Unravelling moderated mediating effects of loss aversion, information avoidance and self-efficacy on cancer fear and cancer screening.

BACKGROUND: Cancer health campaigns provide information to drive early detection. OBJECTIVE: To examine the effect of cancer fear on cancer screening focusing on the mediating role of loss aversion, a concept derived from prospect theory. We hypothesize that fear initiates negative beliefs that cancer can cause the loss of way of life leading to information avoidance, and indirectly influences cancer screening intentions. This theoretical model is conditional, in that one's degree of self-efficacy moderates cancer screening intentions. METHODS: A cross-sectional sample (N = 371), aged 35 to 70, recruited via an online panel. Participants completed a questionnaire containing demographic and examined variables. Using conditional process, we tested the proposed theoretical framework. RESULTS: Cancer fear was positively associated with cancer screening, and an indirect path was found where loss aversion and information avoidance negatively mediated the relationship. Self-efficacy was found to significantly moderate information avoidance and cancer screening intentions. Among those who reported high information avoidance, less self-efficacious individuals had lower cancer screening intentions compared to those more self-efficacious. CONCLUSION: We confirm extant literature that negative views of cancer lead to loss aversion and information avoidance. Using prospect theory can help make messaging for cancer screening more effective.

Effectiveness of a Cluster Randomized Controlled Trial Involving Community-Based Intervention for Older Adults With Type 2 Diabetes Mellitus in Singapore.

PURPOSE: The purpose of the study was to investigate the effectiveness of a community-based intervention on improving knowledge about diabetes, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus (T2DM) in Singapore, a country in Asia with a high prevalence of diabetes. METHODS: A 3-arm cluster randomized controlled trial involving community-dwelling older adults ages 55 to 99 with T2DM was conducted. Intervention group 1 and 2 participants received a 12-session intervention program designed to teach knowledge and practical skills in diabetes self-care with psychological techniques for behavioral change like problem solving, goal setting, and motivational interviewing. In addition, intervention group 2 participants received a glucometer and a supply of accessories each. The control group received routine care from their health care providers. RESULTS: Compared to the control group, intervention group 2 reported an increase in medication adherence and self-monitoring of blood glucose (SMBG) at 3-month follow-up and increased knowledge about diabetes and self-care behavior in general diet control at 6-month follow-up. CONCLUSIONS: The community-based intervention should be extended to more older adults with T2DM in the community. Glucometers and accessories could be provided at subsidized rates or be made free contingent on older adults' income status to overcome the barrier of performing SMBG.

Exploring the Perspective of Diabetes, Diabetes Self-Management, and Quality of Life Among Older Adults With Type 2 Diabetes: A Qualitative Study Before and During the COVID-19 Pandemic.

PURPOSE: The purpose of the study was to explore the perspective and impact of diabetes, diabetes self-management, and quality of life (QoL) among older adults with Type 2 diabetes (T2DM) before and during the COVID-19 pandemic to better inform T2DM self-management interventions. METHODS: A qualitative descriptive approach with focus group discussions (n = 5 sessions with 5-6 older adults per session) and in-depth interviews (n = 15) was conducted with community-dwelling older adults with T2DM. RESULTS: Five themes emerged. The definition of diabetes carries negative connotations, QoL is defined in terms of biopsychosocial health, diabetes self-management refers to the ability to adhere to medical advice and lifestyle changes, the QoL of older adults is differentially affected by COVID-19 measures, and important aspects of diabetes self-management activities are impacted by COVID-19 measures. CONCLUSIONS: Understanding older adults' perspectives on diabetes, diabetes self-management, and QoL provided insights into the facilitators and barriers to diabetes self-management practices before and during the COVID-19 pandemic. Findings inform the need for greater bottom-up initiatives and the need for a multipronged approach that considers the intra- and interpersonal and current policy factors to encourage diabetes self-management behaviors, especially during the COVID-19 era.

Sociodemographic characteristics associated with self-care and quality of life among community-dwelling older adults with type 2 diabetes.

AIMS: To assess how well community-dwelling older adults in Singapore were coping with their diabetes, and the sociodemographic characteristics that were associated with their level of coping. METHODS: This was a cross-sectional study involving 257 older adults. Multiple regression was used to assess the associations between various sociodemographic characteristics and coping measures of present quality of life and level of self-care. RESULTS: Older adults mainly sought care in the primary care setting. They were not coping well given their mean scores for diabetes-dependent quality of life and the self-care index were -3.57 and 3.55 respectively. Compared to those with post-secondary education, individuals who had no formal (adjusted B -0.92, p 0.003), primary level (adjusted B -0.76, p < 0.001) and secondary level (adjusted B -0.50, p < 0.02) education reported lower present quality of life. Those with prior lowest skill level occupations were less likely to consume a healthy diet per week than those with prior highest skill level occupations (adjusted B -1.48, p 0.004). CONCLUSIONS: There should be provision of diabetes self-care interventions targeting older adults in Singapore especially for those with lower education and work skill levels. As the first line of contacts, primary care providers should advocate for diabetes self-care and develop community-based interventions for these priority groups.