Keywords
treatment self-regulation, illness perception, chronic disease, type 2 diabetes
Abstract
Background and Objective: Impaired self-regulation negatively impacts self-efficacy, self-management, blood sugar control, and quality of life of patients with diabetes. Therefore, identifying the predictors for self-regulation is a necessity for healthcare providers. The current study aimed to determine the predictive role of illness perception on treatment self-regulation in patients with type 2 diabetes.
Methods: The current study is a descriptive cross-sectional study. A total of 200 patients with type 2 diabetes who were referred to medical centers affiliated with Qazvin University of Medical Sciences in 2019-2020 were enrolled through a convenience sampling method. The brief Illness Perception Questionnaire and the Treatment Self-Regulation Questionnaire were used for data collection. Collected data were analyzed by SPSS v21 using a multivariable regression model.
Results: Mean and standard deviation scores of self-regulation and illness perception were 69.11±17.61 and 36.21±7.05, respectively. Results of the multivariate regression model showed that self-regulation was significantly correlated with illness perception, age, cardiovascular complications, diabetic retinopathy, and diabetic foot ulcers.
Conclusions: In this study, the level of self-regulation was at a moderate level. The results also showed that illness perception could be a predictor of improving patients’ self-regulation. Therefore, providing infrastructure programs such as continuous education and appropriate care programs for diabetic patients to improve their illness perception can effectively improve their self-regulation behaviors.
References
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[25]. Huang CH, Li SH, Shu B. Exploring the relationship between illness perceptions and negative emotions in relatives of people with schizophrenia within the context of an affiliate stigma model. Nurs Res. 2016; 24( 3): 217-23. doi: 10.1097/jnr.0000000000000124.
[26]. Li J, Qiu X, Yang X, Zhou J, Zhu X, Zhao E, Qiao Z, Yang Y, Cao D. Relationship between illness perception and depressive symptoms among type 2 diabetes mellitus patients in China: a mediating role of coping style. J Diabetes Res. 2020;15. DOI: 10.1155/2020/3142495
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[28]. Rahimi Z, Baljani S, Zadgasem Z. Investigating the relationship between illness perception and quality of life in hemodialysis patients; Iran J Crit Care Nurs 2012;5(3):151-158
[29]. Kato A, Fujimaki Y, Fujimori S, Isogawa A, Onishi Y, Suzuki R, Yamauchi T, Ueki K, Kadowaki T, Hashimoto H. Psychological and behavioural patterns of stigma among patients with type 2 diabetes: a cross-sectional study. BMJ Open. 2017;7(3):e013425. doi: 10.1136/bmjopen-2016-013425
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[31]. Børte, S. and Ottersen, V. S."Stigmatization of children with chronic diseases, exemplified by type 1 diabetes mellitus.: Differences between India and Norway 2012.
[32]. Rasoolinajad M, Abedinia N, Noorbala AA, Mohraz M, Moradmand Badie B. Effect of mental health, coping mechanisms and stigma on risky behaviors in HIV positive patients in Iran: A cross-sectional study. Razi Journal of Medical Sciences.2017; 24(159):83-93. URL: http://rjms.iums.ac.ir/article-1-4685-en.html
[33]. Gaffman E. Stigma-Netesonth Management of Spiiled Identify,15th ed, Touchstone Publish, England.2012.
34. Weiss, M, Ramakrishna, J, Somma, D. Health-related stigma: rethinking concepts and interventions. Psychol Health Med .2006; 11 (3): 277-287. DOI: 10.1080/13548500600595053
[35]. Yousefi A, Shaghaghi F, Dehestani M, Barghi Irani Z., The Relationship between Quality of Life (QoL) and Psychological Capital with Illness Perception in MS Patients . Health Psychol .2012;1(1).32-45.
[36]. Shahbazi H, Ghofranipour F, Amiri P, Rajad A. Perceptions, enablers and nurturers related to self-care behaviors in adolescent with type 1 diabetes. Iran. J. Endocrinol. Metab 2018;19(6):435-43.
[37]. Salehi S, Shafiei S, Amini P, Abdeyazdan G. Self-care performance in children and adolescents with type 1 diabetes mellitus. J Chronic Dis Care. 2014;3(3):e21706. DOI: 10.17795/jjcdc-21706
[38]. Mahdilouy P, Ziaeirad M. Self-care Status and Its Relationship with Demographic and Clinical Characteristics in Adolescents and Young People with Type I Diabetes . J Diabetes Nurs. 2019; 7 (1) :714-727. URL: http://jdn.zbmu.ac.ir/article-1-345-en.html
[39]. Lin K, Yang X, Yin G, Lin S. Diabetes self-care activities and health-related quality-of-life of individuals with type 1 diabetes mellitus in Shantou, China Int J Med Res. 2016;44(1):147-56. DOI: 10.1177/0300060515597933
[40]. Fuladvandi M, Safarpour H, Malekyan L, Moayedi S, Mahani MA, Salimi E. The Survey of self-regulation behaviors and related factors in elderly with hypertension in south-east of Iran. Health. 2017;9(04):592-600. doi: 10.4236/health.2017.94042.
[41]. Sabeti Bilondi S, Delshad Noghabi A, Aalami H. The relationship between illness perception and medication adherence in patients with diabetes mellitus type II: illness perception and medication adherence. J Prev Med Hyg. 2021;62(4): E966–E971. doi: 10.15167/2421-4248/jpmh2021.62.4.2277
[42]. Abubakari AR Jones , MC, Lauder W, Kirk A, Anderson J, Devendra D. Associations between knowledge, illness perceptions, self-management and metabolic control of type 2 diabetes among African and European-origin patients. J Nurs Healthc Chronic Illn.. 2011; 3 (3): 245-256. https://doi.org/10.1111/j.1752-9824.2011.01098.x
[43]. Gholamaliei B, Karimi-Shahanjarini A, Roshanaei G, Rezapour-Shahkolaei F. Medication Adherence and its Related Factors in Patients with Type II Diabetes. J Educ Community Health. 2016;2(4):3-12. DOI: 10.21859/jech-02042.
[44]. Gabr WM, Shams ME. Adherence to medication among outpatient adolescents with epilepsy. Saudi Pharm J. 2015;23 (1):33-40. DOI: 10.1016/j.jsps.2014.05.003
[45]. Selvin E, Coresh J, Brancati FL. The burden and treatment of diabetes in elderly individuals in the U.S. Diabetes Care. 2006; 29(11):2415-9. doi: 10.2337/dc06-1058. PMID: 17065677.
International Diabetes Federation; 2010.
[2]. Mohamadinejad F, Pedram Razi S, Aliasgharpour M, Tabari F, Kazemnejad A. Effect of patient education program on self-efficacy in patients with diabetes. Iran J Nurs Res. 2015;10(1):35-41. URL: http://ijnr.ir/article-1-1479-en.html
[3]. Olfatifar M, Karami M, Shokri P, Hosseini SM. Prevalence of chronic complications and related risk factors of diabetes in patients referred to the diabetes center of Hamedan Province. Sci J Hamadan Nurs Midwifery Fac . 2017;25(2):69-74. URL: http://nmj.umsha.ac.ir/article-1-1507-en.html
[4]. IDF T. Diabetes Atlas Eighth edition 2017 provides the latest figures, information and projections on diabetes worldwide 2017 https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html.
[5]. Jafarvand E, Ataey A, Edalati S. Epidemiology and Death Trends Due to Diabetes in Iran. The Horizon of Medical Sciences. 2021;10;27(2):198-213. URL: http://imtj.gmu.ac.ir/article-1-2939-en.html
[6]. Jafarvand E, Ataey A, Edalati S. Epidemiology and Death Trends Due to Diabetes in Iran. Horizon Med Sci. 2021; 27 (2) :198-213 URL: http://hms.gmu.ac.ir/article-1-2939-fa.html
[7].Agardh CD, Berne C. Diabetes. Liber AB, Stockholm. 2009.
[8]. Azizi Karaj M,Dehghani F, Kamali Zarch . Mediating Role of Emotional Self-Regulation in the Relationship between Mindfulness and Self-Efficacy in Diabetes Type 2 Patients. Horizon of Medical Sciences. 2017;23(3):243-250. DOI: 18869/acadpub.hms.23.3.243
[9]. Richards DK. A Psychometric Evaluation of the Treatment Self-Regulation Questionnaire (TSRQ) for Assessing Motivations for Responsible Drinking. The University of Texas at El Paso; 2018.
[10]. Chew B-H, Shariff-Ghazali S, Fernandez A. Psychological aspects of diabetes care: Effecting behavioral change in patients. World J Diabetes . 2014;5(6):796- 808. doi: 10.4239/wjd.v5.i6.796
[11]. Abasi MH, Eslami AA, Rakhshani F, Shiri M. Development and psychometric properties of a selfregulation scale about leisure time physical activity in Iranian male adolescents. Iran J Nurs Midwifery Res. .2016;21(2):1890.
[12]. Deci E, Ryan, RM. The "What" and "Why" of goal pursuits: human needs and the self-determination of behavior. An International Journal for the Advancement of Psychological Theory. 2009;11(4). https://doi.org/10.1207/S15327965PLI1104_01
[13]. Kadivar, P. Psychology of learning. 2014; 7th Edition, Tehran: Samt. [In Persian].
[14]. Chuman N, Hatamochi C. Intervention Effect Based on Self-Regulation to Promote the Continuation of Self-Care Behavior of Patients with Type-2 Diabetes Mellitus. Health. 2021; 30;13(04):472. DOI: 10.4236/health.2021.134037.
[15]. Abdoli S, Ashktorab T, Ahmadi F, Parvizy S, Dunning T. Seeking new identity through the empowerment process Iran J Nurs Midwifery Res. 2014;19(2):145-51. Iran J Nurs Midwifery Res.
[16]. Vaid E, Lansing AH, Stanger C. Problems with self-regulation, family conflict, and glycemic control in adolescents experiencing challenges with managing type 1 diabetes. J. Pediatr Psychol. 2018;43(5):525-33. https://doi.org/10.1093/jpepsy/jsx134.
[17]. American Diabetes Association. Standards of medical care in diabetes 2019. Diabetes Care. 2019;42: S1–193.
[18]. Araki E, Goto A, Kondo T, Noda M, Noto H, Origasa H, Osawa H, Taguchi A, Tanizawa, 8 Kazuyuki Tobe Y, Yoshioka N. Japanese clinical practice guideline for diabetes 2019. J Diabetes Investig. 2020;11(3):165–223. doi: 10.1111/jdi.13306.
[19]. Gerdi Weidner, Monika Sieverding & Margaret A. Chesney The role of self-regulation in health and illness, Psychol Health Med . 2016; 21:2, 135-137, DOI:
10.1080/13548506.2015.1115528
[20]. Egede LE, Gebregziabher M, Echols C, Lynch CP. Longitudinal effects of medication nonadherence on glycemic control. Ann Pharmacother. 2014;48(5):562–70. DOI: 10.1177/1060028014526362.
[21]. Siebolds M, Gaedeke O, Schwedes U, SMBG Study Group. Self-monitoring of blood glucose—psychological aspects relevant to changes in HbA1c in type 2 diabetic patients treated with diet or diet plus oral antidiabetic medication. Patient Educ Couns 2006; 62: 104-10. DOI: 10.1016/j.pec.2005.06.013
[22]. Al-Sahouri A, Merrell J, Snelgrove S. Barriers to good glycemic control levels and adherence to diabetes management plan in adults with Type-2 diabetes in Jordan: a literature review. Patient Preference And Adherence. 2019;13:675. DOI: 10.2147/PPA.S198828.
[23]. Kugbey N, Oppong Asante K, Adulai K. Illness perception, diabetes knowledge and self-care practices among type-2 diabetes patients: a cross-sectional study. BMC Res Notes. 2017; 10;10(1):381. doi: 10.1186/s13104-017-2707-5
[24]. Pizzignacco TMP, Mello DFd, Lima RAGd. Stigma and cystic fibrosis. Revista Latino-Americana De Enfermagem. 2010;18(1):139-42. https://doi.org/10.1590/S0104-11692010000100021
[25]. Huang CH, Li SH, Shu B. Exploring the relationship between illness perceptions and negative emotions in relatives of people with schizophrenia within the context of an affiliate stigma model. Nurs Res. 2016; 24( 3): 217-23. doi: 10.1097/jnr.0000000000000124.
[26]. Li J, Qiu X, Yang X, Zhou J, Zhu X, Zhao E, Qiao Z, Yang Y, Cao D. Relationship between illness perception and depressive symptoms among type 2 diabetes mellitus patients in China: a mediating role of coping style. J Diabetes Res. 2020;15. DOI: 10.1155/2020/3142495
[27]. Zhou Q, Li X, Zou F, Wu L, Chen H, Liu Z. Effect of systematic self-management education on quality of life, anxiety and depression of patients with Type 2 diabetes in communities. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2011; 36: 133-7. doi: 10.3969/j.issn.1672-7347.2011.02.007.
[28]. Rahimi Z, Baljani S, Zadgasem Z. Investigating the relationship between illness perception and quality of life in hemodialysis patients; Iran J Crit Care Nurs 2012;5(3):151-158
[29]. Kato A, Fujimaki Y, Fujimori S, Isogawa A, Onishi Y, Suzuki R, Yamauchi T, Ueki K, Kadowaki T, Hashimoto H. Psychological and behavioural patterns of stigma among patients with type 2 diabetes: a cross-sectional study. BMJ Open. 2017;7(3):e013425. doi: 10.1136/bmjopen-2016-013425
[30]. Browne JL, Ventura A, Mosely K, Speight J. ‘I call it the blame and shame disease’: a qualitative study about perceptions of social stigma surrounding type 2 diabetes. BMJ Open. 2013;3(11):e003384. doi: 10.1136/bmjopen-2013-003384
[31]. Børte, S. and Ottersen, V. S."Stigmatization of children with chronic diseases, exemplified by type 1 diabetes mellitus.: Differences between India and Norway 2012.
[32]. Rasoolinajad M, Abedinia N, Noorbala AA, Mohraz M, Moradmand Badie B. Effect of mental health, coping mechanisms and stigma on risky behaviors in HIV positive patients in Iran: A cross-sectional study. Razi Journal of Medical Sciences.2017; 24(159):83-93. URL: http://rjms.iums.ac.ir/article-1-4685-en.html
[33]. Gaffman E. Stigma-Netesonth Management of Spiiled Identify,15th ed, Touchstone Publish, England.2012.
34. Weiss, M, Ramakrishna, J, Somma, D. Health-related stigma: rethinking concepts and interventions. Psychol Health Med .2006; 11 (3): 277-287. DOI: 10.1080/13548500600595053
[35]. Yousefi A, Shaghaghi F, Dehestani M, Barghi Irani Z., The Relationship between Quality of Life (QoL) and Psychological Capital with Illness Perception in MS Patients . Health Psychol .2012;1(1).32-45.
[36]. Shahbazi H, Ghofranipour F, Amiri P, Rajad A. Perceptions, enablers and nurturers related to self-care behaviors in adolescent with type 1 diabetes. Iran. J. Endocrinol. Metab 2018;19(6):435-43.
[37]. Salehi S, Shafiei S, Amini P, Abdeyazdan G. Self-care performance in children and adolescents with type 1 diabetes mellitus. J Chronic Dis Care. 2014;3(3):e21706. DOI: 10.17795/jjcdc-21706
[38]. Mahdilouy P, Ziaeirad M. Self-care Status and Its Relationship with Demographic and Clinical Characteristics in Adolescents and Young People with Type I Diabetes . J Diabetes Nurs. 2019; 7 (1) :714-727. URL: http://jdn.zbmu.ac.ir/article-1-345-en.html
[39]. Lin K, Yang X, Yin G, Lin S. Diabetes self-care activities and health-related quality-of-life of individuals with type 1 diabetes mellitus in Shantou, China Int J Med Res. 2016;44(1):147-56. DOI: 10.1177/0300060515597933
[40]. Fuladvandi M, Safarpour H, Malekyan L, Moayedi S, Mahani MA, Salimi E. The Survey of self-regulation behaviors and related factors in elderly with hypertension in south-east of Iran. Health. 2017;9(04):592-600. doi: 10.4236/health.2017.94042.
[41]. Sabeti Bilondi S, Delshad Noghabi A, Aalami H. The relationship between illness perception and medication adherence in patients with diabetes mellitus type II: illness perception and medication adherence. J Prev Med Hyg. 2021;62(4): E966–E971. doi: 10.15167/2421-4248/jpmh2021.62.4.2277
[42]. Abubakari AR Jones , MC, Lauder W, Kirk A, Anderson J, Devendra D. Associations between knowledge, illness perceptions, self-management and metabolic control of type 2 diabetes among African and European-origin patients. J Nurs Healthc Chronic Illn.. 2011; 3 (3): 245-256. https://doi.org/10.1111/j.1752-9824.2011.01098.x
[43]. Gholamaliei B, Karimi-Shahanjarini A, Roshanaei G, Rezapour-Shahkolaei F. Medication Adherence and its Related Factors in Patients with Type II Diabetes. J Educ Community Health. 2016;2(4):3-12. DOI: 10.21859/jech-02042.
[44]. Gabr WM, Shams ME. Adherence to medication among outpatient adolescents with epilepsy. Saudi Pharm J. 2015;23 (1):33-40. DOI: 10.1016/j.jsps.2014.05.003
[45]. Selvin E, Coresh J, Brancati FL. The burden and treatment of diabetes in elderly individuals in the U.S. Diabetes Care. 2006; 29(11):2415-9. doi: 10.2337/dc06-1058. PMID: 17065677.