The practice of diabetes self-care plays an important role in achieving and maintaining good glycaemic control. However, not all patients with insulin-treated diabetes engage in their self-care activities. There is some evidence that self-care practices in patients with insulin-treated diabetes can be understood and predicted by their health beliefs, although studies are often hampered by methodological weaknesses, and the fact that less is known about adults with insulin-treated diabetes in Malaysia. This study was conducted to examine whether health beliefs (as specified in the Health Belief Model: HBM) can predict self-care practices and glycaemic control in patients with insulin-treated diabetes in Malaysia. Longitudinal design with self-reported questionnaire measures was administered at baseline (Time 1:T1) and six months later (Time 2: T2). Participants were recruited from three endocrinology clinics in Malaysia. The measures included self-care practices (diet, insulin intake, exercise and self-blood glucose monitoring: SMBG), health beliefs and diabetes knowledge. Participants’ glycaemic control was examined based on their glycated hemoglobin (HbA1c) results. Data analysis was performed at different points of the study times; T1, T1-T2 and T2. Diabetes knowledge and demographic data were controlled for in predictive statistical analyses. A total of 159 patients with insulin-treated diabetes (aged 18-40 years) completed the measures at T1. Of these, only 108 (67.9%) completed follow-up measures at T2. However, demographic characteristics were not significantly different between those who completed and dropped out of the study (p>0.05). The HBM was significantly predictive of diet self-care at T2, insulin intake practice at T1 and HbA1c at T1-T2 andT2. Of the HBM constructs, perceived benefits significantly predicted good dietary habits at T1 (OR 1.92) and T2 (OR .23) and adherence to insulin injection at T1 (OR 3.17) and T1-T2 (OR 2.68). With the exception of perceived severity, all other HBM constructs significantly predicted HbA1c [perceived susceptibility (β .169) at T1, perceived barriers (β -.206) and perceived benefits (β -.397) at T2 and cues to action (β -.233) at T1-T2]. Health beliefs predict self-care practices and glycaemic control in young to middle-aged adults with insulin-treated diabetes in Malaysia. Diabetes educators could use this knowledge in their efforts to improve diabetes self-care in this patient groupby modifying those beliefs through their diabetes education.
Study site: Endocrinology clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Hospital Putrajaya, and Hospital Melaka, Malaysia