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Traditionally, carbohydrate has been the largest contributor to energy intake among people with diabetes, yet different carbohydrate foods produce different glycaemic responses. Glycaemic load represents the total glycaemic effect of the diet and influences glycaemic control. Adequate self-efficacy and outcome expectations are needed to change carb...
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Citations
... Response options ranged from strongly disagree to strongly agree. An instrument developed and validated previously to assess action SE for eating low GI foods also was administered (Miller, Gutschall, & Lawrence, 2007). ...
Purpose: A healthy diet and consistent physical activity (PA) form the foundation for effective self-management in adults with type 2 diabetes mellitus (T2DM). Behavioral interventions, which target diet and PA, can facilitate effective diabetes self-management practices. Greater clarity regarding the ‘active ingredients’ incorporated into behavioral interventions is needed to inform the evidence base about effective intervention techniques to advance behavioral theories and to improve clinical practice. The use of intervention mapping (IM) to develop a novel diabetes intervention to increase consumption of low glycemic index (GI) foods and to increase moderate-to-vigorous intensity PA is presented.
Methods: Determinants from self-regulation and the Health Action Process Approach theoretical framework formed the foundation of the intervention. The IM taxonomy of behavior change methods and strategies from Hope Therapy (e.g. goal maps) were used to guide techniques for changing selected theoretical determinants of behavior. A pilot study of the intervention among adults with T2DM (n = 12) was conducted using a pre-/post-test design to evaluate intervention components and participant acceptability.
Results: Participants attended a mean (±SD) of 8 (±1.4) of the 10 weekly 90-minute, group-based sessions. The magnitude of effect was moderate (d > 0.50) for the change in behavioral intentions, action control, and action and coping planning for engaging in PA and large (d > 0.80) for the change in action self-efficacy and action and coping planning for eating low GI foods post-intervention.
Conclusions: Greater emphasis on value-based decision-making, the goal mapping process, and successively progressive exercise goals should be included in future versions of the intervention. Based on pilot testing, a larger randomized controlled trial that incorporates these intervention modifications is warranted and the modified intervention has a greater likelihood for success.
... It would be highly desirable to test construct validity by directly comparing the DSES scores with 1 or more of the previously validated DSESs referred to in the introduction or with the slightly more recent DSES from Miller and colleagues, 39 which also uses a 10-point range. ...
Purpose:
The purpose of this study was to examine the characteristics of the Spanish-language diabetes self-efficacy scale (DSES-S) and the English-language version (DSES).
Methods:
This study consists of secondary data from 3 randomized studies that administered the DSES-S and DSES at 2 time points. The scales consist of 8 Likert-type 10-point items. Principal component analysis was applied to determine if the scales were unitary or consisted of subscales. Univariate statistics were used to describe the scales. Sensitivity to change was measured by comparing randomized treatment with control groups, where the treatment included methods designed to enhance self-efficacy. General linear models were used to examine the association between the scales and the 8 medical outcomes after controlling for demographic variables.
Results:
Principal component analysis indicated that there were 2 subscales for both versions: self-efficacy for behaviors and self-efficacy to manage blood levels and medical condition. The measures had similar means across the 3 studies, high internal consistent reliability, values distributed across the entire range, and they showed no evidence of floor effects and little evidence of ceiling effects. The measures were sensitive to change. They were associated with several health indicators and behaviors at baseline, and changes were associated with changes in health measures.
Conclusions:
The self-efficacy measures behaved consistently across the 3 studies and were highly reliable. Associations with medical indicators and behaviors suggested validity, although further study would be desirable to compare other measures of self-efficacy for people with type 2 diabetes. These brief scales are appropriate for measuring self-efficacy to manage diabetes.
... Group sessions were held weekly and each lasted for up to 2 hours. Two questionnaires were used to assess self-efficacy: 1) an 8-item questionnaire of general diabetes self-efficacy, the Diabetes Empowerment Scale-Short Form (DES-SF) that does not have specific questions related to diet (43,44) and 2) a 20-item questionnaire of dietary self-efficacy designed to evaluate confidence in using the glycemic index to make healthy food choices, control portion size of food, control of carbohydrate intake and self-monitoring for optimal glycemic control (45). Food intake was assessed using a 3-day dietary recall. ...
The importance of self-management in diabetes cannot be underestimated. It includes a variety of behaviours that are affected by multiple factors. Although much attention has been given to diabetes management as a whole, the purpose of this review is to focus on dietary aspects. One relevant factor in understanding this complex system of management is self-efficacy, defined according to the social cognitive theory (SCT) as an individual’s confidence in being able to carry out a behaviour. The primary purpose of this review is to determine the role of self-efficacy in understanding dietary behaviours and corresponding outcomes in type 2 diabetes mellitus. We identified 59 articles and 19 met our inclusion criteria: studies focusing exclusively on type 2 diabetes, having a self-efficacy measure that included a dietary component, and including self-efficacy and/or related SCT constructs in the intervention. The majority of studies used a general diabetes self-efficacy measure that included diet as one component of management, along with exercise, medications and blood sugar control. Results of cross-sectional studies found that self-efficacy was associated with dietary self-care behaviours, reduced fat intake and improved glycemic index-load; it also was found to mediate the association between body mass index (BMI) and depression. Intervention studies, that integrated the concept of self-efficacy and other constructs of the SCT, resulted in improvements in self-efficacy, behaviours, BMI, and glycated hemoglobin (A1C) with self-efficacy mediating the effect of the intervention on A1C levels. In general, improving dietary self-efficacy has positive effects; however, the development of specific dietary self-efficacy scales seems warranted to better capture the multiple aspects of dietary management in type 2 diabetes.
... An instrument adapted from a previously developed questionnaire to assess self-efficacy for consuming LGI foods was used for assessment purposes [27]. The instrument included three subscales: the GI efficacy subscale (6 items) evaluated confidence for choosing and preparing LGI foods; the goal difficulty subscale (8 items) evaluated confidence for consuming 1-8 LGI foods/day; and the negative food selection subscale (3 items) evaluated difficulty in choosing LGI foods. ...
... Response options ranged from 0 = strongly disagree to 10 = strongly agree, and negatively stated items were reverse scored. The coefficient α for internal consistency was ≥0.77 for subscales and coefficient H values were ≥0.80 in previous research [27]. ...
... Personal beliefs or perceptions about the likelihood that certain experiences will occur are referred to as expectations (1)(2)(3)(4) Regardless of how expectations originate, their relationship with actual experiences subsequently influence an individuals' overall satisfaction with outcomes (5)(6)(7). Numerous studies have demonstrated positive and negative associations between patients' overall satisfaction and their expectations towards and experience with products and ⁄ or services (7)(8)(9)(10)(11)(12)(13). For example, in a sample of 344 patients, Kumar et al. (7) found that both the expectations and experiences with newly prescribed medication significantly impacted overall treatment satisfaction. ...
... avoid high blood sugars with insulin treatment (28)] may lead to more positive experiences and subsequently better treatment satisfaction. Prior research among patients with type 2 diabetes has shown that self-efficacy and outcome expectations correlate with self-care behaviours and clinical outcomes independently (4,(7)(8)(9)(10)(11)(12)(13)29). However, those studies did not evaluate how these constructs correlate with overall experiences and treatment satisfaction. ...
The aim of this study was to investigate how patients' expectations about and experiences with insulin therapy contribute to diabetes treatment satisfaction.
The Expectations about Insulin Therapy (EAITQ) and the Experience with Insulin Therapy Questionnaires (EWITQ) were administered at baseline and end-point, respectively to insulin-naïve patients with type 2 diabetes in a randomised trial comparing treatment algorithms for inhaled insulin. Pearson correlation coefficients were calculated between EAITQ and EWITQ scores, patient characteristics and patient-reported outcomes measures. Wilcoxon Signed Rank test compared EAITQ and EWITQ item score distributions. Differences between EAITQ and EWITQ scores were calculated to categorize patients according to the extent to which their expectations were met by experiences (i.e. unmet, met, exceeded).
EAITQ and EWITQ data were available for 240 patients (61% male, mean age 58 years, mean diabetes duration 10 years, mean baseline HbA(1c) 8.4%). Increasingly positive expectations were significantly associated with greater self-efficacy; greater levels of positive experiences were significantly associated with greater positive expectations, shorter diabetes duration, less symptom distress, greater well-being, self-efficacy and diabetes treatment satisfaction. Overall, patients' experiences with inhaled insulin therapy were significantly more positive than their expectations: 58% patients' experiences exceeded expectations, 29% patients' experiences met expectations and 13% patients' experiences did not meet expectations. Post hoc tests indicated that treatment satisfaction scores differed among these groups (all p < 0.01).
Expectations may not independently impact treatment satisfaction, but the relationship with experiences significantly contributes to it. The EAITQ and EWITQ may be useful tools for clinicians to better understand patients' expectations about and experiences with insulin therapy.
... Finally, 25 papers could be included in the review. The largest number of studies included patients with diabetes (n = 13) [17,19,20,232425262730,31,33,35,36], followed by asthma (n = 5) [16,22,32,34,37], arthritis (n = 4) [14,15,21,28], and COPD (n = 3) [18,29,38]. No study could be included for patients with heart failure. ...
... For 6 scales, one aim was described and for 2 scales more than one. The most frequently described aims were evaluative (n = 4)28293037] and planning (n = 4) [16,25,29,36], followed by discriminative (n = 2) [28,38]. Only one instrument had the aim a predictive [28]. ...
... The most common sources to identify items for self-efficacy scales were the use and adaptation respectively of items from existing self-efficacy or health related quality of life instruments only without a literature search or further input (4 instruments [17,19,23,32] ) and unsystematic literature searches in combination with input from experts (4 instruments [22,30,35,36]), followed by input from experts and patients without literature searches (for 3 instruments [21,28,33]). Overall, for the development of 12 instruments, patients' opinion was considered, for 10 instruments it was not. ...
Measurement of self-efficacy requires carefully developed and validated instruments. It is currently unclear whether available self-efficacy instruments for chronic diseases fulfill these requirements. Our aim was to systematically identify all existing self-efficacy scales for five major chronic diseases and to assess their development and validation process.
We conducted a systematic literature search in electronic databases (MEDLINE, PSYCHINFO, and EMBASE) to identify studies describing the development and/or validation process of self-efficacy instruments for the five chronic diseases diabetes, chronic obstructive pulmonary disease (COPD), asthma, arthritis, and heart failure. Two members of the review team independently selected articles meeting inclusion criteria. The self-efficacy instruments were evaluated in terms of their development (aim of instrument, a priori considerations, identification of items, selection of items, development of domains, answer options) and validation (test-retest reliability, internal consistency reliability, validity, responsiveness) process.
Of 584 potentially eligible papers we included 25 (13 for diabetes, 5 for asthma, 4 for arthritis, 3 for COPD, 0 for heart failure) which covered 26 different self-efficacy instrument versions. For 8 instruments (30.8%), the authors described the aim before the scales were developed whereas for the other instruments the aim was unclear. In one study (3.8%) a priori considerations were specified. In none of the studies a systematic literature search was carried out to identify items. The item selection process was often not clearly described (38.5%). Test-retest reliability was assessed for 9 instruments (34.6%), validity using a correlational approach for 18 (69.2%), and responsiveness to change for 3 (11.5%) instruments.
The development and validation process of the majority of the self-efficacy instruments had major limitations. The aim of the instruments was often not specified and for most instruments, not all measurement properties that are important to support the specific aim of the instrument (for example responsiveness for evaluative instruments) were assessed. Researchers who develop and validate self-efficacy instruments should adhere more closely to important methodological concepts for development and validation of patient-reported outcomes and report their methods more transparently. We propose a systematic five step approach for the development and validation of self-efficacy instruments.
... Three additional instruments were administered that were adapted from existing tools to evaluate the impact of the intervention on knowledge, self-efficacy, and outcome expectations. The instruments were based on previously valid and reliable tools and assessed information specific to this intervention by incorporating concepts regarding GI and GL (Miller & Achterberg, 1999;Miller, Gutschall, & Lawrence, 2007). ...
... An 18-item questionnaire was used to assess outcome expectations, and a 27-item questionnaire was used to assess self-efficacy for dietary intake and glucose monitoring (Miller et al., 2007). Both these scales comprised 11 points, from 0 = strongly disagree to 10 = strongly agree. ...
Glycemic index (GI) represents the postprandial glucose response of carbohydrate foods, and glycemic load (GL) represents the quantity and quality of carbohydrate consumed. A diet lower in GI and GL may improve diabetes management. A 9-week intervention regarding GI and GL was evaluated among adults in the age range of 40-70 years who had had type 2 diabetes > or =1 year (n = 103). Randomized pre-post test design with immediate and delayed treatment groups was employed. Dietary intake, knowledge, outcome expectations, self-efficacy, and empowerment regarding GI and GL and glucose monitoring were assessed. Four components were identified for outcome expectations using principal components analysis (dietary barrier, glycemic control, family support, and glucose monitoring), and two components were identified for self-efficacy (GI and self-regulation). Significant improvements in GI, knowledge, empowerment, self-efficacy, and outcome expectations (all p < .05) were observed except for glucose monitoring expectations. Only self-regulation efficacy significantly declined (p < .05) at the follow-up assessment in the immediate group. Nutrition education regarding GI and GL can improve dietary intake, knowledge, outcome and efficacy expectations, and empowerment for diabetes management.
Objective:
To evaluate the feasibility of a grocery store tour for parents and their adolescents being led by adults or adolescent peers.
Design:
Randomized controlled pilot study with surveys at baseline and post-program, and at 3- and 6-month follow-up.
Setting:
Midwestern midsized grocery stores.
Participants:
Sixty-one parents and their 71 11- to 14-year-old adolescents.
Intervention:
Nutrition education during 1 90-minute grocery store tour.
Main outcome measures:
Process observations and participants' tour perceptions provided fidelity outcomes. Questionnaires quantitatively assessed participants' knowledge, self-efficacy, and tour strategy use.
Analysis:
Chi-square and McNemar tests were used to analyze categorical data, and Kruskal-Wallis, Wilcoxon signed-rank, and Mann-Whitney U tests were employed for continuous variables (significance at P < .05).
Results:
Over 90% of tour tasks were rated as completed well for adult and peer leaders. Participants had positive tour perceptions but noted deficiencies in teen leaders' knowledge and leadership skills. Overall, parents and adolescents retained increased self-efficacy from pre-tour to post-tour intervals. Despite limited knowledge retention, parents reported they had increased (6.5 ± 4.19) healthful grocery shopping behaviors in the 6 months after the intervention.
Conclusions and implications:
Peers may feasibly lead grocery store tours but they may need additional resources and support to be highly effective.
Health Ballistics aims to quantify preventive health measures in relation to their health impact on an individual's productive lifespan, and in turn for a societally beneficial impact. An uninformed individuals behaviors will significantly affect their overall Health Wealth Commodity and are based upon the notion that what an individual does not know will with high probability lead to unhealthy monetary savings decision further empowering already established poor health outcome trajectories. The current theory emphasized the necessity for intensified focus on only a few health variables, as only a few variables indeed affect an individual's health trajectory with extreme weight at any moment. By calculating the highly probable and realistic health outcomes of an individual's health behavior based on these variables, a monetary savings can be retrospectively associated with the preventive measures utilized to obtain the health outcomes observed and in turn, prospectively associated to calculate statistically predictable individual health behavior and chronic diseases.
Many individuals do not engage in health-promoting behaviors that would confer important health benefits despite research that has shown that engaging in a suite of four health behaviors (physical activity, eating a healthy diet, not smoking, drinking alcohol in moderation) leads to a 11–14 year delay in all-cause mortality (Khaw et al., 2008; Ford et al., 2011). Motivating people disinclined to engage in health behavior presents a significant challenge to public health practitioners. Although there have been advances in interventions to increase individuals' motivation to engage in health-related behaviors, gaps in knowledge exist. In particular, effective strategies to promote behavior change in individuals with little or no motivation to change are relatively scarce. Most social psychological theories applied to health behavior change tend to assume a degree of motivation for change and have focused on attempts to promote action by converting motivation into action. Approaches such as goal-setting (Locke, 1996; Fenner et al., 2013), self-monitoring (Miller and Thayer, 1988), action planning (Schwarzer, 2014), and implementation intentions (Gollwitzer, 1999; Hagger and Luszczynska, 2014) focus on harnessing motivation and promoting action in those already likely to be motivated to change. As a consequence, such approaches are heavily dependent on individuals having some motivation to change even though they are not actually engaging in the behavior. These individuals are best characterized as " inclined abstainers " (Orbell and Sheeran, 1998) or " unsuccessful intenders " (Rhodes and de Bruijn, 2013). The approaches, however, do not focus on individuals with low or no motivation to change which account for a substantive proportion of the population. For example, less than 10% of smokers report wanting to quit (Wewers et al., 2003) and 60% of smokers do not make a quit attempt during any given year (Centers for Disease Control and Prevention, 2007). Similarly, up to 30% of individuals express no intention to exercise (Ronda et al., 2001; Rhodes and de Bruijn, 2013). It is clear, therefore, that a large number of individuals are not motivated to engage in health-promoting behaviors and tend to be those most at risk. In this article, we briefly review theoretical perspectives focusing on individuals who are not motivated to engage in health-promoting behaviors. We contend that although theories identify low motivation as a state, they do not provide complete explanations of, and underlying reasons for, the absence of motivation, nor do they suggest comprehensive strategies that may engage these hard-to-reach individuals. We offer some theory-derived suggestions on how to engage unmotivated individuals to increase their participation in health-promoting behaviors. Two prominent theoretical perspectives offer conceptualizations of " unmotivated " individuals: self-determination theory and the transtheoretical model. Self-determination theory (Deci and Ryan, 1985, 2000) distinguishes between different types of motivation or reasons underlying behavioral engagement (Chatzisarantis et al., 2007, 2008). According to the theory, the state in which an individual lacks intention to act is termed amotivation (Vallerand, 2001). Individuals
