Factors Influencing Physical Activity Behavior among Iranian Women with Type 2 Diabetes Using the Extended Theory of Reasoned Action

Predictors of self-care behaviors and glycemic control among patients with type 2 diabetes mellitus

Aims

This study used the Extended Theory of Reasoned Action (ETRA) to predict self-care behaviors and HbA1c among patients with type 2 diabetes in Iran.

Materials and methods

A cross-sectional study was performed using a multistage random sample. A total of 240 patients with type 2 diabetes, who were referred to the diabetes healthcare centers in Chaldoran, participated in the research. Instruments consisting of standardized questionnaires were used based on the Extended Theory of Reasoned Action (ETRA) constructs and the summary scale of diabetes self-care behaviors measure.

Findings

The results of this study demonstrated that demographic variables explained ~ 7% (p-value = 0.23) and ETRA constructs 18% of the variance (p-value = 0.02) in behavioral intention, respectively. According to the hierarchical multiple linear regressions on self-care behaviors, demographic factors (p-value 0.001) dictated 45.7% of the variation of the self-care behavior, while knowledge, attitude, self-efficacy, and behavioral intention (p-value 0.001) accounted for 63.4% of the variance. The ETRA constructs, self-care practices, and demographic factors together account for almost 57% of the variation in the HbA1c. Self-care practices were the best indicator of HbA1c (β = -0.593).

Conclusion

ETRA constructs and self-care behavior can be the best determinants of HbA1c level in type 2 diabetes. This model is suggested to be applied in designing intervention programs to improve HbA1c in these groups of patients.

Self-Care Behaviors in Patients with Hypertension to Prevent Hypertensive Emergencies: a Qualitative Study Based on the Theory of Planned Behavior

Background: Hypertension is a crucial general health issue. Severe and acute hypertension needs urgent medical intervention. Self-care behaviors can help patients with hypertension in controlling blood pressure and preventing hypertensive emergencies. This study aimed to determine the perception of hypertension towards self-care behaviors using constructs of the theory of planned behavior (TPB) in critically ill patients with hypertension to prevent hypertensive emergencies.

Material and Methods: This study was conducted based on the directed qualitative content analysis of 33 critically ill patients with hypertension who participated in semi-structured interviews and focus group discussions. Results: The data were analyzed based on the four main categories of TPB. The attitude category consisted of positive and negative subcategories. The subjective norms category consisted of authority of healthcare staff, family support and approval, and influence of friends subcategories. The perceived behavioral control category included discipline, self-control, receiving consultation, individual concerns, financial problems, access to medicine, food culture, and coronavirus limitations subcategories. The behavioral intention category had intention to perform the behavior and intention to continue a behavior subcategories.

Conclusion: The results revealed the requirement for a multidimensional approach to improve attitude, subjective norms, and behavioral control for performing self-care behaviors to reduce the number of hypertensive emergencies in critically ill patients with hypertension. Factors affecting self-care included socioeconomic status, family support, governmental organizations, and participants’ health condition.

Determining intention, fast food consumption and their related factors among university students by using a behavior change theory

Background

Today, with the advancement of science, technology and industry, people’s lifestyles such as the pattern of people’s food, have changed from traditional foods to fast foods. The aim of this survey was to examine and identify factors influencing intent to use fast foods and behavior of fast food intake among students based on the theory of planned behavior (TPB).

Methods

A cross-sectional study was conducted among 229 university students. The study sample was selected and entered to the study using stratified random sampling method. Data were collected using a four-part questionnaire including Participants’ characteristics, knowledge, the TPB variables, and fast food consumption behavior. The study data were analyzed in SPSS software (version 16.0) using descriptive statistics (frequencies, Means, and Standard Deviation) and inferential statistics (t-test, Chi-square, correlation coefficient and multiple regressions).

Results

The monthly frequency of fast food consumption among students was reported 2.7 times. The TPB explained 35, 23% variance of intent to use fast food and behavior of fast food intake, respectively. Among the TPB variables, knowledge (r = .340, p < 0.001) and subjective norm (r = .318, p < 0.001) were known as important predictors of intention to consume fast foods - In addition, based on regression analyses, intention (r = .215, p < 0.05), perceived behavioral control (r = .205, p < 0.05), and knowledge (r = .127, p < 0.05) were related to fast food consumption, and these relationships were statistically significant.

Conclusions

The current study showed that the TPB is a good theory in predicting intent to use fast food and the actual behavior. It is supposed that health educators use from the present study results in designing appropriate interventions to improve nutritional status of students.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12696-x.

Time-varying association between physical activity and risk of diabetes in the early and late adulthood: A longitudinal study in a West-Asian country

BACKGROUND

The time-varying association between physical activity (PA) and incidence of type 2 diabetes (T2DM) is still unclear. The present study aimed to investigate this association in the early- and late-adulthood during a 9-year follow-up.

METHODS

This study was conducted on 3905 participants in early and late adulthood, using the Tehran Lipid and Glucose Study (TLGS) dataset. PA was assessed via the Iranian version of Modified Activity Questionnaire (MAQ). The association between trend of PA and incident T2DM was investigated using time-varying Cox's proportional hazard model. Variables including job, education, smoking and body mass index (BMI) were adjusted in the final model.

RESULTS

The distribution of sex- and age-specific levels of PA changed significantly over time. Compared with physically inactive women, for older women with high level of PA, the risk of T2DM was 0.64 (95% CI: 0.43-0.95, P = 0.02) in adjusted model. Moreover, hazard for low PA group was significantly higher than the moderate group, and for these two groups were significantly higher than high PA level (P < 0.05).

CONCLUSION

High PA level can postpone the incident T2DM in early-aged and elderly women, over time. Therefore, gender and age are of great importance in designing the PA modifying programs to prevent T2DM.

Moderate-to-vigorous physical activity changes in a diabetes prevention intervention randomized trial among South Asians with prediabetes - The D-CLIP trial

AIMS

The Diabetes Community Lifestyle Improvement Program (D-CLIP) was a lifestyle education program to prevent diabetes in South Asians with prediabetes. This paper examines the impact of the D-CLIP intervention on moderate-to-vigorous intensity physical activity (MVPA).

METHODS

This randomized controlled trial to prevent diabetes included 573 individuals with prediabetes from Chennai, India. The intervention was designed to increase MVPA to ≥150 minutes per week. MVPA was measured by questionnaire at baseline, six, 12, 18, 24, 30 and 36 months of follow-up. Random effects models were used to examine the relationship between treatment group and odds of reporting ≥150 weekly minutes of MVPA and to examine the impact of the intervention on weekly MVPA.

RESULTS

With the exception of the proportion of respondents at baseline with a high waist circumference, selected sample characteristics did not differ at baseline between the intervention and control groups. The intervention significantly (p < 0.05) increased the proportion of respondents who reported ≥150 weekly minutes of MVPA by 28.5%, 13.6% and 14.0% at six, 12 and 18 months respectively. Mean minutes of weekly MVPA significantly (p < 0.05) increased by an additional 56.7, 34.3, 23.6 and 24.3 minutes/week at six, 12, 18, and 24 months, respectively.

CONCLUSION

The D-CLIP intervention significantly increased MVPA at six, 12 and 18 months of follow-up. Interventions to prevent diabetes in South Asians with prediabetes can significantly increase MVPA in this population.

The Effect of Educational Intervention Based on BASNEF Model on Self-Medication Behavior of Type 2 Diabetic Patients

BACKGROUND

Diabetes is one of the main reasons of the increase of morbidity and mortality around the world. Considering the burden of disease, self-medication can result in irrecoverable consequences. The aim of this study is to investigate the effect of educational intervention based on Beliefs, Attitudes, Subjective Norms and Enabling Factors (BASNEF) model on self-medication behaviors of type 2 diabetic patients in Fasa, Fars province, Iran, in 2017-2018.

MATERIALS AND METHODS

In this quasi-experimental study, 200 type 2 diabetic patients under cover of the diabetes center of Fasa were investigated (100 patients for experimental group and 100 patients for control group). A questionnaire investigating demographic information and BASNEF Model constructs (knowledge, attitude, enabling factors, subjective norms, and behavioral intention) was used for evaluating self-medication behaviors of patients before and 3 months after intervention.

RESULTS

The average age of experimental group was 53.25 ± 8.42 and the average age of control group was 54.18 ± 8.13. Three months after intervention, experimental group showed significant enhancement in knowledge, attitude, enabling factors, subjective norms, and behavioral intention and their self-medication behaviors reduced, while control group showed no significant changes in mentioned factors.

CONCLUSION

The present study indicated the efficiency of BASNEF model on reduction of self-medication behaviors of diabetic patients. Hence, this model can act as a framework for designing and implementing educational interventions in this field.

Cognitive predictors of physical activity behaviors among rural patients with type 2 diabetes: applicability of the Extended Theory of Reasoned Action (ETRA)

Background: This study aims to examine the cognitive-behavioral determinants of physical activity behaviors (PABs) of patients diagnosed with type 2 diabetes. Subjects and methods: In this cross-sectional study, census sampling was employed to enroll 120 rural patients with type 2 diabetes in the Chalderan County in 2015. To collect data, a valid and reliable instrument, based on the Extended Theory of Reasoned Action (ETRA) constructs, was used. Data were analyzed by SPSS 21 software using descriptive and inferential statistical methods. Results: Using the one-way ANOVA test, it was found that PABs had statistically significant correlation with all ETRA constructs except subjective norms (P=0.574). Knowledge (P=0.015), self-efficacy (P<0.001) and behavioral intention (P<0.001) had a significant association with PABs, respectively. Also, ETRA structures were able to reflect 41.0% of the behavioral changes. Among structures, knowledge (P=0.014), self-efficacy (P<0.001), and behavioral intention (P=0.020) were significant predictors of PABs (R2=0.414). Conclusions: Health care providers may consider the ETRA an appropriate framework to design educational interventions aimed at improving PABs among rural patients with type 2 diabetes.

Underdiagnosis of delirium on admission and prediction of patients who will develop delirium during their inpatient stay: a pilot study

INTRODUCTION

The study aimed to determine the prevalence and documentation of delirium among the elderly and if the Clock Drawing Test (CDT) can be used to predict which patients had delirium on admission and those who may develop delirium during their stay in acute medical wards.

METHODS

A single researcher performed the Mini-Mental State Examination (MMSE) and CDT on admission and discharge of 57 elderly adults at the National University Hospital, Singapore. Delirium was defined as a ≥ 3-point improvement or ≥ 2-point decline in MMSE scores from admission to discharge, where a fall denotes development of delirium and a rise denotes resolution. The case notes of the same patients were reviewed for documentation of delirium. All inpatients from two acute medical wards were examined. One CDT score and a pair of MMSE scores were collected from each patient.

RESULTS

A total of 57 patients (28 male, 29 female) were involved in the study. Their mean age was 76.0 ± 8.7 years. The prevalence of delirium based on MMSE scores was 40.4%; 16 patients had delirium on admission while seven developed delirium during their inpatient stay. However, delirium was documented in the case notes of only 7 (30%) of the 23 patients. CDT score was better than baseline MMSE score at predicting a decline in MMSE score.

CONCLUSION

The prevalence of delirium in the acute medical setting is high but underdiagnosed. The CDT may be a good screening tool to identify patients at risk of delirium during their inpatient stay. Baseline cognition screening should be performed in every elderly patient admitted to hospital.

Applying Socioecological Model to Improve Women's Physical Activity: A Randomized Control Trial

Background:

A sedentary life without sufficient physical activity is recognized as a risk factor for various diseases, and a major modifiable risk factor for noncommunicable diseases. This study was conducted to investigate the effect of intervention using socioecological model in promoting women’s physical activity in the city of Kerman, Iran.

Materials and Methods:

In this randomized, double-blinded, controlled study, 360 women were studied at health and medical centers of Kerman. This educational intervention was based on socioecological model and conducted on 4 levels of personal, social, organizational, and political. Data collection tool included a researcher-made questionnaire based on constructs of socioecological model and the international physical activity inventory.

Results:

The results indicated insignificant differences between the two groups in terms of perceived social, physical, and political support and also with regard to level of physical activity before intervention. However after the intervention and according to independent t test, significant differences were observed between two groups in perceived social, physical, and political support and also level of physical activity (P < 0.001). Furthermore, mean values of the above terms increased in the intervention group.

Conclusions:

According to the results, interventions based on socioecological model can positively affect women’s physical activity.

Health-Related Quality of Life and its Determinants Among Women With Diabetes Mellitus: A Cross-Sectional Analysis

BACKGROUND

Diabetes is a chronic and threatening condition. However, there are controversies on the factors affecting the health related quality of life (HRQOL) in patients with diabetes.

OBJECTIVES

The current study aimed to evaluate HRQOL and its determinants among females with type II diabetes referred to Diabetes Clinic of Khoy city, Northwest of Iran.

PATIENTS AND METHODS

This cross-sectional study was performed on 352 eligible females with diabetes referring to Diabetes Clinic of Khoy. The study data were collected using a three-part instrument including a socio-demographic questionnaire, a questionnaire to assess patients' knowledge on diabetes and the world health organization's quality of life (WHOQOL-BREF) questionnaire. Based on descriptive and inferential statistics, analyses were conducted using frequency, independent samples t-test, correlation coefficient and regression analysis.

RESULTS

The total mean score of QOL was 58.02 ± 17.63. The lowest and the highest mean scores were observed in physical health and social relationship domains (53.84 ± 17.09) and (65.08 ± 14.87), respectively. The regression models revealed that age, education, duration of disease, and family income were significantly associated with all areas of quality of life (P < 0.05). The results also revealed that co-morbidity was significantly correlated with the overall quality of life and the physical health domain (P < 0.01).

CONCLUSIONS

The mean score of quality of life (QOL) in females with diabetes was far from desirable condition. These findings can help physicians and healthcare providers to design suitable interventions to improve the patients QOL.

Predicting intentions and behaviours in populations with or at-risk of diabetes: A systematic review

Purpose

To systematically review the Theory of Planned Behaviour studies predicting self-care intentions and behaviours in populations with and at-risk of diabetes.

Methods

A systematic review using six electronic databases was conducted in 2013. A standardised protocol was used for appraisal. Studies eligibility included a measure of behaviour for healthy eating, physical activity, glucose monitoring, medication use (ii) the TPB variables (iii) the TPB tested in populations with diabetes or at-risk.

Results

Sixteen studies were appraised for testing the utility of the TPB. Studies included cross-sectional (n = 7); prospective (n = 5) and randomised control trials (n = 4). Intention (18%–76%) was the most predictive construct for all behaviours. Explained variance for intentions was similar across cross-sectional (28–76%); prospective (28–73%); and RCT studies (18–63%). RCTs (18–43%) provided slightly stronger evidence for predicting behaviour.

Conclusions

Few studies tested predictability of the TPB in populations with or at-risk of diabetes. This review highlighted differences in the predictive utility of the TPB suggesting that the model is behaviour and population specific. Findings on key determinants of specific behaviours contribute to a better understanding of mechanisms of behaviour change and are useful in designing targeted behavioural interventions for different diabetes populations.

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Intention was the most predictive construct for diabetes self-care behaviours (18% – 76% of explained variance).

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Studies included cross-sectional (n = 7); prospective (n = 5) and randomised control trials (n = 4).

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Explained variance for intentions were similar across the study designs and RCTs provided slightly stronger evidence for predicting diabetes-related behaviour.

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The predictive utility of the TPB is behaviour specific and depends largely on the target population.

Physical Activity Status and Position of Governmental Employees in Changing Stage Based on the Trans-Theoretical Model in Hamadan, Iran

Physical inactivity is the fourth leading risk factor for death worldwide. Given the key role of employees as valuable human resources and increasing sedentary life style among them, the aim of this study was to evaluate physical activity status and position of governmental employees in changing stage based on the Trans-Theoretical Model (TTM) in Hamadan, Iran, in 2014. This descriptive-analytical study was performed on 1200 government employees selected using proportional stratified random sampling. Data collection was performed using a three-section questionnaire containing demographic characteristics, SQUASH (Short questionnaire to assess health-enhancing physical activity) questionnaire and Marcus et al’s five-part algoritm. Data were analyzed by multiple linear and logistic regression, Chi-square, T-test and ANOVA using SPSS-20.

The mean age of the participants was 38.12±8.04 years. About a half of the employees were in the preparatory stage of TTM.49.2% and 50.8% of the sample were classified as active and inactive, respectively. Associations between physical activity status and exercise stage of change were found. The associations between exercise stage of change and age, sex, work experience, education and marital status were significant (p<0.05). Work experience and education were strongly predictors of physical activity (PA) status and accounted for 31.2% of variance in PA (adjusted R²=0.312, R² change=0.01).

The results of this study showed that TTM was useful to evaluate and predict physical activity behavior among the Iranian governmental employees and can be utilized by health planners to inform appropriate intervention strategies, specifically in work place.