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Show Variations in Self-Management Behavior among Adult Utahns with Diabetes Brenda Rails, Ph.D.; William F. Stinner, Ph.D.; Carol Rasmussen, R.N., C.D.E.; Nancy C. Neff, M.S.; LaDene Larsen, R.N. Diabetes complications can be avoided or delayed if patients adhere to a consistent regimen of self-management behaviors. Little, however, is known about what factors influence engagement in these behaviors and how these effects might vary in strength and direction across self-management behaviors. Multivariate logistic regression techniques were used to explore the degree and nature of the effects of seven covariates on four self-management behaviors among a sample of 321 adult Utahns with diabetes. Four self-management behaviors show a high degree of selectivity in the strength and direction of their effect. Diabetes is a serious disease for which effective management requires substantial and persistent commitment from patients. Complications of this potentially fatal disease include blindness, amputation, kidney failure, and heart failure. The management regimen can be inconvenient and time-consuming; however, effective management can delay complications or prevent them altogether. (American Diabetes Association, 2003). Patient management covers a broad spectrum of lifestyle adaptations including such behaviors as daily monitoring of blood glucose levels, following a meal plan, checking feet daily for sores or irritations, and participating in a regular exercise program. Regimen prescriptions are filtered through the interpretive lenses of diverse subgroups and they may differ in their capacity or ability to meet regimen demands. The subgroup variations in perceptions and coping ability can produce subgroup differences in compliance with a particular self-management regimen. For example, males may interpret the need for strict adherence to a regimen differently than females, and persons in poor physical and mental health may face greater obstacles in adhering with the requirements and demands of a self-management regimen than those in better physical and mental health. Various practice regimens, however, entail different requirements and demands. For example, daily monitoring of blood glucose levels carries a considerably more complex set of requirements and demands and degree of personal investment than conducting daily foot exams. A certain amount of personal investment must be made in obtaining a glucometer and training in its use. Test strips are costly even though they may offer some convenience. Daily foot exams, on the other hand, are minimally invasive, requiring only a visual and manual inspection; no equipment is necessary. Since regimens themselves vary in requirements, demands, and levels of personal investment, subgroup variations in strength and direction of the effect of different management structures might reasonably be anticipated across self-management behaviors. For example, subgroup variations could be greatest where regimens have complex requirements and demands, involving high personal investment, e.g., daily blood glucose monitoring. Conversely, subgroup variations would be less evident where regimen requirements and demands are less complex, involving lower levels of personal investment, e.g., daily feet checking. Finally, members of certain subgroups may be more compliant regarding one treatment regime but less compliant on another than members of another counterpart subgroup; hence, there could even be a reversal in the direction of influence. hi summary, compliance involves a complex meshing of subgroup perceptions and ability to cope with the diverse requirements, demands, and the personal investment of various regimens. Little is known, however, regarding these dynamics for adult Utahns with diabetes. A good beginning point is to document the influence of subgroup membership on a range of self-management behaviors among adults with diabetes. The present investigation is centered on exploring the degree and nature of the effects of seven covariates on four self-management behaviors among a sample of adult Utahns with diabetes. Specifically, this study seeks to ascertain: (1) the degree of selectivity or consistency in the pattern of regimen effects and overall fit of the model across self-management behaviors; and (2) which specific covariates appear most relevant to each self-management behavior. DATA AND METHODS The data for this analysis were drawn from the Utahns with Diabetes Survey, a 2002 statewide telephone survey of Utahns with diabetes. The survey was aimed at collecting data on self-management behaviors, complications, and provider care among Utahns diagnosed with diabetes. The present analysis focuses on a sample of 321 respondents who provided information on all of the variables included in the analysis. The sample was weighted to reflect the age and gender distribution of the Utah population. As previously indicated, four self-management behaviors were examined from the responses to the survey questions. Each behavior was measured as a dichotomy. For both glucose monitoring and foot checking, those who replied engaging in the behavior at least once daily were coded as "1", while those who did not were coded "0". Those who followed a meal plan were coded "1" whereas those who did not were coded "0". Those exercising at least three times a week (regardless of intensity or duration) were coded as "1", while those exercising less than three times a week or not at all were coded "0**. All seven covariates were also measured as dichotomies. The coding was as follows: Age (50 Years or Older=l; Else=0), Gender (Male =1; Female =0); Diagnosis Duration (5+ years since diagnosis =1; Else=0); Education (College Graduate or Higher =1; Else=0); Health Status (Good, Very Good. Excel-lent=l; Fair/Poor=0); Not Depressed (=1: Else =0); Diabetes Education During 12 Months Preceding Survey (Yes=l; No=0). Data were analyzed using multivariate logistic regression analysis with the primary focus on the odds ratios measuring the effect of each covariate. Each was considered simultaneously. Utah's Health: An Annual Review Volume DC 37 |
