This descriptive study examined the relationships between diabetes-specific health beliefs and adherence to the diabetes regimen and glycemic control in 102 older subjects with non-insulin-dependent diabetes mellitus. Health beliefs and self-care behaviors were assessed by self-report questionnaires. Glycemic control was assessed by HbA1c values. Perceived barriers to treatment were related to adherence, while perceived severity of disease was related to glycemic control. No significant associations were found between other health belief model subscales and adherence or glycemic control. Subjects not on diabetes medication had better glycemic control than those on medication. Subjects with more recently diagnosed diabetes also had better glycemic control. Practice and research attention should include older diabetic persons' perceived barriers to performing diabetes-specific self-care behaviors and perceived severity of the disease to identify potential health beliefs that may need to be altered for improving glycemic control.
Get full access to this article
View all access options for this article.
References
1.
National Diabetes Data Group.Diabetes in America-1985. Washington, DC: Government Printing Office, 1985; DHHS publication no. (NIH)85-1468.
Unger R.Meticulous control of diabetes: benefits, risks, and precautions. Diabetes1982;31:479-83.
4.
DCCT Research Group.Diabetes control and complications trial (DCCT): results of a feasibility study. Diabetes Care1987;10:1-19.
5.
Cerkoney K., Hart L.The relationship between the health belief model and compliance of persons with diabetes mellitus. Diabetes Care1980 ;3:594-98.
6.
Wilson W., Ary D., Biglan A., Glasgow R., Toobert D., Campbell D.Psychosocial predictors of self-care behaviors (compliance) and glycemic control in non-insulin-dependent diabetes mellitus. Diabetes Care1986;9:614-22.
7.
Glascow R., McCaul K., Schafer L.Barriers to regimen adherence among persons with type I diabetes. J Behav Med1986;9:65-77.
8.
Johnson S.Psychosocial factors in juvenile diabetes: a review. J Behav Med1980;3:95-116.
9.
Schlenk E., Hart L.Relationship between health locus of control, health value, and social support and compliance of persons with diabetes mellitus. Diabetes Care1984;7:566-74.
10.
Wishner W.Special problems of elderly diabetic patients detailed at ADA postgraduate course. Diabetes Outlook1984; 19:8.
11.
Wu R.Behavior and illness. Englewood Cliffs, NJ: Prentice-Hall, 1973.
12.
Becker M.Patient adherence to prescribed therapies. Med Care1985;23:539-55.
13.
Becker M., Janz N.The health belief model applied to understanding diabetes regimen compliance . Diabetes Educ1985;11(1):41-47.
14.
Rosenstock I.Why people use health services. Milbank Mem Fund Q1966;44:94-127.
15.
Ary D., Toobert D., Wilson W., Glascow R.Patient perspectives on factors contributing to nonadherence to diabetes regimen . Diabetes Care1986;9:168-78.
16.
Kurtz MSAdherence to diabetes regimens: empirical status and clinical applications . Diabetes Educ1990;16:50-56.
17.
Peterson G. , McLean S., Senator G.Determinates of patient compliance, control, presence of complications, and handicap in non-insulin-dependent diabetes . Aust NZ J Med1984;14:135-41.
18.
Rosenstock IMUnderstanding and enhancing patient compliance with diabetic regimen. Diabetes Care1985;8:610-16.
19.
Haynes R., Taylor D., Sackett D.Compliance in healthcare. Baltimore: Johns Hopkins University Press, 1979.
20.
McCaul K., Glascow R., Schafer L.Diabetes regimen adherence: predicting adherence. Med Care1987;25:868-79.
21.
Algona M.Perception of severity of disease and health locus of control in compliant and noncompliant diabetic patients. Diabetes Care1980;3:533-40.
22.
Zisook S., Gammon E.Medical non-compliance. Int J Psychiatry Med1980; 10:291-95.
23.
Watkins J., Williams T., Martin D., Hogan M., Anderson E.A study of diabetic patients at home. Am J Public Health1967;57:452-59.
24.
Williams T. , Anderson E., Watkins J., Coyle V.Dietary errors made at home by patients with diabetes. J Am Diet Assoc1967;51:19-25.
25.
Sackett D.The magnitude of compliance and noncompliance. In: Sackett D, Hayes R, eds. Compliance with therapeutic regimens. Baltimore : Johns Hopkins University Press, 1979.
26.
Kaplan R, Atkins C.The behavioral management of type II diabetes mellitus. In: Kaplan R, Criqui M, eds. Behavioral epidemiology and disease preventions. New York: Plenum Press, 1985.
27.
Sackett P., Snow E.The magnitude of compliance and noncompliance. In: Sackett D, Hayes R, eds. Compliance with therapeutic regimens. Baltimore: Johns Hopkins University Press, 1979.
28.
Meichenbaum D. , Turk D.Facilitating treatment adherence . New York: Plenum Press, 1987.
29.
Glascow RE, McCaul KD, Schafer L.Self-care behaviors and glycemic control of type I diabetes. J Chronic Dis1987;49:399-412.
30.
Orme C., Binik YMConsistency of adherence across regimen demands. Health Psychol1989;8:27-43.
31.
Schafer LC, Glascow RE, McCaul KD, Drecher M.Adherence to IDDM regimens: relationship to psychosocial variables and metabolic control. Diabetes Care1983;6:493-98.
32.
Page P., Verstraete DG, Dobb JR, Etzwiller DDPatient recall of self-care recommendations in diabetes. Diabetes Care1981;4:96-98.
33.
Leventhal H. , Zimmerman R., Gutmann M.Compliance: a self-regulation perspective . In: Gentry WD, ed. Handbook of behavioral medicine. New York, Guilford Press, 1984:369-436.
34.
Lewis K., Jennings A., Ward J., Bradley C.Health belief scales developed specifically for people with tablet-treated type II diabetes. Diabetes Med1990;7:148-55.
35.
Bradley C., Brewin CR, Gamsu DS, Moses JLDevelopment of scales to measure perceived control of diabetes mellitus and diabetes-related health beliefs. Diabetes Med1984;1:213-18.
36.
Little R., Wiedmeyer J., England E., McKinzie D., Goldstein D.Evaluation of a fully automated system for glycosylated hemoglobin analysis . Diabetes1980;29:623-29.
37.
Harris R., Skyler J., Linn M., Pollack L., Tewksbury D.Relationship between the health belief model and compliance as a basis for intervention in diabetes mellitus. Pediatr Adolesc Endocrinol1982;10:123-32.
38.
Lomsky SLD'Eramo G., Shamoon H., Fleischer N.Relationship of insulin secretion and glycemic response to dietary intervention in non-insulin-dependent diabetics. Arch Intern Med1990; 150:169-72.
39.
Williams TF , Martin DA, Hogan MD, et al. The clinical picture of diabetic control, studies in four settings. Am J Public Health1967;57: 441-51.
40.
Watts B., Spanheimer RG, DiGirolamo M., et al. Prediction of glucose response to weight loss in patients with non-insulin-dependent diabetes mellitus. Arch Intern Med1990;150:803-6.
41.
Schatz PEAn evaluation of the components of compliance in patients with diabetes . J Am Diet Assoc1988;88:708-12.
42.
Singh B., Holland M., Thom P.Metabolic control of diabetes in general practice clinics: comparison with a hospital clinic. Br Med J1984;289:726-28.
43.
Janz N., Becker M.The health belief model: a decade later. Health Educ Q1984;11:1-47.
44.
Stanislav KVThe health belief model and behavior related to chronic illness. Health Educ Monogr1974 ;2:433-54.
