Shu-Ming Marine Chen FooyingUniversityID: 65452
The Burden of Diabetes in Taiwan The prevalence of Type II diabetes is between 5-10%, and over 45 years old is higher at 11% (Department of Health, Taiwan, 2013) The death rate take 5 th place among the ten leading causes of death (Department of Health, Taiwan, 2013) Diabetes accounted 11.5% of total medical expenses, with a care cost 4.3 times required for people without diabetes (Department of Health, Taiwan, 2013)
Background Particular psychosocial factors appear to act as important personal barriers or facilitators to diabetes self-care, such as health locus of control, self-efficacy and depression. However, little information is available regarding the relationships among these variances with glycemic control. (Zulman et al., 2012)
Background The health locus of control construct holds that people view the attainment of a particular outcome as either within their control (internal) or outside of their control (external). Health locus of control is the potential for a behaviorto occur in a given situation and the expectation that the behaviorwill lead to a particular outcome.
Background Little information is available regarding the relationship among health locus of control co-morbid depression and self-efficacy for type 2 diabetes adults. This study is community-based clinical practice that provides an approach for understanding the predicators of diabetic self-care behavior. Enhanced understanding of the relationships among health locus of control, self-efficacy, and depression in diabetes and help to identify the potential effects of these factors on self-care behaviors and glycemic control.
Purpose We determine whether the factors of health locus of control, self-efficacy, depression, and self-care behavior relate to glycemic control in type 2 diabetes.
Study design METHODS This study was a cross-sectional design with a descriptive correlation approach.
Sample Inclusion criteria (a) age 18 years and able to communicate in Chinese; (b) diagnosed with type 2 diabetes; (c) do not have history of critical disease or mental disease; (d) voluntary participation. Exclusion criteria (a) having type 1 diabetes, gestational diabetes or types of diabetes with other causes; (b) having complications that would interfere with their ability to participate in the study (i.e. patients with vision problems, end-staged renal disease and renal dialysis, cognitive impairments, diabetes ketoacidosis).
Measurements The personal-information questionnaire The Multidimensional Health Locus of Control Scale (MHLC). The Self-Efficacy Scale. Depression Anxiety Stress Scale (DASS-21) Diabetes Self-Care Behavior Scale HbA1C
RESULTS Table 1 Demographic variables and disease status (n = 285) Items n (%) Mean SD Range Age(year) 60.44 10.99 19-83 Gender male female Marital status single married Education No education Literacy Primary school High school Vocational education Bachelor or more 104 (36.5) 181 (63.5) 47 (17.9) 238 (82.1) 64 (22.5) 16 (5.6) 95 (33.3) 46 (16.1) 45 (15.8) 19 (6.9) Income (per month) 9999 or below 10,000-19,999 20,000-49,999 $50,000 or more Religion yes no 80 (28.2) 86 (30.1) 102(35.9) 17(5.8) 233 (81.8) 52 (18.2)
Items n (%) Mean SD Range HbA1c(%) 8.52 2.14 4.6-14.5 Disease duration(year) 8.66 6.30 1-45 Hypertension yes no 167 (58.6) 118 (41.4) Lipemia yes no Cardiomyopathy yes no Nephropathy yes no Neuropathy yes no 131 (46.0) 154 (54.0) 21 (7.2) 264 (92.8) 116 (40.7) 169 (59.3) 140 (49.1) 145 (50.9)
Figure 1. Path analysis model of determinants for glycemic control in type 2 diabetes. Note: Unless otherwise indicated, the standardized regression coefficients are significant (P<.05); n.s.: non-significant (P>.05); m.s.: marginally significant (0.05 < P < 0.1).
Int-locus - Depression + + HbA1c-initial + HbA1c-last Ext-locus + + - + Self-E + Behavior Figure 2. Final factor model related to glycemiccontrol. Note: +: positive correlation,-: negative correlation
CONCLUSIONS The current study found that depression and self efficacy mediated the associations of health locus of control, self-care behaviour and glycemiccontrol. Future studies are needed, however, investigating health locus of control in different cultures and the diversity among diabetes populations; with a longitudinal follow up in order to study how health locus of control really impacts upon self-care behaviour and glycemic control.
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