Causal model of decision-making for type 2 diabetes mellitus patients regarding self-management
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Apr 29, 2024
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Abstract
Indonesia faced a 49.9% mortality rate in 2019 due to diabetes mellitus, predominantly Type 2 DM, accounting for over 90% of cases. This type of diabetes, often complicated, stands as a leading cause of death in the country. Managing Type 2 DM necessitates medical care and self-management education to prevent long-term complications. Effective strategies encompass education, nutritional therapy, exercise, and pharmacological treatment, reliant on adherence, knowledge, and self-awareness. The doctor-patient relationship significantly influences adherence, emphasizing the need for enhanced decision-making frameworks. This study, employing an analytic observational approach with 99 respondents, explores decision-making models for Type 2 DM self-management in primary and secondary healthcare settings. Results from Partial Least Squares (PLS) analysis indicate patient (0.253), doctor (0.344), and family (0.312) factors influencing decision-making, which, in turn, impacts self-efficacy (0.330). Family dynamics strongly correlate with self-efficacy (0.550), further impacting self-management (0.679). Recommendations advocate shared decision-making, emphasizing disease knowledge, patient involvement in treatment planning, adequate consultation time, and increased family participation to bolster self-efficacy and self-management in Type 2 DM patients.
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How to Cite
Amin Rais, M., Dini, M. P. and Supriyanto, S. (2024) “Causal model of decision-making for type 2 diabetes mellitus patients regarding self-management”, Science Midwifery, 12(1), pp. 328-337. doi: 10.35335/midwifery.v12i1.1502.
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Nixon, A. L., Leonardi-Bee, J., Wang, H., & Chattopadhyay, K. (2021). Barriers and facilitators to type 2 diabetes management in the Caribbean region: A qualitative systematic review. In JBI Evidence Synthesis (Vol. 19, Issue 5). https://doi.org/10.11124/JBISRIR-D-19-00424
O’Connell, J. M., & Manson, S. M. (2019). Understanding the economic costs of diabetes and prediabetes and what we may learn about reducing the health and economic burden of these conditions. In Diabetes Care (Vol. 42, Issue 9). https://doi.org/10.2337/dci19-0017
Paget, L., & Han, P. (2015). A randomized controlled trial to evaluate the effectiveness of a patient-centered care management strategy in type 2 diabetes patients: The Patient-centered Assessment and Counseling for Exercise and Diet Study II. Diabetes Research and Clinical Practice, 110(1), 71–80. https://doi.org/https://doi.org/10.1016/j.diabres.2015.07.032
Pamungkas, R. A., Chamroonsawasdi, K., & Usman, A. M. (2021). Unmet basic needs and family functions gaps in diabetes management practice among Indonesian communities with uncontrolled type 2 diabetes: A qualitative study. Malaysian Family Physician, 16(3). https://doi.org/10.51866/oa1123
PERKENI. (2021). Konsensus Pengelolaan dan Pencegahan Diabetes Mellitus Tipe 2 di Indonesia.
Reisi, M., Mostafavi, F., Javadzade, H., Mahaki, B., Tavassoli, E., & Sharifirad, G. (2016). Impact of health literacy, self-efficacy, and outcome expectations on adherence to self-care behaviors in iranians with type 2 diabetes. Oman Medical Journal, 31(1). https://doi.org/10.5001/omj.2016.10
World Health Organization. (2016). Global Report on Diabetes. Isbn, 978. https://doi.org/ISBN 978 92 4 156525 7
World Health Organization. (2022). Noncommunicable Diseases Progress Monitor. https://www.who.int/publications/i/item/9789244020227
Zandbelt, L. C., Smets, E. M. A., Oort, F. J., Godfried, M. H., & De Haes, H. C. J. M. (2004). Satisfaction with the outpatient encounter: A comparison of patients’ and physicians’ views. Journal of General Internal Medicine, 19(11). https://doi.org/10.1111/j.1525-1497.2004.30420.x
Zhu, L., Pan, Z., Shen, F., Shen, Y., & Zhang, W. (2024). Effects of family support system on the self-management behaviour of patients with T2DM: a multi-centre cross-sectional study in community settings. Family Practice. https://doi.org/10.1093/fampra/cmae010
Altin, S. V., & Stock, S. (2016). The impact of health literacy, patient-centered communication and shared decision-making on patients’ satisfaction with care received in German primary care practices. BMC Health Services Research, 16(1). https://doi.org/10.1186/s12913-016-1693-y
American Diabetes Association. (2024). Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes—2024. Diabetes Care, 47. https://doi.org/10.2337/dc24-S004
Barksdale, D. J., Newhouse, R., & Miller, J. A. (2014). The patient-centered outcomes research institute (PCORI): Information for academic nursing. Nursing Outlook, 62(3). https://doi.org/10.1016/j.outlook.2014.03.001
Chrvala, C. A., Sherr, D., & Lipman, R. D. (2016). Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. In Patient Education and Counseling (Vol. 99, Issue 6). https://doi.org/10.1016/j.pec.2015.11.003
Emery, K. A., Robins, J., Salyer, J., & Thurby-Hay, L. (2019). Self and Family Management in Type 2 Diabetes: Influencing Factors and Outcomes. Nursing Science Quarterly, 32(3). https://doi.org/10.1177/0894318419845399
Entwistle, V. A., & Watt, I. S. (2006). Patient involvement in treatment decision-making: The case for a broader conceptual framework. Patient Education and Counseling, 63(3 SPEC. ISS.). https://doi.org/10.1016/j.pec.2006.05.002
Gao, Y., Wang, J., Luo, X., Song, X., Liu, L., Ke, L., Liao, Z., Wang, D., Mu, Y., Chen, Y., & Estill, J. A. M. (2019). Quality appraisal of clinical practice guidelines for diabetes mellitus published in China between 2007 and 2017 using the AGREE II instrument. BMJ Open, 9(9). https://doi.org/10.1136/bmjopen-2018-022392
Iis, D. saviqoh. (2021). Analisis pola hidup dan dukungan keluarga pada pasien diabetes melitus tipe 2 di wilayah kerja Puskesmas Payung Sekaki. HEALTH CARE : JURNAL KESEHATAN, 10(1), 181–193. https://doi.org/10.36763/healthcare.v10i1.116
International Diabetes Federation. (2021). IDF Diabetes Atlas 2021 _ IDF Diabetes Atlas. In IDF official website.
Kadirvelu, A., Sadasivan, S., & Ng, S. H. (2012). Social support in type II diabetes care: A case of too little, too late. In Diabetes, Metabolic Syndrome and Obesity (Vol. 5). https://doi.org/10.2147/DMSO.S37183
Kaplan, S. H., Greenfield, S., & Ware, J. E. (1989). Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Medical Care, 27(3). https://doi.org/10.1097/00005650-198903001-00010
Khan, M. A. B., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Kaabi, J. Al. (2020). Epidemiology of Type 2 diabetes - Global burden of disease and forecasted trends. Journal of Epidemiology and Global Health, 10(1). https://doi.org/10.2991/JEGH.K.191028.001
Kumar, L., & Mohammadnezhad, M. (2022). Perceptions of patients on factors affecting diabetes self-management among type 2 diabetes mellitus (T2DM) patients in Fiji: A qualitative study. Heliyon, 8(6). https://doi.org/10.1016/j.heliyon.2022.e09728
Laakso, M. (2019). Biomarkers for type 2 diabetes. In Molecular Metabolism (Vol. 27). https://doi.org/10.1016/j.molmet.2019.06.016
Li, J., Bao, Y., Chen, X., & Tian, L. (2021). Decision models in type 2 diabetes mellitus: A systematic review. Acta Diabetologica, 58(11). https://doi.org/10.1007/s00592-021-01742-6
Li, Z., Jin, Y., Lu, C., Luo, R., Wang, J., & Liu, Y. (2021). Effects of patient decision aids in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. In International Journal of Nursing Practice (Vol. 27, Issue 6). https://doi.org/10.1111/ijn.12914
Montori, V. M., Gafni, A., & Charles, C. (2006). A shared treatment decision-making approach between patients with chronic conditions and their clinicians: The case of diabetes. Health Expectations, 9(1). https://doi.org/10.1111/j.1369-7625.2006.00359.x
Myers, A., Garnica, P., & Ling, J. (2018). Advances in Managing Type 2 Diabetes in the Elderly: A Focus on Inpatient Care and Transitions of Care. American Journal of Therapeutics, 25(1). https://doi.org/10.1097/MJT.0000000000000667
Ng, C. J., Lee, P. Y., Lee, Y. K., Chew, B. H., Engkasan, J. P., Irmi, Z. I., Hanafi, N. S., & Tong, S. F. (2013). An overview of patient involvement in healthcare decision-making: A situational analysis of the Malaysian context. BMC Health Services Research, 13(1). https://doi.org/10.1186/1472-6963-13-408
Nixon, A. L., Leonardi-Bee, J., Wang, H., & Chattopadhyay, K. (2021). Barriers and facilitators to type 2 diabetes management in the Caribbean region: A qualitative systematic review. In JBI Evidence Synthesis (Vol. 19, Issue 5). https://doi.org/10.11124/JBISRIR-D-19-00424
O’Connell, J. M., & Manson, S. M. (2019). Understanding the economic costs of diabetes and prediabetes and what we may learn about reducing the health and economic burden of these conditions. In Diabetes Care (Vol. 42, Issue 9). https://doi.org/10.2337/dci19-0017
Paget, L., & Han, P. (2015). A randomized controlled trial to evaluate the effectiveness of a patient-centered care management strategy in type 2 diabetes patients: The Patient-centered Assessment and Counseling for Exercise and Diet Study II. Diabetes Research and Clinical Practice, 110(1), 71–80. https://doi.org/https://doi.org/10.1016/j.diabres.2015.07.032
Pamungkas, R. A., Chamroonsawasdi, K., & Usman, A. M. (2021). Unmet basic needs and family functions gaps in diabetes management practice among Indonesian communities with uncontrolled type 2 diabetes: A qualitative study. Malaysian Family Physician, 16(3). https://doi.org/10.51866/oa1123
PERKENI. (2021). Konsensus Pengelolaan dan Pencegahan Diabetes Mellitus Tipe 2 di Indonesia.
Reisi, M., Mostafavi, F., Javadzade, H., Mahaki, B., Tavassoli, E., & Sharifirad, G. (2016). Impact of health literacy, self-efficacy, and outcome expectations on adherence to self-care behaviors in iranians with type 2 diabetes. Oman Medical Journal, 31(1). https://doi.org/10.5001/omj.2016.10
World Health Organization. (2016). Global Report on Diabetes. Isbn, 978. https://doi.org/ISBN 978 92 4 156525 7
World Health Organization. (2022). Noncommunicable Diseases Progress Monitor. https://www.who.int/publications/i/item/9789244020227
Zandbelt, L. C., Smets, E. M. A., Oort, F. J., Godfried, M. H., & De Haes, H. C. J. M. (2004). Satisfaction with the outpatient encounter: A comparison of patients’ and physicians’ views. Journal of General Internal Medicine, 19(11). https://doi.org/10.1111/j.1525-1497.2004.30420.x
Zhu, L., Pan, Z., Shen, F., Shen, Y., & Zhang, W. (2024). Effects of family support system on the self-management behaviour of patients with T2DM: a multi-centre cross-sectional study in community settings. Family Practice. https://doi.org/10.1093/fampra/cmae010