by XU, YIN

Abstract (Summary)
Background: It China, more than 20 million people were diagnosed with diabetes in 2000 and it was estimated there would be 42.3 million people with diabetes by 2030 (Wild, Roglic, Green, Sicree, & King, 2004). Diabetes mellitus self-management (DMSM) is considered the cornerstone for controlling diabetes and preventing diabetic complications. To develop effective interventions to promote DMSM in China, it is critical to identify the factors influencing DMSM relevant to this population. The purposes of this study were to test a hypothesized model describing the effects of individual and environmental factors on DMSM in patients with type 2 diabetes in China, and to test if the estimated effects are the same between two subgroups, patients treated with insulin vs. patients treated without insulin. The individual factors included diabetes knowledge, beliefs of treatment effectiveness, and diabetes self-efficacy. Environmental factors included social support from family members and provider-patient communication. Methods: A cross-sectional survey research design was used in this study. The study was conducted at a major hospital in Beijing China. A convenience sample of 201 Chinese adult patients with type 2 diabetes mellitus who attended the outpatient department of the Endocrinology unit at the hospital from September 2004 to November 2004 was obtained for this study. Data were collected using a self-reported questionnaire. Structural equation modeling (SEM) analysis was conducted to test the hypothesized model, and examine and explore the relationships between and among the individual and environmental factors and DMSM. Findings: The initial hypothesized model did not fit the observed data. Based on statistical findings and theoretical soundness, the model was modified. The final model had a good fit to the data. The key findings were that belief in treatment effectiveness and diabetes self-efficacy were key proximal factors affecting DMSM. Knowledge and the environmental factors indirectly affected DMSM through belief in treatment effectiveness and self-efficacy. The findings based on the multi-group SEM analysis indicated that patient-provider communication was a more important factor affecting DMSM for the insulin-treated subgroup, while family support was more important for the non-insulin treated subgroup. Conclusions: The good fit of the final model indicated that significant determinants of DMSM described in American studies were also important predictors of DMSM in Chinese with diabetes. The model illustrated that individual and environmental factors affected DMSM both directly and indirectly. Understanding the complex relationships between and among the individual and environmental factors and DMSM helps the practitioner to design intervention programs promoting DMSM using a more comprehensive approach. The practitioner should also be aware of the differences between the subgroups when developing intervention programs.
Bibliographical Information:


School:University of Cincinnati

School Location:USA - Ohio

Source Type:Master's Thesis

Keywords:diabetes self management chinese structural equation modeling


Date of Publication:01/01/2005

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