Construction Of Self-management Behaviors Pathway For Patients With Type 2 Diabetes Mellitus Based On Attachment Theory

Objectives1.To investigate the status of self-management behaviors and glycemic control in patients with type 2 diabetes mellitus and analyze the correlation between them.2.To investigate the status of attachment patterns,illness perception,medical coping modes in patients with type 2 diabetes mellitus and explore their impact on self-management behaviors.3.To construct the path of self-management behaviors for patients with type 2diabetes mellitus based on attachment theory and the common-sense model of self-regulation.To analyze the mechanism of attachment patterns,illness perception and medical coping modes on self-management behaviors.MethodsA cross-sectional study was carried out in a tertiary hospital in Tianjin from October 2018 to April 2019.A total of 253 inpatients with type 2 diabetes mellitus were recruited and inquired by general information questionnaire,the summary of diabetes self-care activities measure,experience in close relationship questionnaire,brief illness perception questionnaire and medical coping modes questionnaire.The data was described using mean±standard deviation,median,frequency and composition ratio.The Comparison between groups was analyzed using t test or one-way analysis of variance.The correlation between variables was analyzed using Pearson test or Spearman test.Multiple stepwise regression was used to explore the factors associated with self-management behaviors.Path analysis was used to explore the effect path of attachment patterns,illness perception and medical coping modes on self-management behaviors.ResultsThe researcher distributed a total of 253 questionnaires and recovered 252questionnaires,of which 232 were valid.The effective ratio was 91.70%.Through statistical analysis of valid questionnaires,the main results were as follows.1.Self-Management Behaviors and Glycemic Control（1）The total score of self-management behaviors of the subjects was 16.30±7.24.The dimension of general diet scored the highest with a score of 4.50（2.50,6.00）and the dimension of foot care scored the lowest with a score of 1.00（0.00,3.50）.（2）The average values of BMI,FBG,h2BG and Hb A_1c were 26.86±4.05,8.82±2.53,12.47±3.96 and 9.33±2.05,respectively.（3）The correlation analysis showed that the total score of self-management behaviors was negatively associated with FBG（r=-0.159,P<0.05）,h2BG（r=-0.133,P<0.05）and Hb A_1c（r=-0.160,P<0.05）.General diet was negatively associated with FBG（r=-0.159,P<0.05）and h2BG（r=-0.131,P<0.05）.Physical exercise was negatively associated with FBG（r=-0.210,P<0.01）and Hb A_1c（r=-0.139,P<0.05）.Blood glucose monitoring was negatively associated with h2BG（r=-0.145,P<0.05）and Hb A_1c（r=-0.178,P<0.01）.2.Factors Associated with Self-Management Behaviors（1）The scores of attachment avoidance and attachment anxiety of the subjects were 3.57±0.80 and 2.91±1.06.The prevalence for secure,dismissing,preoccupied and fearful attachment patterns were 37（15.9%）,116（50.0%）,9（3.9%）and 70（30.2%）,respectively.（2）The total score of illness perception was 42.50±9.93.The scores of consequences,timeline,personal control,treatment control,symptom identity,concern,coherence and emotional response were 6.00（4.00,8.00）,10.00（6.00,10.00）,4.00（2.00,5.00）,2.00（1.00,5.00）,5.00（3.00,8.00）,8.00（5.00,10.00）,4.00（2.00,6.00）and 5.00（3.00,7.00）,respectively.（3）In medical coping modes of the subjects,the scores of confrontation,avoidance and acceptance-resignation were 18.68±3.92,14.55±3.27 and 9.88±2.44,respectively.The score of confrontation was lower than the normal while the score of acceptance-resignation was higher than the normal（P<0.05）.（4）Multiple stepwise regression showed that age,personal control,coherence,confrontation and acceptance-resignation were factors that associated with self-management behaviors,which could explain 31.8%variation of the self-management behaviors.(R²=0.332,R²_adj=0.318,F=22.506,P<0.001)3.Paths of Self-Management BehaviorsAttachment patterns could affect self-management behaviors through illness perception and medical coping modes.Illness perception could directly or indirectly affect self-management behaviors through medical coping modes.The paths were as follows.Path 1:attachment avoidance→cognition→confrontation→self-management behaviors.Path 2:attachment avoidance→cognition→acceptance-resignation→self-management behaviors.Path 3:attachment anxiety→emotion→confrontation→self-management behaviors.Path 4:comprehension→self-management behaviors.Path 5:comprehension→confrontation→self-management behaviors.The path coefficients of the above 5 paths all reached the significant level（P<0.05）and the fitness of the model was good（χ²/df=2.303,AGFI=0.918,RMSEA=0.075）.Conclusions1.Self-Management Behaviors and Glycemic Control（1）Type 2 diabetes patients’self-management behaviors were poor.Patients’performances in different aspects of self-management behaviors were different and varied widely.The performance of general diet behaviors was the best while the performance of foot care behaviors was the worst.（2）Patients’glycemic control was not ideal.The average value of each glycemic control index exceeded the standard recommended by the guideline.（3）Patients with better self-management behaviors had lower glycemic level and better glycemic control.2.Factors Associated with Self-Management Behaviors（1）The number of type 2 diabetes patients with dismissing pattern were the most.As age increased,individual’s needs for intimacy decreased and attachment avoidance became more distinct.（2）Type 2 diabetes patients had a moderately high negative perception.Compared with self-management,more patients were prone to use medication to control disease,and they had insufficient understanding of their own importance in disease management.（3）Compared with the normal,type 2 diabetes patients’confrontation were lower while their acceptance-resignation were higher.They had less confidence to overcome the disease and were more likely to succumb to it.（4）Patients who were older,had a stronger sense of personal control and better understanding of the disease,had a more active coping style were better at self-management behaviors.3.Paths of Self-Management BehaviorsAttachment theory could be incorporated into the common-sense model of self-regulation to jointly explained the self-management behaviors of patients with type 2diabetes.It is suggested that nursing stuff should consider individuals’attachment patterns and develop different methods of education when caring for them,so that could stimulate patients’motivation and improve their self-management behaviors for the benefit of maintain good glycemic level.