Predicting self-care practices and glycaemic control using health belief model (HBM) in patients with insulin-treated diabetes in Malaysia

Background: The practice of diabetes self-care plays an important role in glycaemic control. However, not all patients with insulin-treated diabetes engage in their self-care activities. Although there is evidence that self-care practices in patients with insulin-treated diabetes can be understood and predicted by health beliefs proposed by Health Belief Model (HBM), little is known about adult patients due to several methodological weaknesses of previous studies. Furthermore, knowledge is lacking about adults with insulin-treated diabetes in Malaysia. Aim: To examine whether health beliefs suggested by the HBM can predict self-care practices in patients with insulin-treated diabetes in Malaysia. Methods: A longitudinal design was chosen to conduct this study for a six month period at three endocrinology clinics in Malaysia. Data for self-care practices (diet, insulin intake, exercise and SMBG) and health beliefs were measured using a self-reported questionnaire. In addition, participants’ glycaemic control was also examined as the objective measure for the self-care practices. These data were measured based on the participants’s glycated hemoglobin (HbA1c) results. All data were collected twice: at baseline (Time 1) and at six months follow up (Time 2). Differences in all study variables between Time 1 and Time 2 were tested using paired t-test and McNemar’s. Multiple linear regression and multiple logistic regression were used to predict the dependent variables at different points of time. Age, gender, race and diabetes-related knowledge were statistically controlled in the regression analyses. In addition, a qualitative evaluation was carried out to explore the context of the self-care practices by interviewing diabetes educators in the study setting about their diabetes education practice. Results: A total of 159 patients with insulin-treated diabetes (aged 18-40 years) participated in this study. Of these, only 108 (67.9%) completed the study. The participants were more likely to adhere to their insulin injection than to engage in good dietary habits, regular exercise and testing SMBG ≥ 3 times per day. The mean value of HbA1c was 9.8% (SD 2.61). The self-care practices and HbA1c as well as the participants’ health beliefs remained consistent at six (6) months follow up (p >.05). The HBM significantly predicted dietary self-care, insulin intake practice and HbA1c. Of the HBM costructs, perceived benefits significantly predictive of good dietary habits at Time 1 (OR 1.92) and Time 2 (OR .23) and adherence to insulin injection at Time 1 (OR 3.17) and Time 1-2 (OR 2.68). Meanwhile, except perceived severity, all other HBM contructs were predictive of HbA1c [perceived susceptibility (β .169), perceived barriers (β -.206), perceived benefits (β -.397) and cues to action (β -.233)]. The findings of the qualitative data indicate that some participants might not have been provided with diabetes education while those who did might have received inconsistent and inaccurate information regarding their self-care activities. These data were provided by 27 diabetes educators in the study settings. Conclusion: Self-care practices and glycaemic control in this study were related to health beliefs and also could be a result of limitations in the diabetes education that they had received. These findings should be given attention by diabetes educators in their efforts to improve diabetes self-care in patients with insulin-treated diabetes aged 18-40 years in Malaysia. More studies on health beliefs in diabetes self-care are needed for Malaysian patients