Validation of an Information-Motivation-Behavioral Skills model of diabetes self-care (IMB-DSC)

Abstract

Objective: Comprehensive behavior change frameworks are needed to provide guidance for the design, implementation, and evaluation of diabetes self-care programs in diverse populations. We applied the Information-Motivation-Behavioral Skills (IMB) model, a well-validated, comprehensive health behavior change framework, to diabetes self-care.

Methods: Patients with diabetes were recruited from an outpatient clinic. Information gathered pertained to demographics, diabetes knowledge (information); diabetes fatalism (personal motivation); social support (social motivation); and diabetes self-care (behavior). Hemoglobin A1C values were extracted from the patient medical record. Structural equation models tested the IMB framework.

Results: More diabetes knowledge (r=0.22 p<0.05), less fatalistic attitudes (r=-0.20, p<0.05), and more social support (r=0.27, p<0.01) were independent, direct predictors of diabetes self-care behavior; and through behavior, were related to glycemic control (r=-0.20, p<0.05).

Conclusions: Consistent with the IMB model, having more information (more diabetes knowledge), personal motivation (less fatalistic attitudes), and social motivation (more social support) was associated with behavior; and behavior was the sole predictor of glycemic control.

Practice implications: The IMB model is an appropriate, comprehensive health behavior change framework for diabetes self-care. The findings indicate that in addition to knowledge, diabetes education programs should target personal and social motivation to effect behavior change.

Figure 1

Confirmatory Factor Analysis of Diabetes Self-Care Behaviors (Measurement Model). Note: Overall model fit, χ²(9, N = 130) = 15.60, p = 0.08, CFI = 0.90, RMSEA = 0.07 (90% CI: 0.00 - 0.14). For tests of significance of individual factor loadings, *p < 0.05, **p < 0.01 and ***p < 0.001.

Figure 2

Estimated Information—Motivation—Behavioral Skills model of Diabetes Self-care (Full). Note: Coefficients are standardized path coefficients. Overall model fit, χ²(14, N = 130) = 17.92, p = 0.21, CFI = 0.95, RMSEA = 0.05 (90% CI: 0.00 - 0.10). For tests of significance of individual paths, ^tp = 0.09, *p < 0.05, **p < 0.01 and ***p < 0.001.

Figure 3

Estimated Information—Motivation—Behavioral Skills model of Diabetes Self-care (Trimmed). Note: Coefficients are standardized path coefficients. Overall model fit, χ²(17, N = 130) = 18.27, p = 0.37, CFI = 0.98, RMSEA = 0.02 (90% CI: 0.00 - 0.08). For tests of significance of individual paths, *p < 0.05, **p < 0.01 and ***p < 0.001.