Main Article Content
Poorly controlled type 2 diabetes, a complex phenomenon, is rapidly increasing particularly in older adults worldwide and in Thailand, the setting of this study. Effectiveness of diabetes self-management demands various factors supporting optimal outcomes. This descriptive correlational study examined the influences of ecological factors including gender, time since diagnosis, family history of type 2 diabetes mellitus, abdominal obesity, diabetes complications, health literacy, social networks, and social support on diabetes self-management. Through purposive sampling, the participants consisted of 166 older adults with poorly controlled type 2 diabetes mellitus at two hospitals in central Thailand province. Data were collected using questionnaires on the Functional, Communicative and Critical Health Literacy Scale, the revised Summary of Diabetes Self-Care Activities Scales, the Social Network in Adults Life, and the Diabetes Severity Complication Index; and nutrition assessment including waist circumference and HbA1c. Descriptive statistics and Stepwise Multiple Regression Analysis were used for data analysis.
Results revealed that health literacy, abdominal obesity, time since diagnosis, and gender could together predict diabetes self-management, accounting for 14.7% of the variance. Prior to developing an effective intervention, an additional variable more specific to older adults needs to be examined such as self-efficacy that affects older adults’ confidence regarding health behavior modification. Nevertheless, these findings suggest approaches for nurses to promote diabetes self-management education that includes enhancing health literacy, and modifying health behaviors for control of abdominal obesity based on other health conditions, particularly in male older adults with type 2 diabetes mellitus.
Copyright: The Pacific Rim International Journal of Nursing Research, Thailand Nursing & Midwifery Council has exclusive rights to publish, reproduce and distribute the manuscript and all contents therein.
2. Department of Older Persons. 2018 [cited 2019 April 5]. Available from: https://www.dop.go.th/download/knowledge/ th1550973505-153_0.pdf.
3. International Diabetes Federation. IDF 2017 Atlas. 2017 [cited 2018 April 9]. Available from: https://www.diabetesatlas. org/IDF_Diabetes_Atlas_8e_interactive_EN/.
4. Aekplakorn W. Thai National Examination Survey V: Health System Research Institute. 2016 [cited 2016 April 9]. Available from: https://www.hsri.or.th/researcher/ research/new-release/detail/7711.
5. Abdelhafiz AH, Sinclair AJ. Management of type 2 diabetes in older people. Diabetes Ther. 2013;4:13-26. doi:10.1007/s13300-013-0020-4.
6. Koetsenruijter J, van Lieshout J, Lionis C, Portillo MC, Vassilev I, Todorova E, et al. Social support and health in diabetes patients: An observational study in six European countries in an era of austerity. PLoS ONE. 2015;10(8): e0135079. doi: 10.1371/journal.pone.0135079.
7. Burini RC, Kano, HT, Nakagaki MS, Frenhani PB, McLellan KC. Behavioral factors of abdominal obesity and effects of lifestyle changes with fiber adequacy. Insights Obes Gen Beyond. 2017;1:14-22.
8. Adejoh SO. Family unit in the context of diabetes management among the Igala, North‐Central, Nigeria. Med Soc Online. 2012;6(3):24-35.
9. Ojewale LY, Oluwatosin AO, Fasanmade AA, Odusan O. A survey on patients’ characteristics, perception of family support and diabetes self‐management among type 2 diabetes patients in South‐West Nigeria. Nursing Open. 2019:1-8. doi: 10.1002/nop2.23.
10. Power MA, Bardsley J, Cypass M, Duker P, Funnell MM, Fischl AH, et al. Diabetes self-management education and support in type 2 diabetes: a joint Position Statement of the American Diabetes Association of Diabetes Educators, and the Academy of Nutrition and Dietitians. Diabetes Care. 2015;38(7):1372-82. doi: 10.2337/dc15-0730.
11. Penno G, Solini A, Bonora E, Fondelli C, Orsi E, Zerbini G, et al. Gender differences in cardiovascular disease risk factors, treatments and complications in patients with type 2 diabetes: the RIACE Italian multicentre study. J Inter Med. 2013;274(2):176-91. doi: 10.1111/joim.12073.
12. Ledford CJ, Cafferty LA, Russell TC. The influence of health literacy and patient activation on patient information seeking and sharing. J Health Commun. 2015;20(suppl 2): 77-82. doi: 10.1080/10810730.2015.1066466.
13. Boontasean W, Carlssan A, Rosner ID, Ostman M. Sexrelated illness perception and self-management of a Thai type 2 diabetes mellitus population: a cross-sectional descriptive design. BMC Endocr Disord. 2018;18(5). doi: 10.1186/s12902-017-0229-8.
14. Bronfenbrenner U. The bioecological theory of human development. In Bronfenbrenner U. editor. Making human beings human: bioecological perspectives on human development. CA: Sage; 2005, pp. 3-15.
15. Berkman LF, Krishna A. Social network epidemiology. In Berkman LF, Kawachi I, Glymour MM. editors. Social epidemiology. New York: Oxford University Press; 2014, pp. 234-89.
16. Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2001;15:259-67.
17. Tsutsui H, Nomura K, Kusunoki M, Ishiguro T, Ohkubo T, Oshida Y. Gender differences in the perception of difficulty of self-management in patients with diabetes mellitus: a mixed-methods approach. Diabetol Int. 2016;7:289-98. doi: 10.1007/s13340-015-0249-4.
18. Nutbeam D. Health promotion glossary. Health Promot Int. 1998;13(4):349-364. doi: 10.1093/heapro/13.4.349.
19. Rogers A, Vassilev I,Sanders C, Kirk S, Chew-Graham C, Kennedy A, et al. Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support. Implement Sci. 2011;6:56. doi: 10.1186/1748- 5908-6-56.
20. Wallace DD, Rodriguez HG, Walker E, Dethlefs H, Dowd RA, Filipi L, et al. Types and sources of social support among adults living with type 2 diabetes in rural communities in the Dominican Republic. Glob Public Health. 2019; 14(1):135-46. doi: 10.1080/17441692.2018.1444782.
21. Fazioa S, Edwards J, Miyamoto S, Henderson S, Dharmar M, Young HM. More than a1c: types of success among adults with type-2 diabetes participating in a technologyenabled nurse coaching intervention. PEC. 2019;102:106-12. doi: 10.1016/j.pec.2018.08.028.
22. Antonucci TC, Ajrouch KJ. Birditt KS. The convoy model: explaining social relations from a multidisciplinary perspective. Gerontologist. 2013. doi: 10.1093/geront/gnt118.
23. Ashida S, Heaney CA. Differential associations of social support and social connectedness with structural features of social networks and the health status of older adults. J Aging Health. 2008;20(7):872-93. doi: 10.1177/089 8264308324626.
24. Vassilev I, Rogers A, Blickem C, Brooks H, Kapadia D, Kennedy A, et al. Social networks, and the ‘work’ and work force of chronic illness self-management: a survey analysis of personal communities. PLos ONE. 2013; 8:e59723.
25. Vissenberg C, Stronks K, Nijpels G, Uitewaal PJ, Middelkoop BJ, Kohinor MJ, et al. Impact of a social network-based intervention promoting diabetes selfmanagement in socioeconomically deprived patients: a qualitative evaluation of the intervention strategies. BMJ Open. 2016;6:e010254. doi: 10.1136/ bmjopen2015-010254.
26. The Royal College of Physicians of Thailand, Diabetes Association of Thailand, Endocrine Society of Thailand, Ministry of Public Health, and National Health Security Office. Clinical practice guideline for diabetes 2014. Thailand: Bangkok; 2014 [in Thai].
27. Folstein, MF, Folstein SE, McHugh, PR. “Mini-mental status”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3): 189-98. doi: 10.1016/0022-3956(75)90026-6.
28. Masoompour M, Tirgari B, Ghazanfari Z. The relationship between health literacy, self-efficacy, and self-care behaviors in diabetic patients. EBCJ. 2017;7(3):17-25. doi: 10.22038/EBCJ.2017.24826.1551.
29. Ishikawa H, Takeuchi T, Yano E. Measuring functional, communicative, and critical health literacy among diabetic patients. Diabetes Care. 2008;31(5):874-79.
30. Maneesriwongul W. A study project for caring need evaluation in people with HIV receiving anti-retroviral treatment. Thailand: Bangkok; 2013 [in Thai].
31. Prabsangob K. Relationship of health literacy and self-care behavior among type 2 diabetic patients in Banpong district, Ratchaburi province. SSRU. 2016;2638-50 [in Thai].
32. Keeratiyutawong P, Hanucharurnkul S, Melkus GD, Panpakdee O, Vorapongsathorn T. Effectiveness of a selfmanagement program for Thais with type 2 diabetes. TJNR. 2005;10(2):85-97. 33. Toobert DJ, Hampson SE, Glasgow RE. The Summary of Diabetes Self-Care Activities: Measure results from 7 studies and a revised scale. Diabetes Care. 2000;23(7): 943-50. doi: 10.2337/diacare.23.7.943.
34. Antonucci TC, Akiyama H. Social networks in adult life and a preliminary examination of the convoy model. J Gerontol. 1987;42(5):519-27. doi: 10.1093/geronj/42.5.519.
35. Young BA, Lin E, Von Korff M, Simon G, Ciechanowski P, Ludman EJ, et al. Diabetes complications severity index and risk of mortality, hospitalization, and healthcare utilization. Am J Manag Care. 2008;14(1):15-23.
36. Bureau of Nutrition, Department of Health, Ministry of Public health. Metabolic syndrome. Thailand: Bangkok; 2011 [in Thai].
37. McCollum M, Hansen LB, Lu L, Sullivan PW. Gender differences in diabetes mellitus and effects on self-care activity. Gender Med. 2005;2(4):246-54.
38. Manjula GB, Premkumar J. Self-efficacy and self-care behaviour among patients with type 2 diabetes mellitus – a cross sectional survey. IJSR. 2015;4(12):2047-51.
39. Knutsen IR, Foss IC, Todorova E, Roukova P, Kennedy A, Portillo MC, et al. Negotiating diet in networks: a crossEuropean study of the experiences of managing type 2 diabetes. Qual Health Res. 2015. doi: 10.1177/1049732315610318.
40. Yotsapon T, Sirinate K, Ekgaluck W, Somboon V, Tawee A, Worawit K, et al. Clinical characteristics and outcomes of the oldest old people with type 2 diabetes–perspective from a tertiary diabetes center in Thailand. BMC Endocr Disord. 2016;16:30. doi: 10.1186/s12902-016-0115-9.