A Predictive Model on Self Care Behavior for Patients with Type 2 Diabetes: Based on Self-Determination Theory

Seo, Yeong Mi; Choi, Won Hee

doi:10.4040/jkan.2011.41.4.491

J Korean Acad Nurs. 2011 Aug;41(4):491-499. Korean.
Published online Aug 31, 2011.
https://doi.org/10.4040/jkan.2011.41.4.491

Original Article

A Predictive Model on Self Care Behavior for Patients with Type 2 Diabetes: Based on Self-Determination Theory

Yeong Mi Seo,¹ and Won Hee Choi²

Author information

Author notes

Copyright and License

- ¹Full-time Lecturer, Department of Nursing, Dongseo University, Busan, Korea.
- ²Assistant Professor, Department of Nursing, Koje College, Geoje, Korea.
Address reprint requests to: Choi, Won Hee. Department of Nursing, Koje College, 654-1 Jangseungpo-dong, Geoje 656-701, Korea. Tel: +82-55-680-1570, Fax: +82-55-680-1517, Email: daeam67@hanmail.net

Received January 17, 2011; Accepted August 04, 2011.

Abstract

Purpose

The study was conducted to develop and test a hypothetical model which explains self-care behavior in patients with type 2 diabetes was established based on the Self-Determination Theory.

Methods

The participants were 218 patients with type 2 diabetes mellitus enrolled in an outpatient clinic of one endocrine center in Korea. The data were collected using questionnaires from April 5 through May 7, 2010. The descriptive and correlation statistics were analyzed using the SPSS/WIN 15.0 and the structural equation modeling procedure was performed using the AMOS 7.0 program.

Results

The results of this study showed that competence and autonomous motivation were the strong factors influencing self-care behavior in patients in this sample. Support from health provider for autonomy was a significant indirect factor on self-care behavior. These factors explained 64.9% of variance in the participants' self care behavior. The proposed model was concise and extensive in predicting self-care behavior of the participants.

Conclusion

Findings may provide useful assistance in developing effective nursing interventions for maintaining and promoting self-care behavior in patients with type 2 diabetes.

Keywords

Diabetes mellitus; Type 2; Self-care; Motivation

Figures

Figure 1
Hypothetical model.

X1=Information and options; X2=Nonjudgmental and positive feedback; Y1=Diet; Y2=Medication; Y3=Exercise; Y4=Competence; Y5=Diet and exercise; Y6=Medication and sugar check.

Click for larger image

Figure 2
Path diagram of the modified model.

X1=Information and options; X2=Nonjudgmental and positive feedback; Y1=Diet; Y2=Medication; Y3=Exercise; Y4=Competence; Y5=Diet and exercise; Y6=Medication and sugar check.

Click for larger image

Tables

Table 1
Correlations Matrix among Measurable Variables

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Table 2
Model Fitness Index for Hypothetical and Modified Model

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Table 3
Estimates and Effects of Predictor Variables in Modified Mode

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References

1. Bandura A. Human agency in social cognitive theory. American Psychologist 1989;44:1175–1184.
  doi: 10.1037/0003-066x.44.9.1175.
1. Becker MH. The health belief model and sick role behavior. In: Becker MH, editor. The health belief model and personal health behavior. New Jersey: Charles B. Slack; 1974. pp. 82-92.
1. Choi EJ. In: Factors related to glycemic control in patients with type 2 diabetics mellitus. Seoul: Yonsei University; 2007.
  Unpublished doctoral dissertation.
1. Choi EO. In: Effects of empowerment education program for the type 2 diabetics on the empowerment, self-care behavior and the glycemic control. Seoul: Seoul National University; 1998.
  Unpublished doctoral dissertation.
1. Chou CP, Bentler PM. Estimates and tests in structural equation modeling. In: Hoyle RH, editor. Structural equation modeling. Thousand Oaks, CA: Sage; 1995. pp. 37-59.
1. Deci EL, Ryan RM. In: Intrinsic motivation and self-determination in human behavior. New York: Plenum; 1985.
  CrossRef
1. Deci EL, Ryan RM. The "what" and "why" of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry 2000;11:227–268.
1. Fortier MS, Sweet SN, O'Sullivan TL, Williams GC. A self-determination process model of physical activity adoption in the context of a randomized controlled trial. Psychology of Sport and Exercise 2007;8:741–757.
  doi: 10.1016/j.psychsport.2006.10.006.
1. Gu MO. In: A structural model for self-care behavior and metabolic control in diabetic patient. Seoul: Seoul National University; 1992.
  Unpublished doctoral dissertation.
1. Hazavehei SM, Sharifirad G, Mohabi S. The effect of educational program based on health belief model on diabetic foot care. International Journal of Diabetes in Developing Countries 2007;27:18–23.
1. Kennedy S, Goggin K, Nollen N. Adherence to HIV medications: Utility of the theory of self-determination. Cognitive Therapy and Research 2004;28:611–628.
  doi: 10.1023/B:COTR.0000045568.95219.e2.
1. Kim KS. In: Structural equation model: AMOS 7.0. Seoul: Hannarae; 2007.
1. Ko CH, Gu MO. The effects of a diabetic educational program for coping with problem situation on self-efficacy, self care behaviors, coping and glycemic control in type 2 diabetic patients. Journal of Korean Academy of Nursing 2004;34:1205–1214.
  PubMed
1. Korea Centers for Disease Control and Prevention. 2007 Korea national health statistics: The fourth Korea national health and nutrition examination survey (Issue Brief No. 11702). Seoul: Author; 2008 Dec.
1. Lee YS. The current status of type 2 diabetes management at a university hospital. Korean Diabetes Journal 2009;33:241–250.
  doi: 10.4093/kdj.2009.33.3.241.
1. Lim KB, Lee R, Ko KN, Choi EY, Kim JH, Cheong YS, et al. Self-care for diabetic patients in primary care. Journal of the Korean Academy of Family Medicine 2007;28:106–113.
1. Markland D, Ryan RM, Tobin VJ, Rollnick S. Motivational interviewing and self-determination theory. Journal of Social and Clinical Psychology 2005;24:811–831.
  doi: 10.1521/jscp.2005.24.6.811.
1. Münster Halvari AE, Halvari H. Motivational predictors of change in oral health: An experimental test of self-determination theory. Motivation and Emotion 2006;30:294–305.
  doi: 10.1007/s11031-006-9035-8.
1. Park JH, Kim KW, Kang EJ, Kim TY, Lee SR, Bae SC, et al. Evaluation of glycemic control in type 2 diabetic patients have been treated in general hospital. The Journal of Korean Diabetes Association 2004;28:208–218.
1. Pender NJ. In: Health promotion in nursing practice. 3rd ed. Stanford, CT: Appleton & Lange; 1996.
1. Peyrot M. Behavioral change in diabetes education. Diabetes Educator 1999;25(6):62–73.
  doi: 10.1177/014572179902500624.
1. Ryan RM, Patrick H, Deci EL, Williams GC. Facilitating health behavior change and its maintenance: Interventions based on self-determination theory. The European Health Psychologist 2008;10(1):2–5.
1. Senecal C, Nouwen A, White D. Motivation and dietary self-care in adults with diabetes: are self-efficacy and autonomous self-regulation complementary or competing constructs? Health Psychology 2000;19:452–457.
  doi: 10.1037/0278-6133.19.5.452.
1. Seo YM. In: A structural model development for health behavior adherence in hypertensive or diabetic patients. Daegu: Kyungpook National University; 2008.
  Unpublished doctoral dissertation.
1. Sheldon KM, Williams GC, Joiner T. In: Self-determination theory in the clinic: Motivating physical and mental health. New Haven, CT: Yale University Press; 2003.
1. Prospective U, Holman RR. UK Prospective Diabetes Study(UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837–853.
  doi: 10.1016/S0140-636(98)07019-6.
1. Williams GC, Freedman ZR, Deci EL. Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes Care 1998;21:1644–1651.
  doi: 10.2337/diacare.21.10.1644.
1. Williams GC, Grow VM, Freedman ZR, Ryan RM, Deci EL. Motivational predictors of weight loss and weight-loss maintenance. Journal of Personality and Social Psychology 1996;70:115–126.
  doi: 10.1037/0022-3514.70.1.115.
1. Williams GC, McGregor HA, Zeldman A, Freedman ZR, Deci EL. Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. Health Psychology 2004;23:58–66.
  doi: 10.1037/0278-6133.23.1.58.
1. Williams GC, Patrick H, Niemiec CP, Williams LK, Devine G, Lafata JE, et al. Reducing the health risks of diabetes: How self-determination theory may help improve medication adherence and quality of life. Diabetes Educator 2009;35:484–492.
  doi: 10.1177/0145721709333856.