Relationship between health locus of control, health value, and social support and compliance of persons with diabetes mellitus.

Thirty insulin-dependent outpatients were interviewed during one of their diabetes clinic visits. Questionnaires were used to measure the independent variables of health locus of control, health value, and perceived social support. Self-report and direct observation were used to measure the dependent variable, compliance with insulin administration, diet, exercise, hypoglycemia management, self-monitoring of blood glucose (SMBG), and foot care prescriptions. All patients complied with at least 70% of the points measured; half the group complied with at least 80% of the regimen. However, no one complied with all the behaviors deemed essential for good control. The group was most compliant with SMBG, hypoglycemia management, and insulin administration and least compliant with foot care and exercise. A statistically significant relationship was found between compliance and social support (P less than 0.001), powerful others health locus of control (PHLC) (P less than 0.01), and internal health locus of control (IHLC) (P less than 0.05). A multiple regression analysis found that social support and PHLC accounted for at least 50% of the variance in compliance scores. The multiple-R of the independent variables with compliance reached a significance level of P less than 0.005. However, only the two variables of social support and PHLC added significantly (P less than 0.05) to prediction accuracy. The multiple-R of these two variables used as a set reached the significance level of P less than 0.001.

Predictors of adherence to nutrition recommendations in people with non-insulin-dependent diabetes mellitus.

The purpose of this study was to determine how the components of psychosocial adjustment to diabetes predict adherence to nutrition recommendations based on self-reported successful completion of contingency contracts. The relationships between the components of psychosocial adjustment and adherence to nutrition recommendations were examined in a convenience sample of patients with non-insulin-dependent diabetes mellitus participating in a contingency contracting intervention with nurses. Patients completed a standardized instrument, the Diabetes Care Profile, at the time they were enrolled into this randomized clinical trial. High and low levels of adherence to nutrition recommendations were identified by a median split of the number of contingency contracts completed for adherence to nutrition recommendations. Subjects who reported higher regimen adherence and a higher support ratio (received more diabetes-specific social support than desired) were significantly less likely to engage in contingency contracting for adherence to nutrition recommendations.

Behavioral analysis and behavioral strategies to improve self-management of type II diabetes.

The implications of behavioral analysis for practice and research have significant potential for nursing. This present study was conducted to determine the effectiveness of nurses and patients actively participating in behavioral analysis and the implementation of behavioral strategies in order to improve the patients' self-management of their Type II diabetes. Patients (N = 156) were randomly assigned to one of four groups. The attention control group (n = 41) received routine care. The compliance group (n = 32) agreed to practice compliance behaviors related to the prescribed medical regimen. The behavioral strategies group (n = 42) participated in behavioral analysis and agreed to practice behavioral strategies. The behavioral strategies with instruction group (n = 41) participated in behavioral analysis, agreed to practice behavioral strategies, and received classes and programmed instruction about behavioral analysis and behavioral strategies. There were no outcome differences between groups relative to glycosylated hemoglobin (GHb) and weight loss. There were differences in the outcome measures in subgroups by age, gender, and employment, which have practice and research implications for the individualization of interventions using behavioral strategies.

Adherence in chronic disease.

Nonadherence to treatment regimen is a prevalent problem of patients with chronic disorders. Approximately half of the patients with a chronic disease have problems following their prescribed regimen to the extent that they are unable to obtain optimum clinical benefit. This chapter reviews the state of knowledge regarding adherence to chronic disease regimens across the life span and demonstrates that the extent and nature of the adherence problems are similar across diseases, across regimens, and across age groups. Adherence to the commonly prescribed regimens is addressed, including pharmacological therapies, therapeutic diets, and therapeutic exercise. Randomized, controlled studies focusing on various educational, behavioral, cognitive, and affective interventions to improve adherence are included. Based on this review, further work is needed to better understand and improve adherence. New strategies for analysis and measurement will support these needed advances in the field of adherence.

Behaviors in type II diabetes during contingency contracting.

The purpose of this study was to use existing data to describe the behaviors performed by 117 subjects with Type II diabetes who wrote contingency contracts with nurses. Data were analyzed from a larger, randomized clinical trial of contingency contracting to improve clinical outcomes. Subjects had a high rate of completion of behaviors in contingency contracts (M = 90.9%). Subjects performed a median of six behaviors overall and up to a median of three behaviors of each of the diabetic regimen behaviors. The majority performed diet (n = 68, 58.1%) and exercise (n = 69, 58.9%) behaviors, with only one third performing both behaviors (n = 40, 34.2%). The most frequent behavioral strategies used were breaking the behavior into steps and self-monitoring the behavior. The contingency contracting intervention should be modified to be more comprehensive with increased recognition of the time and effort required for concurrently changing diet and exercise.

Behavioral analysis and nursing interventions for reducing disruptive behaviors of patients with dementia.

In this study, two cases were used to examine the potential of behavioral analysis as an intervention to decrease disruptive behaviors of institutionalized individuals with dementia. Behavioral modeling was used to teach the principles of behavioral analysis. The nurses observed a behavior change plan implemented by the investigator, revised the plan based on behavioral analysis techniques, and subsequently implemented the revised behavioral strategies. The patients' disruptive behaviors decreased markedly when the behavioral intervention was implemented. Patients resumed disruptive behaviors when care was provided without the behavioral plan. The findings suggest the need to address interventions in nursing research, education, and practice that use behavioral analysis to reduce disruptive behaviors in individuals with dementia.

Prostate cancer in African American men: increasing knowledge and self-efficacy.

An educational and screening program for prostate cancer designed to increase knowledge and self-efficacy in African American men was provided in African American churches in a major midwestern city. Modeling was provided by trained lay educators who were African American men previously diagnosed and treated for prostate cancer and who could serve as role models of the desired behaviors. Pretests and posttests developed for this study and provided to the participants were the Prostate Cancer Screening Knowledge Inventory and the Prostate Cancer Screening Self-Efficacy Scale. Paired t tests demonstrated that after completing the church-based intervention, participants had significantly improved knowledge and self-efficacy scores related to prostate cancer screening.

Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36.

The purpose of this report is to examine health-related quality of life (HRQoL) as measured by the Medical Outcomes Study Short Form-36, across patient populations with chronic disorders and to compare quality of life (QoL) in these subjects with normative data on healthy persons. Six studies, within the Center for Research in Chronic Disorders at the University of Pittsburgh School of Nursing, in patients with urinary incontinence, prostate cancer, chronic obstructive pulmonary disease (COPD), acquired immune deficiency syndrome (AIDS), fibromyalgia and hyperlipidaemia provided the data for analysis. The results demonstrated that not only did the prostate cancer and hyperlipidaemia patients have the highest QoL across the chronic disorders, but their QoL was comparable to normative data on healthy persons. Homebound, elderly, incontinent patients had the lowest QoL for physical functioning, whereas patients hospitalized with AIDS had the lowest QoL in general health and social functioning. Patients with COPD had the lowest QoL in role-physical, role-emotional and mental health. Patients with fibromyalgia had the lowest QoL in bodily pain and vitality. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia generally had lower QoL. Prostate cancer and hyperlipidaemia patients had QoL comparable to normative data. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia had more variability for role-emotional. AIDS patients had more variability on physical functioning, bodily pain and social functioning compared to the normative data. These data suggest that patients with various chronic disorders may have QoL that is lower in most domains compared to a healthy population. However, there may be differences in the domains affected as well as the extent of variation across specific chronic disorders.