Associations between patient characteristics and activation in patients with type 2 diabetes

Abstract

Background: Patients with type 2 diabetes (DM-II) need skills, knowledge and motivation to self-manage their disease on a daily basis. Some patient subgroups need more intense self-management support than others. Little is known on the patient and disease characteristics of these subgroups. Aim and research questions: To enhance targeting self-management support, three research questions were formulated. Which patient and disease characteristics are associated with self-management capacity in adult patients with DM-II? Which characteristics increase the risk of being a poor self-manager? What is the distribution of self-management capacity in patients with DM-II? Method: The study had a quantitative, observational, explorative, cross-sectional design, including patients with DM-II from two primary health clinics. Data were collected with questionnaires and chart review. Dependent variable was self-management capacity, measured as activation with the Patient Activation Measure. Independent variables were self-reported health status, depression, anxiety, illness perception, social support, demographic variables and disease specific variables. Data were analysed through linear and logistic regression analysis. Results: Of the 444 participants, 22.9% had activation level one (lowest), 25.3% level two, 38.5% level three and 13.2% level four. Key variables identified with multivariate linear regression were depression, social support and illness perception, explaining 14.1% of the variance in activation. Multiple logistic regression demonstrated that low self-reported health, negative illness perception and low social support increased the risk of poor activation (level one). Conclusion: Many diabetic patients still need support in managing their disease. (Poor) activation is mainly associated with social support, illness perception, depression and self-reported health status. However, variance in activation remains unexplained for the greater part and it is still challenging to identify patients that need more support. Recommendations: Social support, illness perception, depression and self reported health deserve attention in diabetic care. Longitudinal research is indicated to overcome the limitations raised by this study’s cross-sectional design.