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Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Research Article

Understanding Self-Care Behaviours among Type II Diabetes Patients: A Behaviour Change Models’ Perspective

Author(s): Eslavath Rajkumar*, G.T. Kruthika, Ruth Angiel Padiri, R. Lakshmi*, Monica Daniel, Romate John and John Abraham

Volume 19, Issue 4, 2023

Published on: 05 August, 2022

Article ID: e190522205029 Pages: 13

DOI: 10.2174/1573399818666220519142118

Price: $65

Abstract

Background: Self-care behaviours among diabetes patients is often hindered because of various psycho-social factors which become obstacles to their better diabetes management and its proper outcome. The current study aims to find out these psycho-social factors that influence the execution of self–care behaviours among Type II diabetes patients from the perspective of various behaviour change models.

Methods: The study adopted a correlational research design. A total of 266 participants above the age group of 18 years and diagnosed with type 2 diabetes were selected using purposive sampling from the Indian state of Karnataka. The data were collected using The Health Belief Questionnaire, Theory of Planned Behaviour Questionnaire (TPBQ), Socio-Ecological Model Questionnaire, and Diabetic Self-Care Activities Revised (SDSCA-R). The data were analysed using descriptive statistics, Pearson product-moment correlation and multiple regression.

Results: From the findings, it was observed that the domains of perceived susceptibility, cues to action and subjective norms are positively correlated with self-care behaviours significantly at p<0.05 levels, while the domains of socio-ecological theory, personal, interpersonal, media and policy and community organizations are significantly positively correlated with self-care behaviour at p<0.01 levels. The linear regression of the domains of health belief model, theory of planned behaviour and socio-ecological theory on self-care behaviour showed that the statistically significant final model explained 14.9% (R2 =.149), F (3,262) =15.337, p< 0.000. The significant predictors are community at p<0.000 level, self-efficacy and perceived severity at p<0.05 levels.

Conclusion: The study results ascertain the necessity of a psychosocial approach or the sociocognitive perspective to understand the factors that actually enable a diabetes patient to engage in more self-care behaviours. In the Indian scenario, where health literacy is very minimum, the findings of the study can be used to implement better strategies for diabetes management both at the level of medical/mental health professionals and at the level of media and policy.

Keywords: Type II diabetes, self-care behaviours, behaviour change models.

[1]
Haug MR, Wykle ML, Namazi KH. Self-care among older adults. Soc Sci Med 1989; 29(2): 171-83.
[http://dx.doi.org/10.1016/0277-9536(89)90165-2] [PMID: 2749300]
[2]
World Health Organization. Self-care in the context of primary health care 2009. Available from: https://apps.who.int/iris/bitstream/handle/10665/206352/B4301.pdf
[3]
Orem DE, Taylor SG, Renpenning KM. Nursing concept of practice. (6th ed.), ST. Louis: Mosby A Harcout Health Scienc Company 2001.
[4]
Atlas D. International Diabetes Federation. IDF Diabetes atlas. (7th ed..), Brussels, Belgium: International diabetes federation 2015.
[5]
Stumvoll M, Goldstein BJ, van Haeften TW. Type 2 diabetes: Principles of pathogenesis and therapy. Lancet 2005; 365(9467): 1333-46.
[http://dx.doi.org/10.1016/S0140-6736(05)61032-X] [PMID: 15823385]
[6]
Kyrou I, Tsigos C, Mavrogianni C, et al. Sociodemographic and lifestyle-related risk factors for identifying vulnerable groups for type 2 diabetes: A narrative review with emphasis on data from Europe. BMC Endocr Disord 2020; 20 (Suppl. 1): 134.
[http://dx.doi.org/10.1186/s12902-019-0463-3] [PMID: 32164656]
[7]
Galicia-Garcia U, Benito-Vicente A, Jebari S, et al. Pathophysiology of type 2 diabetes mellitus. Int J Mol Sci 2020; 21(17): 6275.
[http://dx.doi.org/10.3390/ijms21176275] [PMID: 32872570]
[8]
Hayden MR, Tyagi SC. Intimal redox stress: Accelerated atherosclerosis in metabolic syndrome and type 2 diabetes mellitus. Atheroscleropathy. Cardiovas Diabetol 2002; 1: 3.
[9]
van Ommen B, Wopereis S, van Empelen P, et al. From diabetes care to diabetes cure-the integration of systems biology, eHealth, and behavioral change. Front Endocrinol (Lausanne) 2018; 8: 381.
[http://dx.doi.org/10.3389/fendo.2017.00381] [PMID: 29403436]
[10]
Baxter AJ, Coyne T, McClintock C. Dietary patterns and metabolic syndrome-a review of epidemiologic evidence. Asia Pac J Clin Nutr 2006; 15(2): 134-42.
[PMID: 16672196]
[11]
Shrivastava SR, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus. J Diabetes Metab Disord 2013; 12(1): 14.
[http://dx.doi.org/10.1186/2251-6581-12-14] [PMID: 23497559]
[12]
Almomani MH, Al-Tawalbeh S. Glycemic control and its relationship with diabetes self-care behaviors among patients with type 2 diabetes in Northern Jordan: A cross-sectional study. Patient Prefer Adherence 2022; 16: 449-65.
[http://dx.doi.org/10.2147/PPA.S343214] [PMID: 35221675]
[13]
Povey RC, Clark-Carter D. Diabetes and healthy eating: A systematic review of the literature. Diabetes Educ 2007; 33(6): 931-59.
[http://dx.doi.org/10.1177/0145721707308408] [PMID: 18057263]
[14]
Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: A meta-analysis of controlled clinical trials. JAMA 2001; 286(10): 1218-27.
[http://dx.doi.org/10.1001/jama.286.10.1218] [PMID: 11559268]
[15]
American Diabetes Association. Standards of medical care in diabetes-2009. Diabetes Care 2009; 32 (Suppl. 1): S13-61.
[http://dx.doi.org/10.2337/dc09-S013] [PMID: 19118286]
[16]
Odegard PS, Capoccia K. Medication taking and diabetes: A systematic review of the literature. Diabetes Educ 2007; 33(6): 1014-29.
[http://dx.doi.org/10.1177/0145721707308407] [PMID: 18057270]
[17]
Deakin TA, McShane CE, Cade JE, Williams R. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005; 2: CD003417.
[http://dx.doi.org/10.1002/14651858.CD003417.pub2]
[18]
Herschbach P, Duran G, Waadt S, et al. Psychometric properties of the questionnaire on stress in patients with diabetes-revised (QSD-R). Health Psychol 1997; 16(2): 171-4.
[http://dx.doi.org/10.1037/0278-6133.16.2.171] [PMID: 9269888]
[19]
Alvarado-Martel D, Ruiz Fernández MÁ, Cuadrado Vigaray M, et al. Identification of psychological factors associated with adherence to self-care behaviors amongst patients with type 1 diabetes. J Diabetes Res 2019; 2019: 6271591.
[http://dx.doi.org/10.1155/2019/6271591] [PMID: 31485453]
[20]
Christie D, Channon S. The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in paediatric and adult populations: A clinical review. Diabetes Obes Metab 2014; 16(5): 381-7.
[http://dx.doi.org/10.1111/dom.12195] [PMID: 23927612]
[21]
Despins LA, Wakefield BJ. Making sense of blood glucose data and self-management in individuals with type 2 diabetes mellitus: A qualitative study. J Clin Nurs 2020; 29(13-14): 2572-88.
[http://dx.doi.org/10.1111/jocn.15280] [PMID: 32279366]
[22]
Ismail K, Maissi E, Thomas S, et al. A randomised controlled trial of cognitive behaviour therapy and motivational interviewing for people with Type 1 diabetes mellitus with persistent sub-optimal glycaemic control: A Diabetes and Psychological Therapies (ADaPT) study. Health Technol Assess 2010; 14(22): 1-101.
[http://dx.doi.org/10.3310/hta14220] [PMID: 20483060]
[23]
Luyckx K, Rassart J, Aujoulat I, Goubert L, Weets I. Self-esteem and illness self-concept in emerging adults with type 1 diabetes: Long-term associations with problem areas in diabetes. J Health Psychol 2016; 21(4): 540-9.
[http://dx.doi.org/10.1177/1359105314531467] [PMID: 24776688]
[24]
Nicolucci A, Burns KK, Holt R, et al. Educational and Psychological Issues Diabetes Attitudes, Wishes and Needs second study (DAWN2TM): Cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med 2013; 30: 767-77.
[http://dx.doi.org/10.1111/dme.12245] [PMID: 23711019]
[25]
Norris SL, Engelgau MM, Narayan KM. Effectiveness of self-management training in type 2 diabetes: A systematic review of randomized controlled trials. Diabetes Care 2001; 24(3): 561-87.
[http://dx.doi.org/10.2337/diacare.24.3.561] [PMID: 11289485]
[26]
Karimy M, Montazeri A, Araban M. The effect of an educational program based on health belief model on the empowerment of rural women in prevention of brucellosis. J Arak Univ Med Sci 2012; 14(7): 85-94.
[27]
Heidarnia A. Factors influencing self-medication among elderly urban centers in Zarandieh based on health belief model. J Arak Univ Med Sci 2011; 14(5): 70-8.
[28]
Ajzen I, Timko C. Correspondence between health attitudes and behavior. Basic Appl Soc Psych 1986; 7(4): 259-76.
[http://dx.doi.org/10.1207/s15324834basp0704_2]
[29]
Peters RM, Templin TN. Theory of planned behavior, self-care motivation, and blood pressure self-care. Res Theory Nurs Pract 2010; 24(3): 172-86.
[http://dx.doi.org/10.1891/1541-6577.24.3.172] [PMID: 20949834]
[30]
Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot 1996; 10(4): 282-98.
[http://dx.doi.org/10.4278/0890-1171-10.4.282] [PMID: 10159709]
[31]
Emmons KM. Health behaviors in a social context. Social Epidemiol 2000; 137: 173.
[32]
McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q 1988; 15(4): 351-77.
[http://dx.doi.org/10.1177/109019818801500401] [PMID: 3068205]
[33]
Brown SA, Hedges LV. Predicting metabolic control in diabetes: A pilot study using meta-analysis to estimate a linear model. Nurs Res 1994; 43(6): 362-8.
[http://dx.doi.org/10.1097/00006199-199411000-00008] [PMID: 7971301]
[34]
Trief PM, Himes CL, Orendorff R, Weinstock RS. The marital relationship and psychosocial adaptation and glycemic control of individuals with diabetes. Diabetes Care 2001; 24(8): 1384-9.
[http://dx.doi.org/10.2337/diacare.24.8.1384] [PMID: 11473074]
[35]
Sorensen G, Emmons K, Hunt MK, Johnston D. Implications of the results of community intervention trials. Annu Rev Public Health 1998; 19(1): 379-416.
[http://dx.doi.org/10.1146/annurev.publhealth.19.1.379] [PMID: 9611625]
[36]
Kaplan GA, Everson SA, Lynch JW. The contribution of social and behavioral research to an understanding of the distribution of disease: A multilevel approach. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press 2000.
[37]
National Academies of Sciences, Engineering, and Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press.
[http://dx.doi.org/10.17226/9939.2007]
[38]
McKinlay JB. The promotion of health through planned sociopolitical change: Challenges for research and policy. Soc Sci Med 1993; 36(2): 109-17.
[http://dx.doi.org/10.1016/0277-9536(93)90202-F] [PMID: 8421787]
[39]
Robinson T. Hypertension beliefs and behaviors of African Americans in selected cleveland public housing. Doctoral Dissertation. Kent State University, Kent, USA December 2012.
[40]
Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess 1988; 52(1): 30-41.
[http://dx.doi.org/10.1207/s15327752jpa5201_2] [PMID: 2280326]
[41]
Norman P, Fitter M. Predicting attendance at health screening: Organizational factors and patients’ health beliefs. Couns Psychol Q 1991; 4(2-3): 143-55.
[http://dx.doi.org/10.1080/09515079108256718]
[42]
Claude JA. An application of health behaviour models to diabetic treatment adherence: A comparison of protection motivation theory and the theory of planned behaviour. Doctoral Theses and Dissertations. The University of Regina, Canada 2011.
[43]
Glasgow RE, Strycker LA, Toobert DJ, Eakin E. A social-ecologic approach to assessing support for disease self-management: The Chronic Illness Resources Survey. J Behav Med 2000; 23(6): 559-83.
[http://dx.doi.org/10.1023/A:1005507603901] [PMID: 11199088]
[44]
Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care 2000; 23(7): 943-50.
[http://dx.doi.org/10.2337/diacare.23.7.943] [PMID: 10895844]
[45]
Asif M. The prevention and control the type-2 diabetes by changing lifestyle and dietary pattern. J Educ Health Promot 2014; 3(1): 1.
[http://dx.doi.org/10.4103/2277-9531.127541] [PMID: 24741641]
[46]
Horton ES. Effects of lifestyle changes to reduce risks of diabetes and associated cardiovascular risks: results from large scale efficacy trials. Obesity (Silver Spring) 2009; 17(S3) (Suppl. 3): S43-8.
[http://dx.doi.org/10.1038/oby.2009.388] [PMID: 19927146]
[47]
Fuller H, Alberti H. Barriers to lifestyle changes in people with diabetes. Br J Gen Pract 2017; 67(655): 61.
[http://dx.doi.org/10.3399/bjgp17X689005]
[48]
Bekele H, Asefa A, Getachew B, Belete AM. Barriers and strategies to lifestyle and dietary pattern interventions for prevention and management of type-2 diabetes in Africa, systematic review. J Diabetes Res 2020; 2020: 7948712.
[http://dx.doi.org/10.1155/2020/7948712] [PMID: 32766315]
[49]
Wiebe DJ, Helgeson V, Berg CA. The social context of managing diabetes across the life span. Am Psychol 2016; 71(7): 526-38.
[http://dx.doi.org/10.1037/a0040355] [PMID: 27690482]
[50]
Botchway MO. Social networks, social support, and contextual factors that affect blood glucose control among individuals with type 2 diabetes mellitus in urban Ghana. Doctoral Disseration. University of South Carolina, Columbia, USA 2019.
[51]
Miller TA, Dimatteo MR. Importance of family/social support and impact on adherence to diabetic therapy. Diabetes Metab Syndr Obes 2013; 6: 421-6.
[http://dx.doi.org/10.2147/DMSO.S36368] [PMID: 24232691]
[52]
Puhl RM, Himmelstein MS, Speight J. Weight stigma and diabetes stigma: Implications for weight-related health behaviors in adults with type 2 diabetes. Clin Diabetes 2022; 40(1): 51-61.
[http://dx.doi.org/10.2337/cd20-0071] [PMID: 35221472]
[53]
Paige SR, Bonnar KK, Black DR, Coster DC. Risk factor knowledge, perceived threat, and protective health behaviors: Implications for type 2 diabetes control in rural communities. Diabetes Educ 2018; 44(1): 63-71.
[http://dx.doi.org/10.1177/0145721717747228] [PMID: 29241427]
[54]
Jalilian F, Motlagh FZ, Solhi M, Gharibnavaz H. Effectiveness of self-management promotion educational program among diabetic patients based on health belief model. J Educ Health Promot 2014; 3(1): 14.
[http://dx.doi.org/10.4103/2277-9531.127580] [PMID: 24741654]
[55]
Patino AM, Sanchez J, Eidson M, Delamater AM. Health beliefs and regimen adherence in minority adolescents with type 1 diabetes. J Pediatr Psychol 2005; 30(6): 503-12.
[http://dx.doi.org/10.1093/jpepsy/jsi075] [PMID: 16055488]
[56]
Schmidt SK, Hemmestad L, MacDonald CS, Langberg H, Valentiner LS. Motivation and barriers to maintaining lifestyle changes in patients with type 2 diabetes after an intensive lifestyle intervention (The U-TURN Trial): A longitudinal qualitative study. Int J Environ Res Public Health 2020; 17(20): 7454.
[http://dx.doi.org/10.3390/ijerph17207454] [PMID: 33066239]
[57]
Alanzi T. Role of social media in diabetes management in the middle east region: Systematic review. J Med Internet Res 2018; 20(2): e58.
[http://dx.doi.org/10.2196/jmir.9190] [PMID: 29439941]
[58]
Alaofè H, Asaolu I, Ehiri J, et al. Community health workers in diabetes prevention and management in developing countries. Ann Glob Health 2017; 83(3-4): 661-75.
[http://dx.doi.org/10.1016/j.aogh.2017.10.009] [PMID: 29221543]
[59]
Tamirat A, Abebe L, Kirose G. Prediction of physical activity among Type-2 diabetes patients attending Jimma University specialized Hospital, southwest Ethiopia: Application of health belief model. Science 2014; 2(6): 524-31.
[60]
Dutton GR, Tan F, Provost BC, Sorenson JL, Allen B, Smith D. Relationship between self-efficacy and physical activity among patients with type 2 diabetes. J Behav Med 2009; 32(3): 270-7.
[http://dx.doi.org/10.1007/s10865-009-9200-0] [PMID: 19156510]
[61]
Thomas N, Alder E, Leese GP. Barriers to physical activity in patients with diabetes. Postgrad Med J 2004; 80(943): 287-91.
[http://dx.doi.org/10.1136/pgmj.2003.010553] [PMID: 15138320]
[62]
Ong WM, Chua SS, Ng CJ. Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: A qualitative study. Patient Prefer Adherence 2014; 8: 237-46.
[PMID: 24627628]
[63]
Brackney DE. Enhanced self-monitoring blood glucose in non-insulin-requiring type 2 diabetes: A qualitative study in primary care. J Clin Nurs 2018; 27(9-10): 2120-31.
[http://dx.doi.org/10.1111/jocn.14369] [PMID: 29603813]
[64]
Adejoh SO. Diabetes knowledge, health belief, and diabetes management among the Igala, Nigeria. SAGE Open 2014; 4(2): 2158244014539966.
[http://dx.doi.org/10.1177/2158244014539966]
[65]
Cameron D. Exploring the application of self-monitoring of blood glucose results in insulin-treated diabetes: A case study of patients, their support persons and health care practitioners. PhD Dissertation. University of Stirling, Stirling, United Kingdom November 2016.
[66]
Hortensius J, Kars MC, Wierenga WS, Kleefstra N, Bilo HJ, van der Bijl JJ. Perspectives of patients with type 1 or insulin-treated type 2 diabetes on self-monitoring of blood glucose: A qualitative study. BMC Public Health 2012; 12(1): 167.
[http://dx.doi.org/10.1186/1471-2458-12-167] [PMID: 22397638]
[67]
Mastura I, Mimi O, Piterman L, Teng CL, Wijesinha S. Self-monitoring of blood glucose among diabetes patients attending government health clinics. Med J Malaysia 2007; 62(2): 147-51.
[PMID: 18705449]
[68]
Ravi S, Kumar S, Gopichandran V. Do supportive family behaviors promote diabetes self-management in resource limited urban settings? A cross sectional study. BMC Public Health 2018; 18(1): 826.
[http://dx.doi.org/10.1186/s12889-018-5766-1] [PMID: 29973181]
[69]
Reyes J, Tripp-Reimer T, Parker E, Muller B, Laroche H. Factors influencing diabetes self-management among medically underserved patients with type II diabetes. Glob Qual Nurs Res 2017; 4: 2333393617713097.
[http://dx.doi.org/10.1177/2333393617713097] [PMID: 28660239]
[70]
Zgibor JC, Simmons D. Barriers to blood glucose monitoring in a multiethnic community. Diabetes Care 2002; 25(10): 1772-7.
[http://dx.doi.org/10.2337/diacare.25.10.1772] [PMID: 12351476]
[71]
Al-Qazaz HKh, Sulaiman SA, Hassali MA, et al. Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes. Int J Clin Pharm 2011; 33(6): 1028-35.
[http://dx.doi.org/10.1007/s11096-011-9582-2] [PMID: 22083724]
[72]
Kähkönen O, Kankkunen P, Saaranen T, Miettinen H, Kyngäs H, Lamidi ML. Motivation is a crucial factor for adherence to a healthy lifestyle among people with coronary heart disease after percutaneous coronary intervention. J Adv Nurs 2015; 71(10): 2364-73.
[http://dx.doi.org/10.1111/jan.12708] [PMID: 26084708]
[73]
Peyrot M, Rubin RR. Perceived medication benefits and their association with interest in using inhaled insulin in type 2 diabetes: A model of patients’ cognitive framework. Patient Prefer Adherence 2011; 5: 255-65.
[http://dx.doi.org/10.2147/PPA.S18799] [PMID: 21792298]
[74]
Peng X, Guo X, Li H, Wang D, Liu C, Du Y. A qualitative exploration of self-management behaviors and influencing factors in patients with type 2 diabetes. Front Endocrinol (Lausanne) 2022; 13: 771293.
[http://dx.doi.org/10.3389/fendo.2022.771293] [PMID: 35250851]
[75]
Gomes-Villas Boas LC, Foss MC, Freitas MC, Pace AE. Relationship among social support, treatment adherence and metabolic control of diabetes mellitus patients. Rev Lat Am Enfermagem 2012; 20(1): 52-8.
[http://dx.doi.org/10.1590/S0104-11692012000100008] [PMID: 22481721]
[76]
Fai EK, Anderson C, Ferreros V. Role of attitudes and intentions in predicting adherence to oral diabetes medications. Endocr Connect 2017; 6(2): 63-70.
[http://dx.doi.org/10.1530/EC-16-0093] [PMID: 28087609]
[77]
Gordon A, Buch Z, Baute V, Coeytaux R. Use of Ayurveda in the treatment of type 2 diabetes mellitus. Glob Adv Health Med 2019; 82164956119861094.
[http://dx.doi.org/10.1177/2164956119861094] [PMID: 31431828]
[78]
Pereira MDG, Ferreira G, Machado JC, Pedras S. Beliefs about medicines as mediators in medication adherence in type 2 diabetes. Int J Nurs Pract 2019; 25(5): e12768.
[http://dx.doi.org/10.1111/ijn.12768] [PMID: 31328394]
[79]
Iloh GU, Amadi AN. Family support, medication adherence andglycaemic control among ambulatory type 2 diabetic Nigerians in a primary care clinic in Eastern Nigeria. J Health Res Rev 2018; 5(2): 71.
[http://dx.doi.org/10.4103/jhrr.jhrr_121_16]
[80]
Schmidt C. Physician-Patient Relationships and Their Effect on T2DM Patient Treatment Adherence. Available from: https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=6934&context=dissertations
[81]
Bishop AC, Baker GR, Boyle TA, MacKinnon NJ. Using the Health Belief Model to explain patient involvement in patient safety. Health Expect 2015; 18(6): 3019-33.
[http://dx.doi.org/10.1111/hex.12286] [PMID: 25303173]
[82]
LeBlanc RG. The effect of social networks on self-care behaviors and health outcomes among older people living with multiple chronic conditions. PhD Dissertation. University of Massachusetts, Amherst, USA May 2018.
[83]
Dilekler İ, Doğulu C, Bozo Ö. A test of theory of planned behavior in type II diabetes adherence: The leading role of perceived behavioral control. Curr Psychol 2021; 40(7): 3546-55.
[http://dx.doi.org/10.1007/s12144-019-00309-7]
[84]
Curry L. The future of the public’s health in the 21st century. Generations 2005; 29(2): 82.
[85]
Wanchai A, Armer JM. Promoting self-care capabilities of patients: Nurses’ roles. Nurs Health Care 2018; 7(4): 1-3.
[86]
Consanu G, Erdogan S. Influence of psychosocial factors on self-care behaviors andglycemic control in Turkish patients with type 2 diabetes mellitus. J Transcult Nurs 2014; 25(1): 51-9.
[http://dx.doi.org/10.1177/1043659613504112]
[87]
Greaves CJ, Campbell JL. Supporting self-care in general practice. Br J Gen Pract 2007; 57(543): 814-21.
[PMID: 17925140]

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