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      Modelling of diabetes knowledge, attitudes, self-management, and quality of life: a cross-sectional study with an Australian sample

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          Abstract

          Background

          Quality of life (QoL) is an important aspect of wellbeing for people with chronic conditions like type 2 diabetes, making it a noteworthy outcome. Knowledge about diabetes, attitudes, and self-management of diabetes are key factors that might directly or indirectly impact QoL. However, little is known about the inter-relationships between diabetes knowledge, attitudes, self-management and QoL among people with type 2 diabetes mellitus (T2DM). The aim of this study was to examine a model describing the relationship between diabetes knowledge, attitudes, self-management, and QoL of people with T2DM that is based on previous research linking pairs of these variables.

          Methods

          A cross-sectional study design was employed in this research. A total of 291 participants, 192 males and 99 females, with T2DM, whose mean age was 55.8 (standard deviation = 11.09) completed questionnaires measuring diabetes knowledge (Diabetes Knowledge Scale), attitudes (Diabetes Integration Scale -19), self-management (Summary of Diabetes Self-care Activities Scale), including the aspects of diet, exercise, blood glucose testing, and foot care, and QoL (Diabetes Quality of Life Scale), comprising the aspects of satisfaction and impact on QoL respectively. To examine the model we proposed relating these variables, data were analysed using the path analysis.

          Results

          In the final model, diabetes knowledge was a significant predictor for attitudes and self-management in terms of blood glucose testing. Attitudes was a significant predictor for self-management in terms of diet. In addition, self-management in terms of blood glucose testing was a significant predictor of impact of QoL, and self-management in terms of diet was a significant predictor of satisfaction and impact of QoL. Self-management in terms of exercise was a significant predictor of satisfaction in QoL. The final model reflected a good fit ( χ 2 (14) = 22.52, p = 0.069; CFI = 0.983; GFI = 0.983; RMSEA = 0.046).

          Conclusions

          Diabetes knowledge, attitudes, and self-management are important factors that can impact the QoL among people with type 2 diabetes.

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          Relationship of depression and diabetes self-care, medication adherence, and preventive care.

          Elizabeth Lin, Wayne J Katon, Michael Von Korff … (2004)
          We assessed whether diabetes self-care, medication adherence, and use of preventive services were associated with depressive illness. In a large health maintenance organization, 4,463 patients with diabetes completed a questionnaire assessing self-care, diabetes monitoring, and depression. Automated diagnostic, laboratory, and pharmacy data were used to assess glycemic control, medication adherence, and preventive services. This predominantly type 2 diabetic population had a mean HbA(1c) level of 7.8 +/- 1.6%. Three-quarters of the patients received hypoglycemic agents (oral or insulin) and reported at least weekly self-monitoring of glucose and foot checks. The mean number of HbA(1c) tests was 2.2 +/- 1.3 per year and was only slightly higher among patients with poorly controlled diabetes. Almost one-half (48.9%) had a BMI >30 kg/m(2), and 47.8% of patients exercised once a week or less. Pharmacy refill data showed a 19.5% nonadherence rate to oral hypoglycemic medicines (mean 67.4 +/- 74.1 days) in the prior year. Major depression was associated with less physical activity, unhealthy diet, and lower adherence to oral hypoglycemic, antihypertensive, and lipid-lowering medications. In contrast, preventive care of diabetes, including home-glucose tests, foot checks, screening for microalbuminuria, and retinopathy was similar among depressed and nondepressed patients. In a primary care population, diabetes self-care was suboptimal across a continuum from home-based activities, such as healthy eating, exercise, and medication adherence, to use of preventive care. Major depression was mainly associated with patient-initiated behaviors that are difficult to maintain (e.g., exercise, diet, medication adherence) but not with preventive services for diabetes.
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            Structural equation modeling with Mplus, basic concepts, application and programming

            B Byrne, M Byrne B., B. M. Byrne … (2011)
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              Diabetes, depression, and quality of life: a population study.

              R D Goldney, P. J. Phillips, L Fisher … (2004)
              The aim of the study was to assess the prevalence of diabetes and depression and their associations with quality of life using a representative population sample. The study consisted of a representative population sample of individuals aged > or = 15 years living in South Australia comprising 3,010 personal interviews conducted by trained health interviewers. The prevalence of depression in those suffering doctor-diagnosed diabetes and comparative effects of diabetic status and depression on quality-of-life dimensions were measured. The prevalence of depression in the diabetic population was 24% compared with 17% in the nondiabetic population. Those with diabetes and depression experienced an impact with a large effect size on every dimension of the Short Form Health-Related Quality-of-Life Questionnaire (SF-36) as compared with those who suffered diabetes and who were not depressed. A supplementary analysis comparing both depressed diabetic and depressed nondiabetic groups showed there were statistically significant differences in the quality-of-life effects between the two depressed populations in the physical and mental component summaries of the SF-36. Depression for those with diabetes is an important comorbidity that requires careful management because of its severe impact on quality of life.
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                Author and article information

                Contributors
                Yee Cheng Kueh: yckueh@usm.my
                Tony Morris: Tony.Morris@vu.edu.au
                Erika Borkoles: erika.borkoles@vu.edu.au
                Himanshu Shee: himanshu.shee@vu.edu.au
                Journal
                Journal ID (nlm-ta): Health Qual Life Outcomes
                Journal ID (iso-abbrev): Health Qual Life Outcomes
                Title: Health and Quality of Life Outcomes
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1477-7525
                Publication date (Electronic): 19 August 2015
                Publication date PMC-release: 19 August 2015
                Publication date Collection: 2015
                Volume: 13
                Electronic Location Identifier: 129
                Affiliations
                [ ]College of Sport and Exercise Science, Victoria University, Melbourne, Australia
                [ ]Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
                [ ]College of Business, Victoria University, Melbourne, Australia
                Article
                Publisher ID: 303
                DOI: 10.1186/s12955-015-0303-8
                PMC ID: 4543474
                PubMed ID: 26286395
                SO-VID: 16902d2c-d42f-4485-aa5d-59de68be2c5d
                Copyright © © Kueh et al. 2015
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 29 April 2015
                Date accepted : 14 July 2015
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                ScienceOpen disciplines: Health & Social care
                Keywords: knowledge,attitudes,self-management,quality of life,type 2 diabetes
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: knowledge, attitudes, self-management, quality of life, type 2 diabetes

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