The literature on self-management in diabetes consists predominantly of investigations on compliance, behavioral modification techniques, assessment of health beliefs, and cognitive theories. Little systematic research has explored the actual experience of applying and adapting to a diabetes regimen. This qualitative study reports a diabetes self-management model (DSMM) based on interview data from 18 adults with Type I diabetes. As described and confirmed by the study participants, the DSMM is composed of sequential phases and stages that evolve over time and is influenced by four major factors: personal considerations, monitoring activities, specific cognitive skills for diabetes problem solving, and definition of control. This study provides a model that affirms the experience and effort of learning self-management and recognizes the importance of individualized regimes developed from personal experiences and perceptions of what "works for me."
Get full access to this article
View all access options for this article.
References
1.
Anderson, R. M. , & Nowacek, G. (1989). Influencing the personal meaning of diabetes: Research and practice. Diabetes Educator, 14(4), 297-302.
2.
Ary, D. V. , Toobert, D., Wilson, W., & Glasgow, R. E. (1986). Patient perspective on factors contributing to nonadherence to diabetes regimen. Diabetes Care, 9(2), 168-172.
3.
Becker, M. H. , & Janz, N. K. (1985). The health beliefs model applied to understanding diabetes regimen compliance. Diabetes Educator, 11(1), 41-47.
4.
Benoliel, J. Q. (1969). Becoming diabetic. Unpublished doctoral dissertation, University of California School of Nursing, San Francisco.
5.
Bloom-Cerkoney, K.A. , & Hart, L. A. (1980). The relationship between the health beliefs model and compliance of persons with diabetes. Diabetes Care, 3(5), 594-598.
6.
Carter, D. J. , Gonder-Frederick, L., Pohl, S., & Pennebaker, J. W. (1983). Reliability of symptom-blood glucose relationships among insulin-dependent adult diabetes. Psychosomatic Medicine, 45(4), 357-360.
7.
Davis, F. (1960). Uncertainty in medical prognosis: Clinical and functional. American Journal of Sociology, 56, 41-47.
8.
Glaser, B. , & Strauss, A. L. (1%7). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine.
9.
Guba, E. G. (1981). Criteria for assessing the trustworthiness of naturalistic inquiries. Educational Communication and Technology Journal, 29, 75-92.
10.
Hamburg, B. A. , & Inoff, G. E. (1983). Coping with predictable crisis of diabetes. Diabetes Care, 6(4), 409-416.
11.
Hess, G. , & Davis, W. K. (1983). The validation of a diabetes patient knowledge test. Diabetes Care, 6(6), 591-596.
12.
Holroyd, K. A. , & Creer, T. L. (1986). Self-management of chronic disease: Hand-book of clinical interventions and research. New York: Academic Press.
13.
Ingersoll, G. M. , Orr, D. P., Herrold, A. J., & Golden, M. P. (1986). Cognitive maturity of self-management among adolescents with insulin dependent diabetes mellitus. Journal of Pediatrics, 108(4), 620-623.
14.
Kleinman, A. (1988). The illness narratives: Suffering, healing and the human condition. New York: Basic Books.
15.
Korhonen, T. , Huttunen, J. K., Aro, A., Hentinen, Me Ihalainen, O., Majander, H., Siitonen, O., Uusitupa, M., & Pyorala, K. (1983). A controlled trial on the effects of patient education in the treatment of insulin dependent diabetes. Diabetes Care, 6(3), 256-261.
16.
Light, D. (1979). Uncertainty and control in professional training. Journal of Health and Social Behavior, 20, 320.
17.
Linn, M. W. , Linn, B. S., Skyler, J. S., & Harris, R. (1980). The importance of self-assessed health in patients with diabetes mellitus. Diabetes Care, 3(5), 599-606.
18.
Lundman, B. , Asplund, K., & Norberg, A. (1988). Tedium among patients with insulin-dependent diabetes mellitus. Journal of Advanced Nursing, 13, 23-31.
19.
Mason, C. (1985). The production and effects of uncertainty with special reference to diabetes mellitus. Social Science in Medicine, 21(12), 1329-1334.
20.
Mazze, R. S. , Lucido, D., & Shomoon, H. (1984). Psychological and social correlates of glycemic control. Diabetes Care, 7(4), 360-366.
21.
Menninger, W. C. (1935). Psychological factors in the etiology of diabetes. Journal of Nervous and Mental Disease, 81, 1-13.
22.
Mishel, M. (1981). The measurement of uncertainty in illness. Nursing Research, 30, 258-263.
23.
Mishel, M. (1984). Perceived uncertainty and stress in illness. Research in Nursing and Health, 7, 163-171.
24.
National Diabetes Advisory Board . (1984). National standards for diabetes patient education programs. Diabetes Care, 7(1), xxxi-xxxv.
25.
Peterson, C. M. , Forham, S. E., & Jones, R. L. (1980). Self-management: An approach to patient with insulin dependent diabetes mellitus. Diabetes Care, 3(1), 82-87.
26.
Price, M. , & Schmidt, S. (1991, July). Monitor talk. Diabetes Forecast, pp. 71-73.
27.
Rosenstock, I. M. (1985). Understanding and enhancing patient compliance with diabetes regimens. Diabetes Care, 8(6), 610-616.
28.
Ruzicki, D. A. (1984). Relationship of participation preferences and health locus of control in diabetes education. Diabetes Care, 7(4), 372-377.
29.
Schafer, L. C. , Glasgow, R. E., McCaul, K. D., & Dreher, M. (1983). Adherence to IDDM regimens: Relationship to psychosocial variables and metabolic control. Diabetes Care, 6(5), 493-498.
30.
Schafer, L. C. , McCaul, K. D., & Glasgow, R. E. (1986). Supportive and nonsupportive family behaviors: Relationships to adherence and metabolic control in persons with Type I diabetes. Diabetes Care, 9(2), 179-185.
31.
Schlenck, E. A. , & Hart, L. K. (1984). Relationship between health locus of control, health values, and social support and compliance of persons with diabetes mellitus. Diabetes Care, 7, 566-574.
32.
Stowig, S. (1982). Patient education: A model for autonomous decision-making and deliberate action in diabetes mellitus. Medical Clinics of North America, 66, 1293-1307.
33.
Strauss, A. (1975). Chronic illness and the quality of life. St. Louis: C. V. Mosby.
34.
Strauss, A. L. (1987). Qualitative analysis for social scientists. New York: Cambridge University Press.
35.
Strauss, A. L. , Corbin, J., Fagerhaugh, S., Glaser, B., Maines, D., Suczek, B., & Wiener, C. L. (1984). Chronic illness and the quality of life. St. Louis: C. V. Mosby.
36.
Surwit, R. S. , Feingloss, M. N., & Scovern, A. W. (1983). Diabetes and behavior: A paradigm for health psychology. American Psychologist, 38(3), 255-262.
37.
Surwit, R. S. , Scovem, A. W., & Feingloss, M. N. (1982). The role of behavior in diabetes care. Diabetes Care, 5(3), 337-342.
38.
Warren-Boulton, E. , Auslander, W. F., & Gettinger, J. M. (1982). Understanding diabetes routines: A professional training exercise. Diabetes Care, 5(5), 537-541.
