECTIVE

This mixed methods study examines the relationship between outcome expectations, self-efficacy, and self-care behaviors in individuals with type 2 diabetes (T2DM). It also explores the personal values motivating these behaviors through in-depth interviews.

METHODS

Adults with T2DM (n = 108, M age = 57 years, 58% female, 48% Black) completed questionnaires and participated in in-depth interviews using a laddering technique.

RESULTS

Ordinary least squares regression models were used to analyze the relationships between self-efficacy, outcome expectations, and four self-care behaviors (physical activity, dietary choices, blood glucose monitoring, and medication usage). The findings indicate that self-efficacy is significantly and positively associated with diet and physical activity. Both outcome expectations for blood glucose testing and self-efficacy are significantly and positively associated with self-reported monitoring. However, neither outcome expectation nor self-efficacy is associated with medication usage. The in-depth interviews revealed three common values related to self-care behaviors: maintaining health and longevity, agentic values of self-control, achievement, and self-esteem, and a sense of belonging.

CONCLUSIONS

This study sheds light on the complexity of diabetes self-management, offering insights into individuals' values, behavioral strategies, and the influence of control perceptions on this relationship, revealing both differences and commonalities in stated values.

PRACTICE IMPLICATIONS

By understanding how personal values drive diabetes self-care behaviors, practitioners can assist patients in establishing meaningful connections between their values and the challenges of living with diabetes.

Exploring the self-efficacy of patients with diabetes: its role as a predictor of diabetes management and well-being

Background

Self-efficacy is a popular psychological concept that refers to an individual's perception or belief in his ability to perform specific actions. This study aimed to assess the predictive value of self-efficacy, measured using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEM6S) questionnaire, for diabetes management and overall well-being in patients with diabetes.

Subject and methods

An anonymous online cross-sectional study was conducted to evaluate the self-efficacy of diabetic patients in the Asser region of Saudi Arabia. The participants were requested to upload their most recent glycated hemoglobin A1C (HbA1C) measurements taken in the last three months, which helped in the accurate categorization of their diabetes as either controlled or uncontrolled. We used the valid Arabic version of the SEM6S and WHO-5 well-being questionnaires to assess patient self-efficacy and well-being.

Results

A cohort of 342 patients was enrolled in the study, 67.25% were married, their mean age was 43.17 ± 17.61 years, and 52.69% had university-level or higher education. Among the participants, 46.0% exhibited well-being, while 24.9% reported poor well-being, including 9.4% who were identified as experiencing depression. The mean scores of self-efficacy and well-being were significantly higher among those with controlled diabetes versus uncontrolled diabetes (40.86 ± 13.26 vs. 36.48 ± 13.26) and (67.35 ± 21.22 vs. 60.93 ± 25.05), respectively. The predictors of glycemic control were self-efficacy [Odds ratio (OR)=1.03 (95%CI, 1.01-1.06, P=0.002], having other chronic diseases [OR=3.25 (95%CI), P<0.001], having type 1 diabetes [OR=7.16, 95%CI, P=0.005], being Saudi [OR=7.67, (95%CI, P=0.027], working in a public sector [OR=0.15, (95%CI, 0.05-0.44), P=0.005], being unemployed [OR=0.19, (95%CI, 0.06-0.59), P=0.005], being a smoker [OR=0.44, 95%CI, 0.19-0.98, P=0.048], and duration of diabetes between 6-10 years [OR= 0.33, 95%CI, 0.11-0.95), P=0.043] or more than 10 years OR=0.32, 95%CI, 0.12-0.86), P=0.026]. The main determinants of well-being were having self-efficacy [OR=1.07 (95%CI, 1.04-1.09), P = 0.0001], having public health insurance [OR=4.36 (95%CI, P=0.015], and education level (read and write) [OR=0.13 (95%CI,.02-.70), P=0.021].

Conclusions

The study reveals that non-modifiable and modifiable factors, including self-efficacy, play a crucial role in diabetes control. The study recommends providing targeted educational interventions, using different social media platforms, psychosocial support programs, and inclusive healthcare policies to improve diabetes control and mental well-being among diabetic patients.

The role of social support and self-management on glycemic control of type 2 diabetes mellitus with complications in Ghana: A cross-sectional study

Background and Aims

Diabetes mellitus (DM) can result in detrimental complications which are connected with long-term impairments and disabilities. Chronic complications are well-known consequences of type 2 diabetes mellitus (T2DM) progression, which reduce patient quality of life, place a burden on the healthcare system, and increase mortality. Measures to promote health outcomes for people with DM are scanty; the study therefore aimed at determining the effects of self-management and social support on glycemic control of T2DM with complications in Ghana.

Methods

A cross-sectional design using convenience sampling was conducted on 400 T2DM patients using Hensarling's Diabetes Family Support Scale and Summary of Diabetes Self‑Care Activities scale. Data analysis was conducted using descriptive, Pearson Moment Product Correlation and Binary Logistic Regression on self-management, social support, and glycemic control in T2DM patients.

Results

Social support among participants was high and there was a positive correlation or relationship between social support and T2DM self-management. There was a correlation between social support and self-management (r = 0.149, p < 0.05) and diet control (r = 0.221, p < 0.05). The results also showed a significant correlation between medication adherence and glycemic management (r = 0.116, p < 0.05) while female T2DM participants, individuals with at least primary education were less likely to have low self-management relative to T2DM.

Conclusion

Though the level of T2DM self-management was high it does not translate to good glycemic control. Focused health education programs should be incorporated into patients' care plans which will be particularly relevant for patients with T2DM and will contribute to positive physiological and psychological outcomes. Furthermore, a more robust monitoring and follow-up scheme should be scaled up or instituted for patients with T2DM.

Acculturation and glycaemic control in Arab immigrants with type 2 diabetes in Australia

AIMS/HYPOTHESIS

This study aimed to investigate acculturation's direct and mediated effects on HbA1c levels in individuals with type 2 diabetes from Arabic-speaking countries that are members of the Arab League who have emigrated to Australia.

METHODS

In this multicentre cross-sectional study, we recruited 382 Arabic-speaking immigrants who were born in any of the 22 countries of the Arab League and who had type 2 diabetes from different healthcare settings in Australia. HbA1c levels were retrieved from medical records. A validated self-report questionnaire was used to assess behavioural and psychosocial outcomes. Acculturation was measured using the General Acculturation Index and the Adherence to Traditional Values tool. We used structural equation modelling to test mediation hypotheses.

RESULTS

Participants had a mean HbA1c value of 63.9 mmol/mol (8.0%), a low acculturation level (mean±SD: 1.9±0.6; range: 1-5) and highly adhered to traditional values (mean General Acculturation Index value: 3.7±0.7; range: 1-5). Higher HbA1c was associated with lower acculturation levels (Pearson correlation coefficient [r] = -0.32, p<0.01) and higher adherence to traditional values (r=0.35, p<0.01). Self-efficacy, health literacy and self-care activities partially mediated the relationship between acculturation and HbA1c.

CONCLUSIONS/INTERPRETATION

Among Arab immigrants in Australia with type 2 diabetes, the degree of acculturation is related to glycaemic control, suggesting possible avenues for new interventions.

Health Literacy, Self-Efficacy and Glycemic Control in Patients With Diabetes Type 2 in a Greek Population

Aim  To investigate the relationship between health literacy (HL), self-efficacy (SE), and achievement of treatment goals in patients with type 2 diabetes mellitus (T2DM). Method The cross-sectional study was conducted with a random sample of patients with T2DM attending the diabetology clinic and the Home Care department of the General Hospital of Drama, Greece. They completed two questionnaires: the short form of the European Health Literacy Survey Questionnaire (HLS-EU-Q16) to measure HL and the Diabetes Management Self-Efficacy Scale (DMSES) for people with T2DM to measure SE. Medical history, demographic characteristics, and values related to glycemic control were also recorded. Linear regression analysis was used to search for the dependence of glycosylated hemoglobin (A1C) values with HL and SE and the dependence between them. Result About 120 patients with T2DM (response rate of 92.3%) were enrolled in the study. The mean age of the participants was 62.5 years [standard deviation (SD) = 10.6 years] and most of them were female (53.3%). A1C was found to be significantly negatively associated with diet, physical activity, and SE score. Also, a statistically significant positive correlation was found between HL and SE. HL was correlated with age, gender, education level, and A1C, with women and older people having lower HL, while conversely higher education level was significantly associated with higher HL. Higher A1C was significantly associated with lower HL. Also, SE partially mediates the relationship between HL and A1C, in a significant way. Conclusion The results of the study confirm the important role of HL and SE in the successful management of T2DM. Multi-level educational interventions for diabetic patients could improve HL and SE and promote diabetes self-management.

Sex differences in symptom network structure of depression, anxiety, and self-efficacy among people with diabetes: a network analysis

Aims

The present study aims to explore the relations between symptoms of depression and anxiety and self-efficacy among people with diabetes. At the same time, we also examined the sex difference between network structures.

Methods

This study recruited 413 participants with diabetes, and they completed Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and the Self-efficacy for Diabetes (SED). Symptom network analysis and network comparison test were used to construct and compare the depression-anxiety symptom network models of the female and male groups. Finally, we conducted flow diagrams to explore the symptoms directly or indirectly related to self-efficacy.

Results

The strongest edges in the depression-anxiety symptom networks are the edge between "GAD3" (Excessive worry) and "GAD4" (Trouble relaxing) and the edge between "PHQ1" (Anhedonia) and "PHQ4" (Energy) in the female and male groups, respectively. Most of the symptoms with the highest EI and bridge EI are related to worry and nervousness. Additionally, in the flow diagram of the female group, "PHQ6" (Guilt) has a high negative association with self-efficacy.

Conclusion

Females with diabetes are more vulnerable to depression and anxiety. Interventions targeting key symptoms in the network may be helpful in relieving the psychological problems among people with diabetes.

Ensuring fidelity: key elements to consider in disseminating a diabetes telemanagement program for underserved Hispanic/Latinos living with type 2 diabetes

Background

The Hispanic/Latino population has greater risk (estimated >50%) of developing type 2 diabetes (T2D) and developing it at a younger age. The American Diabetes Association estimates costs of diagnosed diabetes in 2017 was $327 billion; with medical costs 2.3x higher than patients without diabetes. The purpose of this manuscript is to describe the methodology utilized in a randomized controlled trial aimed at evaluating the efficacy of a diabetes telemanagement (DTM) program for Hispanic/Latino patients with T2D. The intent is to provide information for future investigators to ensure that this study can be accurately replicated.

Methods

This study was a randomized controlled trial with 240 participants. Eligible patients (Hispanic/Latino, aged 18+, living with T2D) were randomized to Comprehensive Outpatient Management (COM) or DTM. DTM was comprised of usual care, including routine clinic visits every three months, as well as: Biometrics (a tablet, blood glucose meter, blood pressure monitor, and scale); Weekly Video Visits (facilitated in the patient's preferred language); and Educational Videos (including culturally congruent diabetes self-management education and quizzes). COM consisted of usual care including routine clinic visits every three months. For this study, COM patients received a glucometer, glucose test strips, and lancets. Establishing a therapeutic nurse-patient relationship was a fundamental component of our study for both groups. First contact (post-enrollment) centered on ensuring that patients and caregivers understood the program, building trust and rapport, creating a non-judgmental environment, determining language preference, and establishing scheduling availability (including evenings and weekends). DTM were provided with a tablet which allowed for self-paced education through videos and weekly video visits. The research team and Community Advisory Board identified appropriate educational video content, which was incorporated in diabetes educational topics. Video visits allowed us to assess patient involvement, motivation, and nonverbal communication. Communicating in Spanish, and awareness of diverse Hispanic/Latino backgrounds was critical, as using relevant and commonly-used terms can increase adherence and improve outcomes. Shared decision-making was encouraged to make realistic health care choices.

Conclusion

Key elements discussed above provide a framework for future dissemination of an evidence-based DTM intervention to meet the needs of underserved Hispanic/Latino people living with T2D.

The mediating effect of self-efficacy on the relationship between social support and medication adherence in adults with type 2 diabetes

Objective

To evaluate the status of medication adherence in diabetic patients and its effective factors.

Methods

A cross-sectional descriptive study was conducted with 170 diabetic patients in Iran. Participants were assessed for medication adherence, self-efficacy, and social support. Descriptive statistics, bivariate analyses, and multiple stepwise regression were conducted to explore predictors for medication adherence.

Results

Regression analysis showed that 48% of medication adherence changes stemmed from the four variables including social support, self-efficacy, income, and education levels, (R2adj = 0.480, F = 39.943, p < 0.001). According to the model, the highest effects were related to income level (β = 0.332, t = 5.493, p ⩽ 0.001) and self-efficacy (β = 0.330, t = 4.789, p ⩽ 0.001), respectively. Based on the final model, only the social support variable showed no significant relationship with adherence (β = 0.002, t = 0.032, p = 0.947).

Conclusion

Social support and self-efficacy were related to medication adherence in diabetic patients, and social support can improve medication adherence in patients with diabetes by affecting self-efficacy. Healthcare workers who interact with individuals with diabetes should take into account the factors mentioned above when designing health promotion interventions to address the needs of these individuals.

Status and associated factors of food and nutrition literacy among young adults aged 15-44 years in Shenzhen City, China

Background

Food and nutrition literacy (FNL) plays an important role in young adults' dietary habits and nutrition. This study aimed to investigate FNL status and its associated factors among young adults aged 15-44 years in Shenzhen.

Methods

A cross-sectional survey of 5,390 participants was conducted in June 2021. FNL was measured using the Food and Nutrition Literacy Questionnaire for Chinese Adults (FNLQ). A generalized linear model was employed to analyze the factors associated with FNL.

Results

The median FNL score (total score = 100) was 68.00, which was below the adequate level of 80. FNL was divided into the two different domains of knowledge and skills, with significantly different scoring rate of 85.30 and 67.77%, respectively. The overall proportion of respondents with adequate FNL was 19.52%. The FNL score was significantly higher among the participants who were female (β = 2.665; 95% confidence interval [CI]: 2.031-3.299) and with higher education levels (β ranging from 5.632 [CI: 3.845-7.419] to 10.756 [CI: 8.973-12.538]), healthcare-related work experience (β = 4.197; CI: 3.557-4.837) and a higher economic status (β ranging from 0.753 [CI: 0.079-1.426] to 6.217 [CI: 5.208-7.227]). Those who were divorced or with an unknown marital status (β = -8.438; CI: -9.701, -7.175), abnormal body mass index (thin [β = -2.115; CI: -3.063, -1.166], overweight [β = -1.427; CI: -2.254, -0.600]), and suffering from chronic diseases (single disease [β = -3.483; CI: -4.485, -2.480], multimorbidity [β = -5.119; CI: -5.912, -4.327]) had significantly lower FNL scores.

Conclusion

Generally, the level of FNL among young adults in Shenzhen, China, was relatively low. Thus, nutrition education programs targeted at promoting improved FNL status call for additional emphasis, especially in subgroups with lower scores.

American Diabetes Association Professional Practice Committee, ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Cusi K, Ekhlaspour L, Fleming TK, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Napoli N, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Verduzco-Gutierrez M, Younossi ZM, Gabbay RA. 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes-2024

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Towards Understanding Disparities in Using Technology to Access Health Care Information: African American Veterans' Sociocultural Perspectives on Using My HealtheVet for Diabetes Management

The digital divide, a racial disparity in computer and internet use, persists among Veterans. This study examined African American Veterans' experiences with and attitudes about using My HealtheVet (MHV), the online patient portal used in the Department of Veterans Affairs (VA) health care system. Semi-structured interviews were conducted with 35 non-Hispanic African American Veterans about preferences for health information, use of web-enabled devices, and experiences with and preferences for using MHV. Twenty-nine men and 6 women, ranging 35 to 73 years old, participated in this study. About 75% (n = 26) had completed some college or more, and about 75% (n = 26) considered their families financially comfortable. Ninety-one percent (n = 32) of participants were aware of MHV, and 78% (n = 25) of those who were aware reported having enrolled for an account. Data revealed participants valued that MHV provided realistic solutions to cumbersome aspects (e.g., phone call hold-times) of receiving care at the VA. However, participants admitted to not using the patient portal at all or to its full potential for two reasons: a) preference for their pre-MHV routine, b) distrust in the institutional, technological, and organizational aspects surrounding MHV. By highlighting the sociocultural aspects of patient portal use, this study provides a meaningful explanation for barriers and facilitators of health information technology adoption, particularly for MHV among African American Veterans, and ways practitioners may influence uptake.

Health Behavior Changes after a Diabetes Diagnosis: The Moderating Role of Social Support

The present study aims to investigate the relationship between a diagnosis of diabetes and health behavior changes among middle-aged and older adults, and whether self-efficacy and social support moderate the relationship. The study sample was selected from the 2006 to 2016 waves of the Health and Retirement Study (N = 13,143). A diagnosis of diabetes was ascertained by self-reported physician-diagnosed condition. Self-efficacy was measured using a 5-item scale. Social support from family and friends was measured separately by a same 3-item scale. Three health behaviors were assessed, including drinking, smoking, and physical activity. Mixed-effects regression models were conducted to test the study aims. Findings showed that participants reduced drinking after a diagnosis of diabetes. A significant interaction between social support from family and a diabetes diagnosis was found in predicting drinking reduction and smoking cessation. These findings suggest that a diagnosis of diabetes may trigger individuals' motivation to initiate health-promoting behaviors. Mobilizing social support from family may help individuals adopt health-promoting behaviors and manage diabetes after a diagnosis.

Prevalence of diabetes in the USA from the perspective of demographic characteristics, physical indicators and living habits based on NHANES 2009-2018

Objective

To determine differences in DM in the U.S. population according to demographic characteristics, physical indicators and living habits.

Methods

23 546 participants in the 2009 to 2018 National Health and Nutrition Examination Survey (NHANES) who were 20 year of age or older and not pregnant. All analyses used weighted samples and considered the stratification and clustering of the design. Specific indicators include length of leg (cm), BMI (kg/cm2), TCHOL (mg/dL), fasting plasma glucose (mg/dL) and comparison of means and the proportion of participants with DM.

Results

The prevalence of DM in the USA has been rising modestly in the past decade, and were consistent and robust for the observed differences in age, sex, and ethnicity. Compared with white participants, black participants and Mexican-American were both more likely (P<0.001) to have diabetes: 14.6% (CI, 13.6% to 15.6%) among black participants, 10.6% (CI, 9.9% to 11.3%) among white participants, and 13.5% (CI, 11.9% to 15.2%) among Mexican-American participants. The prevalence of diabetes is increasing with age, males peaked around the 60s, and women around the 70s. The overall mean leg length and TCHOL was lower in diabetics than in non-diabetics (1.07 cm, 18.67 mg/dL, respectively), while mean BMI were higher in diabetics than in non-diabetics (4.27 kg/cm2). DM had the greatest effect on decline of TCHOL in white participants (23.6 mg/dL), less of an effect in black participants (9.67 mg/dL), and the least effect in Mexican-American participants (8.25 mg/dL). Notably, smoking had great effect on percent increment of DM in whites (0.2%), and have little effect on black and Mexican-Americans.

Conclusions

DM is more common in the general population than might be clinically recognized, and the prevalence of DM was associated to varying degrees with many indicators of demographic characteristics, physical indicators, and living habits. These indicators should be linked with medical resource allocation and scientific treatment methods to comprehensively implement the treatment of DM.

Stories for change protocol: A randomized controlled trial of a digital storytelling intervention for Hispanic/Latino individuals with type 2 diabetes

BACKGROUND

Hispanic/Latino adults are disproportionately impacted by type 2 diabetes mellitus (T2D). The Stories for Change (S4C) Diabetes digital storytelling intervention promotes T2D self-management among Hispanic/Latino people. We describe the S4C protocol and participant baseline characteristics.

METHODS

Study eligibility criteria: Hispanic or Latino, age 18-70 years, ≥1 office visit within a year at a participating clinic, T2D diagnosis for ≥6 months, HbA1c ≥ 8%, and intention to continue care at the recruitment clinic. We used a two-group, parallel randomized controlled trial design and an intervention derived through a community-based participatory research approach. All participants received usual diabetes care and two cards describing how to engage healthcare teams and access diabetes-related resources. At baseline, the intervention group additionally viewed the 12-min, intervention video (four stories about diabetes self-management). To encourage subsequent video viewing, participants received five monthly text messages. The messages prompted them to self-rate their motivation and self-efficacy for T2D management. The control group received no additional intervention. Bilingual (English/Spanish) staff collected data at baseline, six weeks, three months, and six months including biometric measurements and a survey on diabetes self-management outcomes, theory-based measures, and the number of video views. We reviewed the number of diabetes-related appointments attended using electronic medical record data.

RESULTS

Participants (n = 451; 70% women, mean age = 53 years) had an average HbA1C ≥9%. Intervention participants reported identifying with the storytellers and engaging with the stories.

CONCLUSION

We present a digital storytelling intervention protocol that provides a template for future health promotion interventions prioritizing health disparity populations.

CLINICALTRIAL

gov#NCT03766438.

Self-Efficacy and Readiness to Change Among Women with Recent Gestational Diabetes Engaging in a Web-Based Lifestyle Intervention: The Balance After Baby Intervention Trial

Few evidence-based programs exist to help women with a history of gestational diabetes reduce their risk of developing type 2 diabetes. In secondary analyses from a randomized clinical trial of a web-based lifestyle intervention program for postpartum women with recent gestational diabetes, we studied changes in self-efficacy for diet and physical activity and readiness to change health behaviors. Women were randomized at ∼6 weeks postpartum and completed questionnaires at 6 weeks and 6, 12, 18, and 24 months. Our study included 181 women (mean age 32.4 ± 5.2 years; 48% White, 19% Asian, 14% Black or African American, 17% other/mixed race; 34% Hispanic). In a linear mixed effects model, women in the intervention had significantly greater improvement in overall self-efficacy scores for physical activity compared with the control group at 24 months (difference in change scores between groups .35, 95% CI: .03 to .67, P = .03). The intervention group also demonstrated significantly greater improvement in self-efficacy scores for both physical activity subdomains, specifically “sticking to it” at 24 months and “making time” at 12 months. Participants in the intervention did not experience a significant difference in change in self-efficacy for diet or readiness to change compared with those in the control arm.

4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes-2023

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Health literacy and fatigue, anxiety, depression, and somatic symptoms in patients with differentiated thyroid carcinoma from West China: A cross-sectional study

Background and Aims

Differentiated thyroid carcinoma (DTC) patients are associated with excellent prognosis but impaired health-related quality of life (HRQOL) by initial and subsequent therapy. Health literacy plays a pivotal role in public health and medical settings, but data on its relationship with DTC patients' HRQOL are insufficient and equivocal. This study was designed to explore the relationship between health literacy and HRQOL in patients with DTC from West China areas.

Methods

A cross-sectional study with a descriptive correlational design was conducted. 126 patients with DTC were recruited between 2020 and 2021. Levels of health literacy and HRQOL (including fatigue level, anxiety/depression status, and somatoform symptoms) were assessed by questionnaires. Pearson product-moment correlation and Stepwise multiple regression were used to examined the adjusted association of health literacy with HRQOL.

Results

Health literacy and receiving DTC-related education together explained 16.2% of the variance in fatigue level. Patients who had higher health literacy, received more DTC-related education were currently employed and less fatigue. Health literacy, fatigue level and DTC-related education together explained 31.0% of the variance in anxiety and depression of DTC patients. Patients who had higher health literacy, received more DTC-related education and less fatigue level were less anxious and depressive. Age explained 8.3% of the variance in DTC patients' somatoform symptoms. Older patients complained more somatoform symptoms.

Conclusion

Health literacy was positively associated with HRQOL in DTC patients regarding to fatigue level and anxiety/depression status across the entire sample. Interventions to improve HRQOL should take the patients' health literacy into account.

Mediating Role of Depression Between Diabetes Management Self-Efficacy and Diabetes Self-Care Behavior Among Elderly Type 2 Diabetes Mellitus Patients in China

Objective

To investigate the current status of diabetes self-care behavior and the association between depression, self-efficacy and self-care in a sample of Chinese elderly type 2 diabetes mellitus (T2DM) patients.

Methods

A cross-sectional study with a convenient sample including 240 elderly T2DM patients collected the data of demographic characteristics, diabetes self-care behavior, self-efficacy and depression status. The difference of self-care behavior in different sample characteristics was compared by independent t-test. The Personal correlation analysis was employed to examine the correlation of study variables. The method of bootstrap was used to analyze mediating role of depression.

Results

Only 22.5% of patients reported better diabetes self-care behavior and depression partly mediated the association between self-efficacy and self-care behavior. The significant coefficient of path a (B = -0.052, p < 0.001) and path b (B = -0.423, p < 0.05) indicated negative associations of self-efficacy on depression, and depression on self-care behavior. The indirect effect (Path a × b) between self-efficacy and self-care behavior through depression was significant (B = 0.022, p < 0.05), the 95% bias-corrected bootstrap confidence interval was 0.004 to 0.006. Meanwhile, the mediating role of depression was not found significant among the participants reported 60-74 years old (B = 0.104, p < 0.001). But depression completely mediated this association among the participants reported 75-89 years old (B = 0.034, p > 0.05).

Conclusion

The level of diabetes self-care behavior among the elderly T2DM patients in Dahu community of Anqing city was hardly optimistic. The self-efficacy focused intervention could be encouraged for community and clinicians to improve diabetes self-care behavior. Moreover, the prevalence of depression and T2DM is increasing in younger population. More work is needed to confirm these findings, especially conducting cohort studies on different populations.

Self-efficacy for self-management and its influencing factors among adults living with HIV on antiretroviral therapy in northwest Ethiopia

Previous research has identified that self-efficacy is an essential factor in the process of self-management; however, the evidence is lacking concerning factors influencing self-efficacy in low-income countries. Therefore, this study examined factors influencing self-efficacy. A validated survey tool was orally administered to 415 adults living with HIV. Many of the respondents, 82.4%, do not have a regular job while one-fourth (25.5%) of the respondents were from a rural area. A mean self-efficacy score, 19.76 ± 0.12 out of a maximum of 24 was identified. This self-efficacy score was positively correlated with age, educational level, income and job status, but negatively correlated with gender, residency and drug side effects. Income, residency in rural, and experiencing drug side effects were significant predictors of self-efficacy and explained 5.4% of the variance. Better income (β = 0.514, p = 0.029) was associated with a higher self-efficacy score but living in rural areas (β = -0.520, p = 0.043) and experiencing drug side effects (β = -1.246, p = 0.001) were associated with a lower self-efficacy score. The use of Individual and Family Self-Management Theory helps clinician and patients to work together to identify factors influencing self-efficacy and to intervene.

Comparing Patient Perspectives on Diabetes Management to the Deficit-Based Literature in an Ethnic Minority Population: A Mixed-Methods Study

Marginalized racial/ethnic minorities have disproportionately high rates of type 2 diabetes prevalence, complications and mortality. Researchers and policymakers have typically addressed these disparities using a deficit-based discourse focused on individual/cultural deficiencies or failure. A mixed-methods study was used to compare the deficit discourse to the perspectives of adults with diabetes in the Arab minority in Israel, using data from 10 focus groups (5 men's, 5 women's) and 296 quantitative in-person surveys. Both qualitative and quantitative data were triangulated. In addition, multivariable regression models tested associations between diabetes management perspectives and participant characteristics. Contrary to the deficit-based characterizations of patients as fatalistic and unknowledgeable, participants viewed diabetes as a chronic disease with serious complications. They expressed more support for patient responsibility in diabetes management than for passive fatalism, and were less fatalistic as educational level and adequacy of diabetes self-care training increased. The impact of social/environmental barriers and changing cultural norms on lifestyle behaviors was highlighted. Over 95% used prescription medications for diabetes management, although 35% reported economic barriers. The deficit discourse is not well-aligned with Arab patients' evolving perceptions and needs, and has deflected attention from the socioeconomic/structural determinants of health, and the healthcare system's responsibility to provide effective, culturally-relevant diabetes services.

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.

Nutrition-Education-Based Interventions in Gestational Diabetes: A Scoping Review of Clinical Trials

Cases of diabetes mellitus have seen a global increase in prevalence, but there are inherent differences in the pathology and management of different types of diabetes. Type 2 and gestational diabetes have the most similar pathophysiology. For that reason, many similar management strategies exist between type 2 and gestational diabetes, including nutrition-based interventions. Diabetes self-management education and medical nutrition therapy have been advanced as cost-effective interventions to manage hyperglycemia. Many of these interventions, however, were designed for type 2 diabetes and adapted for diabetes in gestation. Nutrition-education-based interventions in gestational diabetes have not been fully elucidated. We scrutinized this gap by conducting a scoping review of recently published peer-reviewed studies that evaluated clinical endpoints in cases of gestational diabetes with nutrition-education-based interventions. The search yielded 621 articles, and the 12 articles included were published between 2012 and 2022. The nutrition information varied across the heterogeneous diabetes self-management education, whereas the medical nutrition therapy studies were more consistent. Our literature search revealed similar outcomes across self-management education and medical nutrition therapy interventions implemented during the third trimester of pregnancies with diabetes. These results suggest that both generalized and personalized approaches to nutrition education in gestational diabetes can manage hyperglycemia and offset its adverse consequences.

Tools to Measure Health Literacy among Adult Hispanic Populations with Type 2 Diabetes Mellitus: A Review of the Literature

Health literacy (HL) is associated with short- and long-term health outcomes, and this is particularly relevant in Hispanics, who are disproportionally affected by lower HL. Hispanics have become the largest minority population in the United States. Also, Hispanics experience higher burdens of chronic diseases such as type 2 diabetes mellitus (T2DM) than non-Hispanic whites. Thus, effectively choosing culturally appropriate validated instruments that measure a marker found in health assessments should be a serious consideration. Using a systemized approach, we identified and reviewed 33 publications and found eight different HL and numeracy (separate or combined) instruments. We assessed the study designs and instrument structures to determine how HL was measured across these studies. We categorized the results into direct and indirect measurements of HL. The Test of Functional Health Literacy in Adults (TOFHLA) family of HL instruments was favored for direct measures of HL, while the Brief Health Literacy Screen (BHLS) instrument was favored for indirect measures. Despite identified trends in instruments used, more comprehensive measurement tools have been developed but not validated in Hispanic populations. In conclusion, further validation of more comprehensive HL instruments in adult Hispanic populations with T2DM could better assess HL levels and improve health promotion efforts.

The influence of patriarchy on Nepali-speaking Bhutanese women’s diabetes self-management

Introduction

The Nepali-speaking Bhutanese (NSB) community is a rapidly growing population in Central Pennsylvania. A community-based diabetes education pilot program found a large gender disparity with fewer women in attendance; participants reported that primary household cooks and caretakers were women. This may be an indication of women’s status in the NSB community, their healthcare access, autonomy, and ability to manage their diabetes. Hence, this study aims to understand the manifestations of patriarchy and its impact on NSB women’s diabetes self-management employing a conceptual framework based on Walby’s structures of patriarchy.

Methods

An exploratory feminist qualitative inquiry was conducted. Fifteen NSB women with Type 2 Diabetes were interviewed about their diabetes self-management. Transcripts were coded for key concepts that emerged from the data. A thematic analysis was conducted. Themes were developed inductively through those categories as well as through an a priori approach using the conceptual framework.

Results

Cultural influences such as family structure, religious beliefs, traditional healthcare and gender roles determined NSB women’s patriarchal upbringing and lifestyle. Unpaid household production was largely dependent on women. Multiple immigrations led to poor socioeconomic indicators and marginalization of NSB women. Women’s access to healthcare (including diabetes) was entirely reliant on other family members due to poor autonomy. Women experienced adverse physical and emotional symptoms related to diabetes and their ability and attempts to maintain a healthy diabetes lifestyle was determined by their physical health condition, knowledge regarding good dietary practices and self-efficacy.

Conclusion

Patriarchal practices that start early on within women’s lives, such as child marriage, religious restrictions as well as women’s access to education and autonomy impacted NSB women’s access to healthcare, knowledge regarding their diabetes and self-efficacy. Future interventions tailored for diabetes prevention and self-management among NSB women should factor in patriarchy as an important social determinant of health.

The Mediating Role of Self-Efficacy in the Association Between Diabetes Education and Support and Self-Care Management

RESULTS

A total of 1,318 participants were included in the study (mean age = 52.9 years, SD = 9.6; 72.5% female, 56.4% Black, 3.1% Hispanic). Diabetes education was associated with increases in self-care activity scores related to general diet, physical activity, glucose self-monitoring, and foot care; care coordination was associated with glucose self-monitoring. In addition, mediation analysis models confirmed that improvements in self-efficacy led to improved self-care activities scores, mediating the association of diabetes education and self-care activities.

CONCLUSIONS

Diabetes education and self-efficacy were associated with better self-care. Receiving diabetes education led to a higher likelihood of engaging in self-care activities, driven in part by increases in self-efficacy. Future interventions that aim to improve diabetes self-management behaviors can benefit from targeting self-efficacy constructs and from the integration of diabetes education in the care coordination structure.

The impact of knowledge, self-efficacy, and stigma on STI testing intention among college students

Objective: Young people represent over half of the new cases of sexually transmitted infections (STIs) each year in the United States. This study examined how STI knowledge, self-efficacy, and stigma impact STI testing intention among sexually active college students using path model analysis. Participants: Participants included 76 college students (74.1% undergraduate, M_age = 23.05). Method: Data were collected via online survey. Path analysis was conducted using SPSS AMOS, and MacKinnon's ab product approach in RMediation was used to test mediating effects. Results: The hypothesized path model fit the data well and the relationships between self-efficacy and knowledge, stigma, and STI testing intention were significant. Mediation analysis revealed significant indirect paths for knowledge and stigma on STI testing intention through self-efficacy. Conclusion: Findings suggest that college health providers may be able to increase the frequency of STI testing behavior by promoting strategies to increase students' self-efficacy.

Psychosocial and diabetes risk factors among racially/ethnically diverse adults with prediabetes

Psychosocial factors such as self-efficacy may be important in helping high-risk adults prevent diabetes. We aimed to describe psychosocial and diabetes risk factors in adults with prediabetes and evaluate if these varied by demographic characteristics. Cross-sectional data came from baseline surveys and electronic health records (2018-2021) of adults with prediabetes enrolled in a randomized study of peer support for diabetes prevention at Kaiser Permanente Northern California and Michigan Medicine. Linear regression was used to compare differences between racial/ethnic groups, adjusting for age, sex, and clinic. Of 336 participants in the study, 62% were female; median age was 57; 41% were White, 35% African American, 9% Hispanic. Mean autonomous motivation was 6.6 and self-efficacy to prevent diabetes was 6.0 (1-7 scale); mean perceived social support was 47 (12-72 scale). Hispanic adults reported higher autonomous motivation and African American adults reported higher self-efficacy compared to White adults. Hispanic and African American adults had more diabetes risk factors than White adults, including greater family history of diabetes, hypertension, sugar-sweetened beverage consumption, physical inactivity and food insecurity. In conclusion, participants reported high levels of autonomous motivation and self-efficacy at baseline, with Hispanic and African American adults reporting higher levels of some psychosocial factors related to behavior change, suggesting a significant opportunity to engage a diverse population of adults with prediabetes in diabetes prevention strategies. However, Hispanic and African American participants showed greater diabetes risk factors levels. Diabetes prevention efforts should address both to reduce diabetes incidence.

Racial and Ethnic Disparities in Healthcare Rating, Diabetes Self-efficacy, and Diabetes Management Among Non-pregnant Women of Childbearing Age: Does Socioeconomic Status Matter?

OBJECTIVE

Patient perceptions of healthcare ratings, diabetes self-efficacy, and diabetes management play a role in diabetes-related outcomes, particularly among women of childbearing age. Guided by a modified Interaction Model of Client Health Behavior framework, the objective was to compare differences in perceptions of health care ratings, diabetes self-efficacy, and diabetes management among non-Hispanic Black, Hispanic, and non-Hispanic White women of childbearing age.

METHODS

The sample comprised 7 years (2012-2018) of Medical Expenditure Panel Survey data. The sample was limited to women of childbearing age (18-45 years) who have ever been told they had diabetes (n = 691; weighted n = 932,426). Dependent variables were health care rating, diabetes self-efficacy, and diabetes care management. The key independent variable was race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White). We adjusted for sociodemographic characteristics and perceived health status using multiple linear and multivariable logistic regressions.

RESULTS

Non-Hispanic Black women (41.6%) self-reported their health status as fair or poor (44.9%) compared to non-Hispanic White (33.3%) and Hispanic (37.6%). In adjusted models, non-Hispanic Black women had 46% lower odds (95% CI = 0.31, 0.94) of reporting high health care ratings compared to non-Hispanic White women. Non-Hispanic Black women had 43% lower odds (95% CI = 0.35, 0.95) and Hispanic women had 47% lower odds (95% CI = 0.34, 0.80) of reporting higher levels of diabetes care management than non-Hispanic White women.

CONCLUSIONS

This study provides important information regarding diabetes health care ratings, self-efficacy, and self-management behaviors. Because of the increasing prevalence of diabetes among women of childbearing age, it is important to improve health care particularly for racial/ethnic minority women with diabetes.

Illness perceptions as a mediator between emotional distress and management self-efficacy among Chinese Americans with type 2 diabetes

Objectives: Emotional distress and illness perceptions have been linked to patients' self-efficacy for diabetes management. This study, guided by Leventhal's Self-Regulatory Model, explores the direct effects of emotional distress (diabetes distress and depressive symptoms) on diabetes management self-efficacy, and the indirect effects through illness perceptions among Chinese Americans with type 2 diabetes (T2DM).Design: Data were obtained from a cross-sectional study of Chinese Americans with T2DM recruited from health fairs and other community settings (N = 155, 47.1% male, mean age 69.07 years). Data analyses including descriptive statistics, correlation, and PROCESS mediation models were used to examine the mediation effects of illness perceptions.Results: Diabetes distress and depressive symptoms had direct negative effects on self-efficacy. Perceived treatment control mediated the association between diabetes distress and self-efficacy, while none of the illness perceptions dimensions impacted the relationship between depressive symptoms and self-efficacy.Conclusion: Improved perceptions of treatment control can ameliorate diabetes distress and improve diabetes management self-efficacy among Chinese Americans. Health providers should elicit patients' illness perceptions as a first step in evaluating their diabetes management self-efficacy and provide appropriate culturally-tailored interventions.

Impact of Pharmacist-Led Diabetes Self-Care Education on Patients With Type 2 Diabetes in Pakistan: A Randomized Controlled Trial

Introduction: There is a little evidence on efficacy of pharmacy-based interventions on clinical outcomes of type 2 diabetes mellitus (T2DM) patients in Pakistan.

Objective: To appraise the impact of pharmacist-led self-care education on glycemic control, self-care practices and disease knowledge of T2DM patients with poor glycemic control (HbA1c ≥ 7%).

Methods: In this 6-months, randomized controlled trial (RCT), n = 75, T2DM patients seeking care at a diabetes clinic were randomized in to two groups. Intervention group (n = 38) received two face-to-face educational sessions (at enrollment and on week 12), whereas control group (n = 37) received usual care. Outcome measures such as glycemic control, self-care practices and disease knowledge were assessed at the time of enrollment and after 6-months in both groups.

Results: Thirty-three intervention and thirty-three participants from the control group completed the study. Mean glycated hemoglobin (% HbA1c) significantly reduced in the intervention group from 9.00 ± 1.43 to 8.09 ± 1.16 (p < .01). However, no significant change was observed in the control group (9.20 ± 1.24 to 8.93 ± .97; p = .06). Cohen’s d effect size of the intervention on HbA1c was .78. Percentage of participants achieving glycemic control (HbA1c < 7%) were significantly higher (p < .05) in the intervention group as compared to the control group (twenty-four vs. six), after 6 months of the trial. A significant (p < .01) improvement in mean scores for disease knowledge and self-care activities was also observed in the intervention group participants, whereas no significant improvements (p > .05) were observed in the control group.

Conclusion: The study demonstrated an improvement in glycemic control, disease knowledge and self-care activities of T2DM patients who received pharmacist-led educational intervention. The study findings support clinical significance of integrating pharmacy-based interventions in diabetes management.

Perceived Stress as a Pathway for the Relationship Between Neighborhood Factors and Glycemic Control in Adults With Diabetes

PURPOSE

Neighborhood factors such as crime, discrimination, and violence are increasingly recognized as correlates of poor glycemic control. However, pathways for these relationships are unclear. This study examined stress and self-efficacy as potential pathways for the relationship between neighborhood factors and glycemic control in adults with type 2 diabetes.

DESIGN

Cross-sectional study.

SETTING

Two primary care clinics in southeastern US.

PARTICIPANTS

615 adults aged 18 years and older.

MEASURES

Validated measures were used to capture neighborhood factors, stress, and self-efficacy, while hemoglobin A1c (HbA1c) was abstracted from the electronic health record.

ANALYSIS

Path analysis was used to investigate direct and indirect relationships between neighborhood factors, stress, self-efficacy, and glycemic control.

RESULTS

In the final model, violence (r = .17, P = .024), discrimination (r = .46, P < .001), and crime (r = .36, P = .046) were directly associated with higher perceived stress. Stress (r = -.5, P < .001) was directly associated with lower self-efficacy. Self-efficacy was directly associated with better general diet (r = .12, P < .001), better specific diet (r = .04, P < .001), more exercise (r = .08, P < .001), and lower HbA1c (r = -.11, P < .001). Stress (r = .05, P < .001), crime (r = .20, P < .001), and discrimination (r = .08, P < .001) were indirectly associated with higher HbA1c.

CONCLUSION

Stress and self-efficacy are potential pathways for the relationship between neighborhood factors like violence, discrimination, and crime and glycemic control. Interventions aimed at mitigating stress and improving self-efficacy may improve self-care behaviors and glycemic control.

Impact of a Clinical Pharmacist Intervention Program on the Follow-up of Type-2 Diabetic Patients

Aims

The primary aim of this current study was to investigate the impact of the clinical pharmacist interventions on glycemic control and other health-related clinical outcomes in patients with type 2 diabetes in Egypt.

Methods

A prospective trial was conducted on 100 patients with uncontrolled type 2 diabetes admitted in the diabetes outpatient's clinics. Patients were randomly allocated into the clinical pharmacist intervention group and usual care group. In the intervention group, the clinical pharmacist, in collaboration with the physician had their patients receive pharmaceutical care interventions. In contrast, the usual care group patients received routine care without clinical pharmacist's interference.

Results

After 6-month of follow-up, of the average HbA1c and FBG values of the patients in the clinical pharmacist intervention group (HbA1c % from 8.6 to 7.0; FBG (mg/dL) from 167.5 to 121.5) decreased significantly compared to the usual care group patients (HbA1c % from 8.1 to 7.8; FBG (mg/dL) from 157.3 to 155.9) (P < .05). Additionally, the results indicated that mean scores of patients 'diabetes knowledge, medication adherence, and diabetes self-care activities of the patients in the clinical pharmacist group increased significantly compared to the control group (P < .05).

Conclusions

The study demonstrated an improvement in HbA1c, FBG, and lipid profile, in addition to self-reported medication adherence, diabetes knowledge, and diabetes self-care activities in patients with type 2 diabetes who received pharmaceutical care interventions. The study outcomes support the benefits and the need to integrate clinical pharmacist interventions in the multidisciplinary healthcare team in Egypt.