OCR Text |
Show Table 1. Results of Mulitvariate Logistic Regression Analyses of Four Diabetes Self-Management Behaviors. Daily Blood Glucose Monitoring Daily Feet Checking Following a Meal Plan Exercising 3+ Times a Week Odds Ratio C.I. Odds Ratio C.I. Odds Ratio C.I. Odds Ratio C.I. Age (50+-1) 0.45** 0.25-0.83 1.91* 1.07-3.43 1.01 0.59-1.73 1.14 0.66-1.97 Gender (Male=l) 0.52** 0.37-0.85 0.72 0.42-1.22 0.56** 0.35-0.89 1.94** 1.20-3.12 Diagnosis duration (5+ years=l) 1.65* 1.01-2.70 0.91 0.54-1.56 0.54** 0.33-0.87 1.20 0.74-1.94 Education (college grad+=l) 0.59* 0.35-1.00 0.50** 0.29-0.87 1.04 0.62-1.72 0.79 0.47-1.33 Health Status (good, very good, excellent =1) 1.04 0.61-1.76 1.25 0.71-2.19 1.43 0.87-2.35 1.38 0.83-2.28 Not depressed (=1) 1.07 0.54-2.12 0.90 0.44-1.87 1.18 0.63-2.23 1.96* 1.04-3.68 Diabetes education in past year (=1) 2.71*** 1.48-4.96 1.87* 0.99-3.51 1.22 0.72-2.05 1.03 0.61-1.76 Initial Log Likelihood 427.55 372.96 442.56 430.45 Model x2 37.74** 16.22* 14.19* 17.72* d.f. 7 7 7 7 (n) (321) (321) (321) (321) *** p .001; **p.01: * f ). 05 tion showed a similar positive effect on the likelihood that persons with diabetes will check their feet for sores or irritations at least once daily. Thus, even with this minimally invasive self-management behavior, additional diabetes education efforts yield beneficial results. At the same time, however, it should be noted that diabetes education did not play a prominent role in increasing engagement in the other two behaviors, namely, following a meal plan and exercising regularly. Further attention, therefore, should be directed towards understanding how diabetes education programs could more effectively address these two behaviors. Depression seemed to play a minor role in promoting self-management behaviors when all other factors were considered, except in the case of regular exercise participation. Thus, even though blood glucose monitoring entails complex requirements and high personal investment, mental health does not seem to play a pivotal role in the likelihood of engaging in this behavior. Exercise, on the other hand, which also entails a high degree of effort, does appear dependent on mental health status. Reasons why mental health status operates differently for these two behaviors warrants further investigation. Feet checking promotion efforts need to place more focus on younger adults and those with higher levels of education. As with daily blood glucose monitoring, diabetes education plays an important role in promoting daily feet checking. Following a meal plan deserves greater promotion among males and those five or more years post-diagnosis, hi contrast, promotion of exercise regimens needs to be directed toward females and the depressed. The finding of a lower likelihood of daily blood glucose monitoring and feet checking among the highly educated appears paradoxical. Perhaps those highly educated individuals are more likely to be involved in work roles with high time demands, militating against optimal blood glucose monitoring. This tentative explanation, however, raises the question as to why the influence was also apparent for feet checking with its relatively low requirements, demands and degree of personal investment. Preliminary bivariate analyses employing a trichotomous classification for education revealed no statistically significant difference between those with one to three years of post-high school education and those with lesser amounts of education. hi summary, the results show a complex relation between the examined covariates and diabetes self-management behavior. Further work needs to be done to understand the dynamics underlying the observed variations in the strength and direction of influence of subgroup affiliation across self-management behaviors and for public health personnel to effectively address the challenges implied by these diversities in the development of program initiatives. REFERENCES American Diabetes Association. (2003). Standards of Medical Care for Patients With Diabetes Mellitus. Diabetes Care, 26, S33-S50. ABOUT THE AUTHORS Uremia Rails, PhD, Diabetes Control Program, Utah Department of Health. William F. Stinner, PhD, Department of Sociology, Utah State University Carol Rasmussen, RN, CDE, Diabetes Program Coordinator, Uintah Basin Medical Center Nancy C. Neff, MS, Diabetes Control Program, Utah Department of Health LaDene Larsen, RN, Director of the Bureau of Health Promotion, Utah Department of Health . . Utah's Health: An Annual Review Volume DC 39 |