Academic journal article Health and Social Work

Determinants of Quality of Life in Primary Care Patients with Diabetes: Implications for Social Workers

Academic journal article Health and Social Work

Determinants of Quality of Life in Primary Care Patients with Diabetes: Implications for Social Workers

Article excerpt

Diabetes has long been acknowledged as a biopsychosocial disease (DeCoster, 2001). Diabetes management involves a dramatic change in lifestyle, including keeping a low-sugar diet, maintaining an exercise regime, monitoring daily blood sugar, and taking oral medications or insulin supplements. Social workers are in a unique position to help patients with diabetes maintain a healthy lifestyle and negotiate the medical world (Amir, Rabin, & Galatzer, 1990; DeCoster & Cummings, 2005; Gross et al., 2007). Knowledge of the specific factors that affect one's quality of life (QoL) is of utmost importance to social workers for the development and implementation of future interventions that would help patients with diabetes manage their condition (Claiborne & Massaron, 2000). Because the QoL of diabetic patients is affected by many variables, which are not all related to diabetes, it is particularly important to ask patients about their QoL in the hypothetical absence of diabetes and not only about their subjective general QoL. The former gives information about the perceived effect diabetes has on one's QoL.

QoL has captured an increasing role in medical literature. Research has shown that QoL is a risk factor for longer and more complicated hospital stays, poor adherence to medical treatment, and increased morbidity and mortality (Fan, Curtis, Tu, McDonell, & Fihn, 2002; Jacobson, Wu, & Feinberg, 2003; Rumsfeld et al., 1999; Westin, Nilstun, Carlsson, & Erhardt, 2005).As a result, it is no longer acceptable to evaluate only the biophysiological indicators of the disease, rather a comprehensive evaluation that takes into consideration QoL is indicated (Rubin & Peyrot, 1999).

Diabetes has been associated with low QoL that tends to decline over the years (Brown et al., 2004; Hart, Redekop, Berg, Bilo, & Meyboom-de Jong, 2005). Several studies have identified demographic and clinical characteristics, illness representations, and health behaviors associated with QoL in patients with diabetes. For example, all of the following have been associated with lower QoL in patients with diabetes: lower socioeconomic status (Wandell, 2005), medical comorbidity, diabetes-related complications and symptoms (Davis et al., 2005; De Berardis et al., 2002; Hart et al., 2005; Vileikyte, 2001; Wandell, 2005;), higher body mass index (BMI) (Maddigan, Majumdar, & Johnson, 2005), pain, depression (Lustman & Clouse, 2005; Paschalides et al., 2004), anxiety (Paschalides et al., 2004), lower perceived sense of control over diabetes (Paschalides et al., 2004), lower self-efficacy (Rose, Fliege, Hildebrandt, Schirop, & Klapp, 2002), pessimism (Rose et al., 2002), nonadherence to an exercise regime (Glasgow, Ruggiero, Eakin, Dryfoos, & Chobanian, 1997; Smith & McFall, 2005), and poor continuity of care (Wandell, 2005).

These studies provide important information about potential determinants of QoL in patients with diabetes. However, the majority of these studies did not evaluate a large set of predictors simultaneously to better determine the relative importance of each predictor. Furthermore, potential predictors of QoL such as knowledge of diabetes care or satisfaction with medical services have not been adequately evaluated in past research. In addition, only very few studies have asked people directly about the subjective effect of diabetes on their QoL (that is, perceived QoL in the hypothetical absence of diabetes) (Bradley & Speight, 2002; Bradley et al., 1999). This question is important because it evaluates the specific effect of diabetes on one's QoL rather than a general perception of QoL. In contrast to past research, the present study evaluates a large array of potential predictors of QoL and perceived QoL in the hypothetical absence of diabetes in a sample of primary care patients with diabetes. This study also has the advantage of being conducted in Israel, a country that has a universal health care system. …

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