Predictors of Self-management Behaviour Among Older Adults With Type 2 Diabetes Mellitus in Malaysia
Main Article Content
Abstract
Introduction: Proper self-management is proven to be the key to successful and effective management of the type 2 diabetes mellitus (T2DM). Objective: This study aimed to predict factors associated with self-management behaviour of T2DM among older adults. Methods: A cross-sectional study was conducted among older adults aged 60 years and above, with a month or more history of T2DM. A stratified proportionate-to-size random sampling was conducted in seven government health clinics in the Bera district, Pahang. A pre-tested interviewer-assisted questionnaire was used during data collection, containing six sections: sociodemographic, diabetes profile, knowledge, attitude, self-efficacy, and diabetes self-management behaviour. Descriptive and analytical analyses were performed using the IBM Statistical Package for Social Science Version 25.0. Results: A total of 532 eligible older adults participated in this study, with a response rate of 95.2%. The self-management behaviour mean score was 3.33 (SD 1.13). Higher self-management behaviour related to T2DM was predicted by being Malay (B = -0.545, 95% CI: -0.798, -0.292, p < 0.001), higher monthly income of RM 2500 - ≥ RM5000 (B = 0.328, 95% CI: 0.134, 0.523, p = 0.001), knowledge (B = 0.055, 95% CI: 0.021, 0.089, p = 0.002), and good self-efficacy (B = 0.028, 95% CI: 0.021, 0.036, p < 0.001). Conclusion: Higher self-efficacy was a significant predictor of better self-management behaviour in T2DM. Interventions to enhance knowledge and self-efficacy should be specifically targeted among the non-Malays and those with lower household income. These at-risk group should be targeted at primary, secondary, and tertiary prevention levels.
Downloads
Article Details
References
Khan MAB, Hashim MJ, King JK, Govender RD, Mustafa H, Al-Kaabi J. Epidemiology of type 2 diabetes – Global burden of disease and forecasted trends. J Epidemiol Glob Health. 2020;10:107–11.
Akhtar S, Nasir JA, Ali A, Asghar M, Majeed R, Sarwar A. Prevalence of type 2 diabetes and prediabetes in Malaysia: A systematic review and meta-analysis. PLoS One [Internet]. 2022;17(1 January):1–14. Available from: http://dx.doi.org/10.1371/journal.pone.0263139
Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults. Diabetes Care. 2012;35(12):2650–64.
Abdelhafiz AH, Sinclair AJ. Diabetes in the elderly. Med (United Kingdom) [Internet]. 2019;47(2):119–22. Available from: https://doi.org/10.1016/j.mpmed.2018.11.007
Strain WD, Hope S V., Green A, Kar P, Valabhji J, Sinclair AJ. Type 2 diabetes mellitus in older people: A brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative. Diabet Med. 2018;35(7):838–45.
Chesser AK, Woods NK, Smothers K, Rogers N. Health literacy and older adults: A systematic review. Gerontol Geriatr Med. 2016;2:1–13.
United Nations New York. World economic and social survey 2007 Development in an ageing world. 2007.
Institute for Public Health. National health and morbidity survey 2023 Non-communicable diseases and healthcare demand [Internet]. 2023. Available from: https://iku.nih.gov.my/images/nhms2023/report-nhms-2023.pdf
Li T, Zhou J, Ma J, Luo H, Ye X. What are the self-management experiences of the elderly with diabetes? A systematic review of qualitative research. World J Clin Cases. 2022;10(4):1226–42.
Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: An analysis from 1990 to 2025. Sci Rep [Internet]. 2020;10(1):1–11. Available from: https://doi.org/10.1038/s41598-020-71908-9
International Diabetes Federation. IDF Diabetes Atlas [Internet]. 2017. Available from: https://www.diabetesatlas.org/upload/resources/previous/files/8/IDF_DA_8e-EN-final.pdf
Sinclair A, Saeedi P, Kaundal A, Karuranga S, Malanda B, Williams R. Diabetes and global ageing among 65–99-year-old adults: Findings from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract [Internet]. 2020;162:108078. Available from: https://doi.org/10.1016/j.diabres.2020.108078
Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: A review. Patient Educ Couns. 2002;48(2):177-87.
Tang TS, Funnell MM, Oh M. Lasting effects of a 2-year diabetes self-management support intervention: Outcomes at 1-year follow-up. Prev Chronic Dis. 2012;(16):1–9.
Garcia AA, Villagomez ET, Brown SA, Kouzekanani K, L.Hanis C. The Starr County diabetes education study development of the Spanish-language diabetes knowledge questionnaire. Diabetes Care. 2001;24(1):16–21.
Anderson RM, Fitzgerald JT, Funnell MM, Gruppen LD. Attitude scale. Diabetes Care. 1998;21(9):1403–7.
Stanford Patient Education Research Centre. Self-efficacy for diabetes. 2017;1–2. Available from: https://www.slu.edu/medicine/family-medicine/pdfs/diabetes-management-selfefficacy-scale.pdf
Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care. Epidemiol Heal Serv Psychosoc Res [Internet]. 2000;23(7):943–50. Available from: https://care.diabetesjournals.org/content/diacare/23/7/943.full.pdf
Kanan P, Piaseu N, Malathum P, Belza B. Predictors of diabetes self-management in older adults with poorly controlled type 2 diabetes mellitus. Pacific Rim Int J Nurs Res [Internet]. 2019;23(4):357–67. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/158994/150340
Ahmad Sharoni SK, Shdaifat EA, Mohd Abd Majid HA, Shohor NA, Ahmad F, Zakaria Z. Social support and self-care activities among the elderly patients with diabetes in Kelantan. Malaysian Fam Physician [Internet]. 2015;10(1):34–43. Available from: https://e-mfp.org/wp-content/uploads/original-article-4.pdf
Sherifali D, Bai JW, Kenny M, Warren R, Ali MU. Diabetes self-management programmes in older adults: A systematic review and meta-analysis. Diabet Med. 2015;32(11):1404–14.
Ishak NH, Mohd Yusoff SS, Rahman RA, Kadir AA. Diabetes self-care and its associated factors among elderly diabetes in primary care. J Taibah Univ Med Sci [Internet]. 2017;12(6):504–11. Available from: https://doi.org/10.1016/j.jtumed.2017.03.008
Nguyen AT, Thi H, Nguyen T, Nguyen TN, Thi D, Dinh K, et al. Knowledge, attitude and practice of elderly outpatients with type 2 diabetes mellitus in National Geriatric Hospital, Vietnam. Diabetes, Metab Syndr Obes Targets Ther. 2020;(13):3909–17.
Lim PC, Rajah R, Lee CY, Wong TY, Tan SSA, Karim SA. Systematic review and meta-analysis of diabetes knowledge among type 2 diabetes patients in Southeast Asia. Rev Diabet Stud. 2021;17(2):82–9.
Wilson RS, Yu L, James BD, Bennett DA, Boyle PA, Wilson RS, et al. Association of financial and health literacy with cognitive health in old age. Aging, Neuropsychol Cogn. 2016;24(2):1–12.
Lipnicki DM, Crawford JD, Dutta R, Thalamuthu A, Kochan A, Andrews G, et al. Age-related cognitive decline and associations with sex, education and apolipoprotein E genotype across ethnocultural groups and geographic regions: A collaborative cohort study. PLoS Med. 2017;(Id 1093083):1–21.
Nguyen VB, Thi KHP, Nguyen TX, Pham NTL, Nguyen VVH, Van Le C. Diabetes self-management and its associated factors among patients with diabetes in central Vietnam: A cross-sectional study. PLoS One [Internet]. 2022;17(7 July):1–13. Available from: http://dx.doi.org/10.1371/journal.pone.0270901
Ku GM V, Kegels G. Knowledge, attitudes and perceptions of people with type 2 diabetes as related to self-management practices: Results of a cross-sectional study conducted in Luzon, Philippines. Chronic Illn. 2015;11(2):93–107.
Lima AP de, Benedetti TRB, Rech CR, Cardoso FB, Portella MR. Knowledge and attitude towards type 2 diabetes among older adults: A population-based study. Cienc e Saude Coletiva. 2020;25(2):729–40.
Alsous M, Jalil MA, Odeh M, Al Kurdi R, Alnan M. Public knowledge, attitudes and practices toward diabetes mellitus: A cross-sectional study from Jordan. PLoS ONE. 2019;14(3):1–12. https://doi.org/10.1371/journal.pone.0214479
Tharek Z, Ramli AS, Whitford DL, Ismail Z, Mohd Zulkifli M, Ahmad Sharoni SK, et al. Relationship between self-efficacy, self-care behaviour and glycaemic control among patients with type 2 diabetes mellitus in the Malaysian primary care setting. BMC Fam Pract. 2018;19(1):1–10.
Ishak NH, Mohd Yusoff SS, Rahman RA, Kadir AA. Diabetes self-care and its associated factors among elderly diabetes in primary care. J Taibah Univ Med Sci [Internet]. 2017;12(6):504–11. Available from: https://doi.org/10.1016/j.jtumed.2017.03.008
Werfalli MM, Id SZK, Manning K, Levitt NS. Does social support effect knowledge and diabetes self-management practices in older persons with type 2 diabetes attending primary care clinics in Cape Town, South Africa? PLoS One [Internet]. 2020;1–16. Available from: http://dx.doi.org/10.1371/journal.pone.0230173
Yee KC, Said S, Manaf RA. Identifying self-care behaviour and its predictors among type 2 diabetes mellitus patients at a district of Northern Peninsular Malaysia. Malaysian J Med Heal Sci [Internet]. 2018;14(2):17–29. Available from: https://medic.upm.edu.my/upload/dokumen/2018062611554003_MJMHS_Vol14_No2_25June2018.pdf
Adu MD, Malabu UH, Malau-aduli AEO, Malau-aduli BS. Enablers and barriers to effective diabetes self-management: A multi-national investigation. PLoS One. 2019;14(6):1–22.
Zhu Y, Cheng K, Wang H, Xu Z, Zhang R, Cheng W, et al. Exercise adherence and compliance and its related factors among elderly patients with type 2 diabetes in China: A cross-sectional study. Patient Prefer Adherence. 2022;16: 3329–3339. https://doi.org/10.2147/PPA.S374120
Gurmu Y, Gela D. Factors associated with self-care practice among adult diabetes patients in West Shoa Zone, Oromia Regional State, Ethiopia. BMC Health Serv Res. 2018;18(732):4–11.
Kugbey N, Asante KO, Adulai K. Illness perception, diabetes knowledge and self ‑ care practices among type 2 diabetes patients: A cross‑sectional study. BMC Res Notes. 2017;1–7.
Kurnia AD, Amatayakul A, Karuncharernpanit S. Predictors of diabetes self-management among type 2 diabetics in Indonesia: Application theory of the health promotion model. Int J Nurs Sci [Internet]. 2017;4(3):260–5. Available from: http://dx.doi.org/10.1016/j.ijnss.2017.06.010