Factors Influencing Disease Self-Management Among Veterans with Diabetes and Poor Glycemic Control
Open accessAbstract
Specific aim Although the Department of Veterans Affairs (VA) has made significant organizational changes to improve diabetes care, diabetes self-management has received limited attention. The purpose of this study is to assess factors influencing diabetes self-management among veterans with poorly controlled diabetes.Methods Surveys were mailed to patients with type 2 diabetes and a HbA1c of 8% or greater who attended 1 of 2 VA Medical Centers in Washington State (n = 1,286). Validated survey instruments assessed readiness to change, self-efficacy, provider advice, and diabetes self-care practices.Results Our response rate was 56% (n = 717). Most respondents reported appropriate advice from physicians regarding physical activity, nutrition, and glucose monitoring (73%, 92%, and 98%, respectively), but many were not ready to change self-management behaviors. Forty-five percent reported non-adherence to medications, 42% ate a high-fat diet, and only 28% obtained either moderate or vigorous physical activity. The mean self-efficacy score for diabetes self-care was low and half of the sample reported readiness to change nutrition (52%) or physical activity (51%). Individuals with higher self-efficacy scores were more likely to adhere to medications, follow a diabetic meal plan, eat a lower fat diet, have higher levels of physical activity, and monitor their blood sugars (P < .001 for all).Conclusions Although veterans with poor diabetes control receive appropriate medical advice, many were not sufficiently confident or motivated to make and maintain self-management changes. Targeted patient-centered interventions may need to emphasize increasing self-efficacy and readiness to change to further improve VA diabetes outcomes.
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An extensive body of evidence indicates that self-efficacy influences behavior change across all behavior domains related to cardiovascular disease risk reduction.
“An extensive body of evidence indicates that self-efficacy influences behavior change across all the behavior domains related to CVD risk reduction.83–92”
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- Authors
- Nelson, K. M., McFarland, L., & Reiber, G.
- Affiliations
- VA Puget Sound Health Care System (US)
- University of Washington (US)
- Corresponding author
- Nelson, Karin M.
- Venue
- Journal of General Internal Medicine
- Published
- 2007-02-17
- Volume
- 22
- Issue
- 4
- Pages
- 442-447
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC1829424
- OpenAlex
- W1987728046
- Cited by
- 112
- References
- 54
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2021: 4 · 2020: 5 · 2019: 3 · 2018: 6 · 2017: 10 · 2016: 4 · 2015: 8 · 2014: 8 · 2013: 13 · 2012: 12
- FWCI
- 4.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Health Services Research and Development
- Quality Enhancement Research Initiative
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Keywords
- diabetes self-management, veterans, type 2 diabetes, glycemic control, HbA1c, self-efficacy, readiness to change, medication adherence, physical activity, dietary fat intake, blood glucose monitoring, patient-centered interventions, Department of Veterans Affairs
- MeSH terms
- Adult, Aged, Data Collection, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Self Care, Veterans, Disease Management, Self Efficacy, Glycemic Index
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