What do professionals recommend regarding the frequency of self-monitoring of blood glucose?

BACKGROUND: Patients' adherence to guidelines regarding self-monitoring of blood glucose (SMBG) is limited. However, there are no previous reports about the recommendations that are given in clinical practice concerning SMBG. The aim of this study was to investigate what healthcare providers recommend to insulin-treated patients with diabetes regarding frequency and timing of SMBG. METHODS: In this cross-sectional descriptive study, primary care assistants, diabetes specialised nurses and doctors in the Netherlands were invited via e-mail to complete an internet survey. RESULTS: A total of 980 (14%) professionals returned the questionnaire. Insulin pump users and patients with type 1 diabetes (T1DM) on 4 injections a day were advised to perform SMBG daily by 96% and 63% of the professionals, respectively. The majority of the professionals advised these patients to perform 3-4 measurements per day. There was less agreement on the timing (pre- and÷or postprandial). Patients with type 2 diabetes (T2DM) on four injections were advised to perform SMBG less frequently. There was a wide variation in recommendations that were given to patients with T2DM on less intensive insulin regimens. CONCLUSION: This study investigated SMBG from a professional's perspective. A considerable and relevant variation in the recommendations about the number and timing of SMBG was observed. The most striking differences were found in patients with T2DM on less intensive insulin regimes, also with respect to the frequency of SMBG. Well-designed studies are necessary in order to give a more evidence-based advice on the basic frequency and timing of SMBG.

Preferences and opinions of patients with Type 2 diabetes on education and self-care: a cross-sectional survey.

OBJECTIVE: To assess the preferences of patients with Type 2 diabetes regarding self-care activities and diabetes education. RESEARCH DESIGN AND METHODS: Questionnaire survey carried out in general practices and outpatient clinics across the Netherlands. OUTCOMES: preferred setting for education, preferred educator, and preferred and most burdensome self-care activity. Multinomial logistic regression analysis assessed associations between outcomes and patient characteristics, preferences and opinions. RESULTS: Data of 994 consecutive individuals were analysed (mean 65 years; 54% male; 97% Caucasian; 21% low education level; 80% primary care). Of these, 19% thought they had poor to average glycaemic control, 61% thought they were over-weight and 32% thought they took too little exercise. Eighty per cent of respondents preferred diabetes education during regular diabetes check-ups. Patients taking insulin preferred education to be given by nurses [odds ratio (OR) 2.45; 95% confidence interval (CI) 1.21-4.96]. Individuals who thought their health to be poor/average preferred education to be given by doctors (OR 1.65; 95% CI 1.08-2.53). Physical exercise was the preferred self-care activity of those who thought they took too little exercise (OR 1.97; 95% CI 1.32-2.93) but was preferred less by patients with mobility problems (OR 0.65; 95% CI 0.43-0.97). Patients with eating disinhibition reported keeping to a healthy diet (OR 4.63; 3.00-7.16) and taking medication (OR 1.66; 95% CI 1.09-2.52) as the most burdensome self-care activities. Age was not an independent determinant of any preference. CONCLUSIONS: When providing education for patients with newly diagnosed Type 2 diabetes, healthcare providers should consider making a tailored education plan, irrespective of the patient's age.

Burden, coping and needs for support of caregivers for patients with a bipolar disorder: a systematic review.

This study was aimed to highlight the factors which influence experienced burden, coping and needs for support of caregivers for patients with a bipolar disorder. Research articles meeting content and methodological quality criteria from January 1995 through October 2005 were reviewed. High objective and subjective burden is experienced by these caregivers. Subjective burden is extremely influenced by illness beliefs. High burden is associated more with severity of symptoms (than diagnosis), difficulties in the relationship with patient, lack of support and stigma. Coping is influenced by appraisal and burden. Different phases in the process of caregiving require different coping mechanisms. Little research is available on effectiveness of coping mechanisms and needs for support. Suggestions are nevertheless found in the literature for professional support. Caregivers of patients with a bipolar disorder experience high burden and try to cope in different ways. Little research is available on coping styles and needs for support. However, recommendations can be made to increase support for these caregivers.

The theory and measurement of the self-efficacy construct.

Self-efficacy is the major concept of Bandura's social cognitive theory. Self-efficacy is influenced by four important sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological information. Other determinants of self-efficacy are internal personal factors and external environmental factors. The degree of change in self-efficacy is partly a function of the variability and the controllability of its determinants. Level of self-efficacy predicts how people are functioning in terms of choice of behavior, effort expenditure and persistence, thought patterns and emotional reactions. Measurement of self-efficacy is related to three dimensions: magnitude, strength and generality. Self-efficacy should be measured in terms of particularized judgments of capability that may vary across realms of activity, different levels of task demands within a given activity domain, and different situational circumstances.

Self-efficacy in children with diabetes mellitus: testing of a measurement instrument.

The study reported here assessed the psychometric properties of an instrument to measure diabetes management self-efficacy in Dutch children, ages 8 to 12. Content validity of the item list was tested by consulting an expert panel of diabetes nurse specialists and a child-oriented rating scale was developed. A pretest was conducted to assess whether the instrument was clear and comprehensible for children. Then the instrument was tested in children with diabetes at the outpatient diabetes clinics for children at three Dutch hospitals. Reliability and criterion-related validity of the instrument were assessed. The instrument was judged content valid by the expert panel of diabetes nurse specialists, and the language of the instructions, the items and the rating scale was found to be clear and understandable for children of this age group. The study yielded only a moderate internal consistency estimate (Cronbach's = 0.71) and limited support for criterion-related validity. Several useful theoretical and methodological issues were identified.

The development and psychometric testing of an instrument to measure diabetes management self-efficacy in adolescents with type 1 diabetes.

Adherence to treatment is a major issue for people with diabetes mellitus, and attention has been given to improving self-management in persons with this chronic disease. Most studies show that knowledge alone will not improve self-management behavior. Self-efficacy, a concept introduced by Bandura, has been shown to be an important variable in improving health behaviors. In order to determine whether self-efficacy can influence self-management of diabetes, however, instruments to measure self-efficacy are needed in native languages at an appropriate developmental level, and with good psychometric properties. The study reported here was part of a larger project in the Netherlands, Belgium and the United States in which several instruments, measuring diabetes management self-efficacy, have been developed, both in English and Dutch, for different types of diabetes and different age groups. This article reports on the development and psychometric testing of an instrument measuring self-efficacy in adolescents with type 1 diabetes mellitus. Initially 30 items for the instrument were generated through focus group interviews and their relevance was judged by a team of 10 experts on self-management behavior in adolescents. The final instrument contained 26 items. The sample for psychometric testing consisted of 90 patients with type 1 diabetes who were between 12 and 18 years old. Cronbach's alpha of the instrument was 0.86. An exploratory factor analysis produced two factors which reflect general and more difficult diabetes self-management situations.

Strategies enhancing self-efficacy in diabetes education: a review.

Enhancing self-efficacy in patients with chronic illnesses has been shown to have a positive effect on behavior change. In fact, according to Bandura (1986), self-efficacy is the most important predictor of change in behavior. Thus, in order to make positive changes, effective measures for enhancing self-efficacy are needed in educational programs. There are four important sources of information for increasing self-efficacy: performance accomplishments, vicarious learning, verbal persuasion, and self-appraisal of emotional and physiological responses. Strategies for enhancing self-efficacy are described here for each source of information and for combinations of sources.

The use of self-efficacy enhancing methods in diabetes education in the Netherlands.

According to the social cognitive theory of Bandura, self-efficacy predicts behavorial change. Bandura notes that self-efficacy is based on four major sources of information: performance accomplishments, vicarious experience, verbal persuasion and self-evaluation. This exploratory study examined the use of these four sources of information by Dutch nurse diabetes educators to enhance self-efficacy among people with diabetes mellitus. A survey questionnaire was sent to all Dutch nurse members of the European Association of Diabetes Educators (EADE) asking about the use of self-efficacy-enhancing methods, and four different educational programs were observed. Survey respondents said that performance accomplishments and verbal persuasion were often used, vicarious experience was hardly ever used, and the use of self-evaluation varied. The observations gave a different picture: only verbal persuasion was observed often; the other three sources were hardly ever used. Clearly, self-efficacy-enhancing educational methods are not systematically used in the Netherlands and there is little variety in the methods used. More varied methods of enhancing self-efficacy need to be developed and implemented in diabetes education programs.

International collaborative research on management self-efficacy in diabetes mellitus.

Diabetes mellitus is a leading chronic illness in the United States and in the Netherlands. Assisting persons with diabetes and their families to manage the illness so that they can have satisfying lives is a challenge for all involved. Persons with diabetes mellitus and their significant others (family members, friends, or other caregivers) must learn and perform management behaviors in order to achieve this goal. Self-efficacy has been shown to be an important predictive variable in initiating and continuing management behaviors. In order to test the impact of self-efficacy on the management of diabetes mellitus and to conduct comparative studies in the Netherlands and the United States, a battery of valid and reliable measurement instruments were needed. Six different instruments in two languages were developed to test children with diabetes and their significant other, adults with insulin dependent diabetes and their significant other, and adults with non-insulin dependent diabetes and their significant other. An overview of the instrument development and testing is described. The testing of different formats due to language terminology and the testing of the instruments for the adults with non-insulin dependent diabetes mellitus will be presented.