Information, Motivation and Behavioural Factors in Influencing Diabetes Self-Care: A Conceptual Paper
Globally, diabetes is a major public health concern and has impacted an estimated 425 million adults. The increasing trend of diabetes incidence has impacted the Malaysian population and healthcare system. Evidence from studies suggested that diabetes can be treated and controlled through behavioural intervention. These include combining lifestyle with pharmacotherapy. Scholars in health behaviour highlighted the importance of assessing and monitoring the behavioural intervention among diabetic patients in terms of psychosocial aspects, such as information, motivation and behavioural factors, in relations with diabetes self-care. This article provides an overview of the empirical evidence regarding the importance of identifying information, motivation and behavioural factors, in relations with diabetes self-care. Information is among the prominent factors in establishing good diabetes management. Motivation can be conceptually defined as factors that predispose one to action and cues to behaviour change. Behavioural factors identified in this review includes compliance towards diabetes self-care. The outcome of this review could provide a better understanding of information, motivation and behavioural factors, and its relations with diabetes self-care.
Ajzen, I., & Driver, B. L. (1991). Prediction of leisure participation from behavioural, normative, and control beliefs: An application of the theory of planned behaviour. Leisure Sciences, 13(3), 185–204. https://doi.org/10.1080/01490409109513137
Al-Aboudi, I. S., Hassali, M. A., & Shafie, A. A. (2016). Knowledge, attitudes, and quality of life of type 2 diabetes patients in Riyadh, Saudi Arabia. Journal of Pharmacy and Bioallied Sciences, 8(3), 195–202. https://doi.org/10.4103/0975-7406.171683
Al-Maskari, F., El-Sadig, M., Al-Kaabi, J. M., Afandi, B., Nagelkerke, N., & Yeatts, K. B. (2013). Knowledge, attitude and practices of diabetic patients in the United Arab Emirates. PLoS ONE, 8(1), 1–8. https://doi.org/10.1371/journal.pone.0052857
Al Hamid, A. M., Ghaleb, M., Aljadhey, H., & Aslanpour, Z. (2017). Factors contributing to medicine-related problems in adult patients with diabetes and/or cardiovascular diseases in Saudi Arabia: a qualitative study. BMJ Open, 7(11), 1–8.
Aliaga, C. (2006). How is the time of women and men distributed in Europe. Eurostat.
Aljasem, L. I., Peyrot, M., Wissow, L., & Rubin, R. R. (2001). The impact of barriers and self-efficacy on self-care behaviours in type 2 diabetes. The Diabetes Educator, 27(3), 393–404.
Alshayban, D., & Joseph, R. (2020). Health-related quality of life among patients with type 2 diabetes mellitus in Eastern Province, Saudi Arabia: A cross-sectional study. PLoS ONE, 15(1), 1–12. https://doi.org/10.1371/journal.pone.0227573
American Diabetes Association. (2013). Standards of medical care in diabetes-2013. Diabetes Care, 36(Supplement 1), S11–S66. https://doi.org/10.2337/dc13-S011
Ardeňa, G. J. R. A., Paz-Pacheco, E., Jimeno, C. A., Lantion-Ang, F. L., Paterno, E., & Juban, N. (2010). Knowledge, attitudes and practices of persons with type 2 diabetes in a rural community: phase I of the community-based Diabetes Self-Management Education (DSME) Program in San Juan, Batangas, Philippines. Diabetes Research and Clinical Practice, 90(2), 160–166. https://doi.org/10.1016/j.diabres.2010.08.003
Bains, S. S., & Egede, L. E. (2011). Associations between health literacy, diabetes knowledge, self-care behaviours, and glycemic control in a low income population with type 2 diabetes. Diabetes Technology and Therapeutics, 13(3), 335–341. https://doi.org/10.1089/dia.2010.0160
Bandura, A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ, 1986, 23-28.
Bartlett, E. E. (1982). Behavioural diagnosis: a practical approach to patient education. Patient Counselling and Health Education, 4(1), 29–35.
Brandão, M. P., & Cardoso, M. F. (2020). Associations between depressive symptoms and being employed or retired in older adults with type 2 diabetes. Primary Care Diabetes.
Burke, S. D., Sherr, D., & Lipman, R. D. (2014). Partnering with diabetes educators to improve patient outcomes. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 7, 45–53.
Carver, C.S., & Scheier, M.F. (1998). On the self-regulation of behaviour. Retrieved from https://www.semanticscholar.org/paper/On-the-Self-Regulation-of-Behaviour-Carver Scheier/b8b92cbf8c60d350e62825284173c08d5ef6227b
Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet, 389(10085), 2239–2251. https://doi.org/10.1016/S0140-6736(17)30058-2
Duke, D. C., Barry, S., Wagner, D. V., Speight, J., Choudhary, P., & Harris, M. A. (2018). Distal technologies and type 1 diabetes management. The Lancet Diabetes & Endocrinology, 6(2), 143–156. https://doi.org/10.1016/S2213-8587(17)30260-7
Elmira, E., Banks, E., & Joshy, G. (2018). To what extent is the elevated risk of psychological distress in people with diabetes accounted for by physical disability? Findings from a large population-based study. BMJ Open, 8(8), 1–7. https://doi.org/10.1136/bmjopen-2018-022767
Fishbein, M. (2008). A reasoned action approach to health promotion. Medical Decision Making, 28(6), 834–844. https://doi.org/10.1177/0272989X08326092
Gao, J., Wang, J., Zheng, P., Haardörfer, R., Kegler, M. C., Zhu, Y., & Fu, H. (2013). Effects of self-care, self-efficacy, social support on glycemic control in adults with type 2. BMC Family Practice, (1), 66. https://doi.org/10.1186/1471-2296-14-66
Gautam, A., Bhatta, D. N., & Aryal, R. U. (2015). Diabetes related health knowledge, attitude and practice among diabetic patients in Nepal. BMC Endocrine Disorders, 15(1), 25.
Gillespie, N. D., & Lenz, T. L. (2011). Implementation of a tool to modify behaviour in a chronic disease management program. Advances in Preventive Medicine, 2011, 1–5.
Graham, E. A., Thomson, K. H., & Bambra, C. L. (2018). The association between diabetes and depressive symptoms varies by quality of diabetes care across Europe. European Journal of Public Health, 28(5), 872-878.
Hawal, N. P., Shivaswamy, M. S., Kambar, S., Patil, S., & Hiremath, M. B. (2012). Knowledge, attitude and behaviour regarding self-care practices among type 2 diabetes mellitus patients residing in an urban area of South India. International Multidisciplinary Research Journal, 2(12), 31–35.
Herkert, D., Vijayakumar, P., Luo, J., Schwartz, J. I., Rabin, T. L., Defilippo, E., & Lipska, K. J. (2019). Cost-related insulin underuse among patients with diabetes. JAMA Internal Medicine, 179(1), 112–114. https://doi.org/10.1001/jamainternmed.2018.5008
Hussein, Z., Taher, S. W., Singh, H. K.G., & Swee, W.C.S. (2015). Diabetes care in Malaysia: problems, new models, and solutions. Annals of Global Health, 81(6), 851–862.
Institute for Public Health (2019). National Health and Morbidity Survey 2019 (NHMS 2019). Vol. I: Non-communicable diseases, healthcare demand, and health literacy. Ministry of Health Malaysia (MOH)
International Diabetes Federation (IDF) (2020, June 23). Available at: idf.org/our-network/regions-members/western-pacific/members/108-malaysia.html (Accessed on 23rd June 2020)
Istepanian, R. S. (2015). Mobile applications for diabetes management: efficacy issues and regulatory challenges. The Lancet Diabetes & Endocrinology, 3(12), 921–923.
Islam, S. M. S., Niessen, L. W., Seissler, J., Ferrari, U., Biswas, T., Islam, A., & Lechner, A. (2015). Diabetes knowledge and glycemic control among patients with type 2 diabetes in Bangladesh. SpringerPlus, 4(1). https://doi.org/10.1186/s40064-015-1103-7
Janz, N.K., & Becker, M. H. (1984). The health belief model. A decade later. Health Education Quarterly, 11(1), 1–47.
Karimy, M., Koohestani, H. R., & Araban, M. (2018). The association between attitude, self-efficacy, and social support and adherence to diabetes self-care behaviour. Diabetology & Metabolic Syndrome, 10(1), 1–6. https://doi.org/10.1186/s13098-018-0386-6
Kishore, J., Kohli, C., Gupta, N., Kumar, N., & Sharma, P. (2015). Awareness, practices and treatment seeking behaviour of type 2 diabetes mellitus patients in Delhi. Annals of Medical and Health Sciences Research, 5(4), 266. https://doi.org/10.4103/2141-9248.160184
Kueh, Y. C., & Kuan, G. (2018). Psychometric Properties of Malay Version of Summary of Diabetes Self-Care Activities Measures among the Malay adults with Type 2 Diabetes Mellitus in Kelantan, Malaysia. Austin Diabetes Res, 3(1), 1017.
Lalazaryan, A., & Zare-Farashbandi, F. (2014). A Review of models and theories of health information seeking behaviour. International Journal of Health System and Disaster Management, 2(4), 193. https://doi.org/10.4103/2347-9019.144371
Mikhael, E. M., Hassali, M. A., Hussain, S. A., & Shawky, N. (2019). Self-management knowledge and practice of type 2 diabetes mellitus patients in Baghdad, Iraq: a qualitative study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 12, 1.
Mohammadi, S., Karim, N. A., Talib, R. A., & Amani, R. (2015). Knowledge, attitude and practices on diabetes among type 2 diabetic patients in Iran: a cross-sectional study. Science, 3(4), 520-4.
Mukhopadhyay, P., Paul, B., Das, D., Sengupta, N., & Majumder, R. (2010). Perceptions and practices of type 2 diabetics: A cross-sectional study in a tertiary care hospital in Kolkata. International Journal of Diabetes in Developing Countries, 30(3), 143–149.
Nagar, V., Prasad, P., Mitra, A., Kale, S., Yadav, K., & Shukla, M. (2018). Assessment of knowledge, attitude and practice about diabetes among diabetic patients of tertiary care centre in central India. International Journal of Community Medicine and Public Health, 5(9), 4065.
Nazir, S. U. R., Hassali, M. A., Saleem, F., Bashir, S., & Aljadhey, H. (2016). Disease related knowledge, medication adherence and glycaemic control among patients with type 2 diabetes mellitus in Pakistan. Primary Care Diabetes, 10(2), 136–141.
Neblett, R. S., Chia, Y. C., Abdullah, N., & Ablah, E. (2019). Goals, beliefs, knowledge, and barriers for diabetes self-care in a multi-ethnic population in Malaysia: A qualitative study. Medical Journal of Malaysia, 74(6), 483–491.
O’Connor, L. E., Hu, E. A., Steffen, L. M., Selvin, E., & Rebholz, C. M. (2020). Adherence to a Mediterranean-style eating pattern and risk of diabetes in a US prospective cohort study. Nutrition & Diabetes, 10(1), 1-9.
Othman, S. M., & Khurshid, T.K. (2014). Knowledge and practice about diabetes among adult diabetic patients in Erbil, Iraq. Zanco Journal of Medical Sciences, 18(1), 659–666.
Tohid, H., Papo, M., Ahmad, S., Sumeh, A. S., Jamil, T. R., & Hamzah, Z. (2019). Self-care activities among patients with Type 2 Diabetes Mellitus in Penampang, Sabah and its association with depression, anxiety and stress. Malaysian Journal of Public Health Medicine, 19(1), 117–125.
Peyrot, M., & Rubin, R. R. (2007). Behavioural and psychosocial interventions in diabetes. Diabetes Care, 30(10), 2433–2440. https://doi.org/10.2337/dc07-1222.
Price, A. J., Crampin, A. C., Amberbir, A., Kayuni-Chihana, N., Musicha, C., Tafatatha, T., ... & Nyirenda, M. (2018). Prevalence of obesity, hypertension, and diabetes, and cascade of care in sub-Saharan Africa: a cross-sectional, population-based study in rural and urban Malawi. The Lancet Diabetes & Endocrinology, 6(3), 208–222.
Primanda, Y., Kep, S., Kritpracha, C., & Thaniwattananon, P. (2011). Dietary behaviours among patients with Type 2 Diabetes mellitus in Yogyakarta, Indonesia. Nurse Media Journal of Nursing, 1(2), 211–223.
Polonsky, K. S. (2012). The past 200 years in diabetes. New England Journal of Medicine, 367(14), 1332–1340. https://doi.org/10.1056/NEJMra1110560
Radzi, A. M., Draman, N., Yusoff, S. S. M., & Muhamad, R. (2019). Depression and potential risk factors among the elderly with Type 2 Diabetes Mellitus in Kedah, Malaysia. Medical Journal of Malaysia, 74(2), 103–108.
Rahaman, K. S., Majdzadeh, R., Naieni, K. H., & Raza, O. (2017). Knowledge, attitude and practices (KAP) regarding chronic complications of diabetes among patients with type 2 diabetes in Dhaka. International Journal of Endocrinology and Metabolism, 15(3).
Rashid, A. A., Zuhra, H., & Tan, C. E. (2018). Social support, self-efficacy and their correlation among patients with Type 2 Diabetes Mellitus: A primary care perspective. The Medical Journal of Malaysia, 73(4), 197–201.
Rathod, G. B., Rathod, S., Parmar, P., & Parikh., A. (2014). Study of knowledge, attitude and practice of general population of Waghodia towards Diabetes Mellitus. International Journal of Current Research and Review, 6(1), 63–68.
Saleh, F., Mumu, S. J., Ara, F., Ali, L., Hossain, S., & Ahmed, K. R. (2012a). Knowledge, attitude and practice of type 2 diabetic patients regarding obesity: Study in a tertiary care hospital in Bangladesh. Journal of Public Health in Africa, 3(1), 29–32.
Saleh, F., Mumu, S. J., Ara, F., Begum, H. A., & Ali, L. (2012b). Knowledge and self-care practices regarding diabetes among newly diagnosed type 2 diabetics in Bangladesh: A cross-sectional study. BMC Public Health, 12(1), 1112. https://doi.org/10.1186/1471-2458-12-1112
Sathish, T. (2019). Diabetes prevention and lifestyle intervention in resource-limited settings. The Lancet Diabetes & Endocrinology, 7(3), 165–167.
Shrestha, N., Yadav, S. B., Joshi, A. M., Patel, B. D. P., Shrestha, J., & Bharkher, D. L. (2015). Diabetes knowledge and associated factors among diabetes patients in central Nepal. International Journal of Collaborative Research on Internal Medicine & Public Health, 7(5), 82–91.
Solanki, J. D., Sheth, N. S., Shah, C. J., & Mehta, H. B. (2017). Knowledge, attitude, and practice of urban Gujarati type 2 diabetics: Prevalence and impact on disease control. Journal of Education and Health Promotion, 6(35), 1–6. https://doi.org/10.4103/jehp.jehp
Speight, J., Skinner, T. C., Rose, K. J., Scibilia, R., & Boulton, A. J. (2020). Oh sugar! How diabetes campaigns can be damaging to the cause they aim to serve. The Lancet Diabetes & Endocrinology, 8(7), 566–567. https://doi.org/10.1016/S2213-8587(20)30190-X
Upadhyay, D. K., Izham, M., Alurkar, V. M., Mishra, P., & Palaian, S. (2012). Evaluation of knowledge, attitude and practice of newly diagnosed diabetes patients-a baseline study from Nepal. International Journal of Pharmacy Teaching & Practices, 3(2), 245–252.
World Health Organization. (2016). Global Report on Diabetes.
Wu, S. F. V., Huang, Y. C., Liang, S. Y., Wang, T. J., Lee, M. C., & Tung, H. H. (2011). Relationships among depression, anxiety, self-care behaviour and diabetes education difficulties in patients with type-2 diabetes: a cross-sectional questionnaire survey. International Journal of Nursing Studies, 48(11), 1376–1383. https://doi.org/10.1016/j.ijnurstu.2011.04.008
Zareban, I., Karimy, M., Niknami, S., Haidarnia, A., & Rakhshani, F. (2014). The effect of self-care education program on reducing HbA1c levels in patients with type 2 diabetes. Journal of Education and Health Promotion, 3. https://doi.org/10.4103/2277-9531.145935