Health value & perceived control over health: behavioural constructs to support Type 2 diabetes self-management in clinical practice

Abstract

Aims and objectives: To explore health value and perceived control over health in relation to self-management behaviours in adults with Type 2 diabetes mellitus.

Background: Helping people to modify health related behaviour in diabetes is complex due to a multitude of factors. Exploring the meaning of the constructs of Modified Social Learning Theory could be beneficial to identifying people at risk of poor diabetes self-management.

Design: An exploratory qualitative study.

Methods: Thirteen adults with insulin-treated Type 2 diabetes mellitus were purposively sampled. Data were collected through semi-structured interviews. An in-depth thematic analysis was carried out.

Results: Health became a value priority on diagnosis of Type 2 diabetes mellitus. Participants described holding both terminal (relating to desired end states) and instrumental (a means to an end) health values pre-diagnosis but these became instrumental post-diagnosis to meet new lifestyle needs and maintain their quality of life. Descriptions of 'conflicts' in locus of control beliefs when managing Type 2 diabetes mellitus demonstrated influences on levels of self-efficacy and health value. Common themes that impacted on diabetes self-management included co-morbidities, medication management, blood glucose monitoring and reasoning for Type 2 diabetes mellitus.

Conclusions: Locus of control beliefs, levels of self-efficacy and health value were influenced by complications associated with Type 2 diabetes mellitus. The findings on Modified Social Learning Theory and instrumental health value as a moderator to health behaviour resulted in the development of a proposed framework with potential practical utility.

Relevance to clinical practice: This research demonstrates the relevance of exploring the constructs of Modified Social Learning Theory (MSLT) in relation to diabetes self-management behaviours in Type 2 diabetes mellitus. The proposed Type 2 diabetes mellitus Self-management Behaviour Support framework incorporates Modified Social Learning Theory and instrumental health value as the theoretical basis for development and could provide clinical nurses and doctors with a tool that will allow for in-depth assessment and planning of Type 2 diabetes mellitus patients' self-management behaviours.

Keywords: Modified Social Learning Theory; Type 2 diabetes mellitus; health behaviour; health value; perceived control.