Academic journal article Iranian Journal of Public Health

The Effect of Sociostructural and Collaborative Decision-Making on Diabetes Self-Management

Academic journal article Iranian Journal of Public Health

The Effect of Sociostructural and Collaborative Decision-Making on Diabetes Self-Management

Article excerpt


Background: Diabetic self-management is important for controlling the diabetes complications and promoting health-related quality of life in these patients. The objective of this study was to examine a hypothetical model regarding influences of sociostructural determinants, collaborative decision-making and patient's beliefs system on diabetes self-management.

Methods: In a cross-sectional descriptive study from Dec 2010 to Mar 2010, 500 patients of Iranian adult patients with type II diabetes attended the outpatient diabetic clinics of the Shariati Hospital in Tehran were selected by convenience sampling. Data were collected by The Demographical Information, Social- Economical Status and Diabetic History Questionnaire and eleven self-reported scales of this research. Structural equation modeling (SEM) with LIZREL software applied for data analysis.

Results: The modified model had a desirable fitness to the observed data. Patient's beliefs system directly influenced the diabetes self-management. Sociostructural determinants influenced diabetes self-management indirectly via collaborative decision-making and Patient's beliefs system. In addition, collaborative decision-making significantly influenced patient's beliefs system that thereby impacted diabetes self-management.

Conclusions: Sociostructural determinants, collaborative decision-making and patient's beliefs system are integrated and cooperatively affect on diabetes self-management. Comprehensive intervention schedules required to improve these agents for encouragement the type II diabetes self-management.

Keywords: Diabetes, Self-management, Motivation, Beliefs, Decision-making

(ProQuest: ... denotes formula omitted.)


Diabetes is one of the chronic diseases that substantially causing to disability, functional deterioration, morbidity, mortality and increased health costs (1, 2). Diabetic patients especially those with disease complications present adverse quality of life and serious impairments in global functioning (1). It appears to be also that burden of diabetes in Iranian population is very high (3).

Self-management behaviors are the cornerstone of blood sugar control and preventing the complica-tions in type II diabetes (4). Self-management is the day to day managing actions of diabetes inclined to taking drugs, adherence to regimen, weight loss planning, blood glucose monitoring, perform the regular physical activity and foot care by patients themselves (5).

Various factors have influence in regularly di-abetes self-management (6-8). Adverse psychoso-cial agents and inappropriate therapeutic factors have negative effect in diabetes self-management (9-11). Also, socioeconomic conditions such as lower literacy and minus income hinder the excel-lent diabetes self-management (12). Socio-struc-tural factors such as low support or assistance in family and poor health system agents such as displeasure with medical care as well have promi-nent impacts on diabetes self-management (13-15).

Insufficient participatory decision-making and weak physician-patient communication destroy the diabetes self-management behaviors (16, 17).

Diabetes- related factors including deficient education about diabetes, lower health literacy for diabetes management and demographic characteristics such as elderly may be decline di-abetic self-management behaviors (18-20). Also, diabetes- related literacy, patient's beliefs, self-effi-cacy, access to the healthcare system, and surrounding circumstances of family and relatives affects on diabetes self-management behaviors (21, 22). Hence, individual factors and social, environ-mental and health care backgrounds influencing on diabetes self-management (23, 24).

The sociostructural determinants in this study in-cluded provider-patient communication, health care satisfaction, health care access, duration of diabetes, treatment type, diabetes severity, retinopathy, neuropathy, nephropathy, cardiovascular disease, income, insurance, social support, marriage status, educational level, life network, cigarette smoking, diabetes knowledge, Job, age, and sex. …

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