Characteristics of Diabetes Self-Care Agency in Japan Based on Statistical Cluster Analysis.

INTRODUCTION: Considering the situation where the number of people with diabetes is increasing, we need to find ways to support more efficient and effective outpatient clinics. Therefore, it is necessary to develop effective support methods and to elaborate a strategy as a system for support after grasping the characteristics of the entire population of people with diabetes. OBJECTIVE: The purpose of this study was to identify the characteristics of the diabetes population in outpatient settings by differences in self-care agency and to examine how to support them based on the recognized characteristics. METHODS: Participants were 261 people with diabetes under outpatient care in Japanese institutions from whom demographic data on age, gender, HbA1c, and treatment method were collected as well as self-care agency data based on the Instrument of Diabetes Self-Care Agency consisting of 40 items. The data were analyzed using cluster analysis to compare age, gender, HbA1c, duration of diabetes, type of diabetes, and insulin therapy between clusters. RESULTS: The analysis identified six clusters, including a group with favorable HbA1c but low total self-care agency scores that were likely to affect their blood glucose control in the future, although accounting for as small a portion as 3% of the total. In addition, a cluster with poor HbA1c and generally low self-care agency was also identified accounting for about a quarter of the total population. These clusters were considered to require further support. Clusters having markedly low self-care agency items, stress-coping ability, or the ability to make the most of the support available were also identified. CONCLUSION: The six clusters need to be assisted in focusing on mental or social support. Accordingly, consideration of the support system for people with diabetes based on an understanding of the cluster characteristics seemed to enable more efficient and effective support.

Structural model of self-care agency in patients with diabetes: A path analysis of the Instrument of Diabetes Self-Care Agency and body self-awareness.

AIM: The aim of this study was to examine a causal model of self-care agency by exploring the relationship between the structure of "body self-awareness" and the structure of the Instrument of Diabetes Self-Care Agency (IDSCA). METHODS: The participants were 353 patients with diabetes. The internal consistency of the six items for body self-awareness was examined by calculating the factor structure using principal factor analysis and Cronbach's alpha. In order to examine the relationship between the seven factors in the IDSCA, a path analysis was conducted. RESULTS: With regard to the factor structure, the factor loading of these five items was 0.511-0.743 (α = 0.739). In the path analysis, "body self-awareness" was influenced by the "ability to acquire knowledge" and had a direct effect (0.33) on the "motivation to self-manage", while "motivation to self-manage" had an effect (-0.32) on the "ability to self-manage". The Goodness-of-Fit Index was 0.974. CONCLUSION: "Body self-awareness" plays a part in the self-care operation process and serves as an intermediary factor to enable the performance of self-care operations by making the most use of self-care agency. Moreover, striking a proper balance between self-management that is focused on the treatment of diabetes and a person's ability for self-management of diabetes was found to be important.

Reliability and Validity of a Shortened Version of an Instrument for Diabetes Self-Care Agency.

PURPOSE: The purpose of this study was to develop a shortened version of the Instrument of Diabetes Self-Care Agency (IDSCA). METHODS: In the development of the shortened version of IDSCA, intraclass correlation coefficient 2 (ICC2) analysis was done to determine items to be deleted. However, the 7 subscales were retained. The shortened IDSCA was evaluated for internal consistency, reproducibility, concurrent validity, criterion-related validity, and goodness of fit. RESULTS: The shortened IDSCA included 35 items addressing 7 subscales. High ICC2 (.804) and a high Cronbach's alpha (.89) indicate internal consistency and reproducibility. A high correlation (.62) between the shortened version of the IDSCA and the Self-Care Agency Questionnaire indicated concurrent validity. CONCLUSION: The shortened IDSCA provides a reliable and valid measure of self-care agency of individuals with diabetes.

[Psychophysiological effects of hand massage in geriatric facility residents].

OBJECTIVES: Geriatric facility residents experience easy decrease of their quality of life (QOL) compared with elderly people cared for in their own homes owing to environmental changes. Because complementary and alternative medicine is useful to improve QOL, a simple manual for hand massage for inexperienced volunteers was developed, and the physical and psychological effects of this method were examined. METHODS: Thirty-six female geriatric facility residents (mean age, 84.5 years) were chosen. They were divided into two groups: the control and hand-massaged groups. In the hand-massaged group, females received 15 min hand massage from volunteers in accordance with a simple manual. No hand massage was performed in the control group. Before and after the treatment, a survey using a questionnaire (7 items; e.g., tension, fatigue) and physiological measurements (e.g., blood pressure, hand skin temperature), and measurement of cortisol and chromogranin A levels in saliva samples using enzyme-linked immunosorbent assay kits were carried out. Data were analyzed by two-way analysis of variance (ANOVA) to determine the effects of group and time on the dependent variables. RESULTS: The hand-massaged group showed greater increases in skin temperature than the control group, as shown by ANOVA (p<.05). Results showed that improvements of the scores in the questionnaire (condition and feel-good items) were greater in the hand-massaged group than in the control group (p<.05). Cortisol level increased in the control group, but was not statistically significantly different from that in the hand-massaged group, as shown by ANOVA. Chromogranin A level was also not significantly different between the two groups. CONCLUSIONS: These results confirmed the benefits of complementary and alternative medicine including touching and massage found in previous studies. Hand massage prompted relaxation in geriatric facility residents in this experiment.

[Changes in mental health index, serum biochemical parameters and neutrophil function after start of the wheelchair use at a nursing home in Korea].

OBJECTIVES: In Korea, long-term care insurance has been provided to the elderly since 2008. We conducted a health survey of the elderly in a nursing home in Korea from 2007 to 2010. Since the introduction of the insurance system, many of the elderly have started using wheelchairs. We aimed to determine the effect of using wheelchairs on mental health index, serum biochemical parameters, and neutrophil function. METHODS: The subjects were 32 elderly persons (mean age: 74.44 ± 5.79 years) who could walk unaided in 2007 and were not bedridden until 2010. We classified the subjects into the walking group (subjects could walk unaided or with a cane until 2010; 10 men, 9 women) and the wheelchair group (subjects required the use of a wheelchair from 2007 to 2010; 2 men, 11 women). We determined stress score, stress tolerance, subjective well-being score in accordance with the Philadelphia Geriatric Center Morale Scale, and serum biochemical parameters. We also analyzed oxidant production and phagocytosis by neutrophils and estimated the balance between oxidant production and phagocytosis by correlation analysis. RESULTS: Increases in the stress tolerance of the wheelchair group in 2008 and 2009 and the subjective well-being score in 2009 in the survey were observed. However, in 2010, the stress tolerance and the subjective well-being score decreased to the levels in 2007. In 2010, the levels of serum albumin and high-density lipoprotein cholesterol of the wheelchair group were significantly lower than those of the walking group, and the balance between phagocytosis and oxidant production in the wheelchair group improved.

Development of a support skill scale in insulin therapy: a nationwide study in Japan.

The aim of this cross-sectional, nationwide study in Japan was to develop a support skill scale for insulin therapy (IT-SSS) and to evaluate its validity and reliability. The sample consisted of 1604 nurses at 123 hospitals throughout the country. The factor validity, known-group validity, convergent validity, discriminant validity and internal consistency of IT-SSS were assessed. IT-SSS consisted of 26 minimum and 25 standard support skills. They included 4 subscales for minimum skills: management strategy for hypoglycemia, education about insulin injection technique, individual assessment and support about insulin rejection, and collaboration with medical professionals and patient/family. Three subscales for standard skills: apprehensions concerning the will and emotion of the patient, management for blood glucose control, and coordination in insulin management. Cronbach's alpha coefficient was between 0.75 and 0.90, suggesting strong internal consistency. Multitrait analysis showed that convergent validity was complete, and discriminant validity was found to be almost complete in both minimum and standard skill scales (scaling success rates of 97.6% and 98.7% across all subgroups, respectively). Known group analysis clearly showed that specialist nurses have significantly higher skills than general nurses. These findings indicate that IT-SSS has a reasonable factor validity, convergent validity, discriminant validity, known group validity, and internal consistency.