Diabetes Management and Patient Adherence

Factors Affecting Patient Adherence

• Adherence refers to the extent to which a person's behavior corresponds with agreed recommendations from a healthcare provider.
• Factors affecting patient adherence include:
  • Depression and medication cost
  • Salient beliefs (e.g., attitudes, knowledge, and self-efficacy)
  • Age, safety, tolerability, and polytherapy
  • Information, perception, and duration of disease

Determinants of Health Behavior

• Theories of health behavior include:
  • Social Cognitive Theory (SCT): states that people learn within a social context, facilitated by concepts such as modeling and observational learning.
  • Health Belief Model (HBM): developed to understand the failure of people to adopt disease prevention strategies or screening tests, and later used to study patients' responses to symptoms and compliance with medical treatments.
  • Theory of Planned Behavior (TPB): states that behavioral achievement depends on both motivation (intention) and ability (behavioral control).
  • Transtheoretical Model (TT): conceptualizes behavior change as a process involving a series of six distinct stages: precontemplation, contemplation, preparation, action, maintenance, and termination.

Modifying Patient Behavior

• Influencing behavior can be achieved through:
  • Health Action Process Approach (HAPA) model
  • I-Change Model (integrated change model)
• The I-Change Model differentiates between three phases: awareness, motivation, and action planning.
• The model assumes that behavior change is a result of becoming aware of the necessity of behavior change, and subsequently, weighing the pros and cons of the desired behavior, perceptions of social influences, and self-efficacy.

Lifestyle Counseling

• Goals of lifestyle counseling:
  • Help patients gain insight into their own behavior, reasons, barriers, and solutions.
  • Guide patients toward self-chosen lifestyle changes.
• Steps in lifestyle counseling:
  • Introduction: establish a work relationship
  • Awareness: assess and improve awareness
  • Motivation: assess and improve motivation
  • Action: prepare for action and start making changes
  • Relapse prevention: make plans for difficult situations
  • Continuation: help clients keep going

Behavior Change

• Key factors in behavior change:
  • Intention: the cognitive representation of a person's readiness to perform a given behavior
  • Motivation: determined by motivational factors and awareness factors
  • Action planning: facilitates the translation of intention into actual action
• Coping efforts: problem management and emotional management
• Stress, coping, and health behavior: the primary appraisal is a person's judgment about the significance of an event as stressful, positive, controllable, challenging, benign, or irrelevant.