Problem solving and diabetes self-management - Investigation in a large, multiracial sample
ABSTRACT Problem solving is a core aspect of effective diabetes and chronic illness self-management, yet there are relatively few objective evaluations of problem-solving skills, especially in large, multiracial samples.
A multiracial sample of 506 adults who have type 2 diabetes were assessed on a variety of patient characteristics, self-management behaviors, and biological and psychosocial measures. They also completed the Diabetes Problem-Solving Interview (DPSI).
DPSI scores revealed significant variability across patients in problem-solving skill and were related to a number of comorbid conditions and complications but not to several other demographic factors, including race/ethnicity. Problem solving was also related to self-management behaviors (eating and exercise patterns), biological variables (A1C and lipids), and psychosocial measures (Diabetes Distress Scale) in multivariable analyses controlling for a variety of potential confounding factors.
Diabetes problem solving, as measured by the DPSI, is an important patient skill related to several key diabetes management variables that appears applicable across racial and ethnic groups. Future research is needed to identify the generality versus specificity of diabetes problem solving and practical interventions to enhance problem-solving skills.
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ABSTRACT: Description and Theoretical Background Definition The concept of perceived barriers has been used in behavioral medicine for a long time in one form or another. The earliest widespread use of the barriers concept was associated with the Health Belief Model, as described in the following section. Webster's dictionary defines a barrier as "something that impedes or separates". Interestingly, the concept of barriers to accomplishment of a goal or a specified health behavior is assumed to be so straightforward that it is often left undefined. For the purposes of this summary, perceived barrier will be defined as "a person's estimation of the level of challenge of social, personal, environmental, and economic obstacles to a specified behavior or their desired goal status on that behavior." This definition raises a number of issues. First, the adjective "perceived" (barriers) implies that the individual's judgment about the number and strength of barriers is a cognitive process; as such, this judgment may or may not be closely aligned with "objective" measures of social, environmental, or economic barriers. Many factors in addition to "objective barriers" influence a person's perception of barriers. Several of these factors, including past history, risk or threat perceptions, and perceived social support, influence beliefs about barriers. Figure 1 summarizes the presumed interactions among perceived barriers, "objective barriers", other psychosocial factors, facilitators or promoters, and potential background moderating variables. This figure is an attempt to synthesize the literature and to represent commonalities across theories and several of the key research issues—it is not based on any one theory.
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ABSTRACT: The purpose of this systematic review is to assess the published literature on problem solving and its associations with diabetes self-management and control, as the state of evidence exists. PubMed, PsychINFO, and ERIC electronic databases were searched for the years 1990 to the present and for English-language articles, and reference lists from included studies were reviewed to capture additional studies. Quantitative and qualitative studies that addressed problem solving as a process or strategy for diabetes self-management were included. Fifty-two studies met the criteria for inclusion. Study design, sample characteristics, measures, and results were reviewed. Thirty-six studies were quantitative; 16 were conceptual or qualitative. Studies were classified as addressing the problem-solving definition/framework, assessment, intervention, or health care professional issues. Problem solving is a multidimensional construct encompassing verbal reasoning/rational problem solving, quantitative problem solving, and coping. Aspects of problem solving can be assessed using newly developed diabetes-specific problem-solving measures for children/adolescents and adults. Cross-sectional studies in adults, but not children/adolescents, provide consistent evidence of associations between problem solving and A1C level. Only 25% of problem-solving intervention studies with children/adolescents and 50% of interventions with adults reported improvement in A1C. Most intervention studies reported an improvement in behaviors, most commonly global adherence in children/adolescents and dietary behavior in adults. Methodological limitations (noninclusion of problem-solving measures, inadequate descriptions of problem-solving interventions, homogenous samples) need to be addressed in future research to clarify the effect of problem solving on diabetes outcomes, identify characteristics of effective interventions, and determine the utility across age and racial/ethnic groups.The Diabetes Educator 11/2007; 33(6):1032-50; discussion 1051-2. DOI:10.1177/0145721707308412 · 1.92 Impact Factor
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ABSTRACT: Computer-tailored behavior change programs offer the potential for reaching large populations at a much lower cost than individual or group-based programs. However, few of these programs to date appear to integrate behavioral theory with user choice, or combine different electronic modalities. We describe the development of an integrated CD-ROM and interactive voice response dietary change intervention that combines behavioral problem-solving theory with a high degree of user choice. The program, WISE CHOICES, is being evaluated as part of an ongoing trial. This paper describes the program development, emphasizing how user preferences are accommodated, and presents implementation and user satisfaction data. The program was successfully implemented; the linkages among the central database, the CD-ROM and the automated telephone components were robust, and participants liked the program almost as well as a counselor-delivered dietary change condition. Multi-modality programs that emphasize the strengths of each approach appear to be feasible. Future research is needed to determine the program impact and cost-effectiveness compared with counselor-delivered intervention.Health Education Research 09/2008; 24(3):461-71. DOI:10.1093/her/cyn042 · 1.66 Impact Factor