Maintaining behavioral changes: A descriptive account from individuals with type 2 diabetes

Type 2 diabetes is a serious metabolic disorder occurring in over 90% of the people in the United States diagnosed with diabetes. The standard treatment for type 2 diabetes requires individuals to self-manage a diet, exercise, and self-monitoring of blood glucose (SMBG) to control blood glucose levels and reduce the onset of serious complications. Although there is a plethora of literature addressing the difficulty individuals have to maintain these three behaviors, few studies exist describing how these behaviors are sustained. This descriptive qualitative study was designed to learn how individuals with type 2 diabetes maintained behavioral changes of diet, exercise, and SMBG beyond an initial 6-month period and to identify obstacles, strategies, lapses, relapses, and factors facilitating maintenance. The concept of maintenance, the last stage of change in a series of five within the Transtheoretical Model of Change (TTM) (Prochaska, Norcross, & DiClemente, 1994) begins after changes have been sustained for 6 months. The processes of behavior reinforcement, stimulus control, helping relationships, and self-efficacy are used as facilitating factors. In-depth interviews (May, 1991) were used to elaborate on maintenance behavior. Five informants, who had self-reported on a previous diabetes study that they had maintained behaviors, were interviewed. One-to-two in-depth taped interviews lasting 1–2 hours with 1–2 follow-up phone calls were conducted. Within and between case analyses were completed based on the research questions. Similar behaviors were found among the informants. Informants adapted their behaviors to their personal circumstances. SMBG was used as a feedback mechanism to reinforce positive and negative behavior. Consistent with the TTM, behavior reinforcement, stimulus control, helping relationships, and self-efficacy were used. The findings further indicated the informants\u27 acceptance of responsibility, adaptability, persistence, and determination in self-managing diabetes. Also, fear of complications emerged as a powerful factor. Educators and practitioners when caring for clients in maintenance should consider these findings