Effect of adults' self-regulation of diabetes on quality-of-life outcomes.
OBJECTIVE
To examine the relationships among cognitive representations of diabetes, diabetes-specific health behaviors, and quality of life using Leventhal and Diefenbach's self-regulation model of illness (Leventhal H, Diefenbach M: The active side of illness cognition. In Mental Representation in Health and Illness. SkeltonJA, Croyle RT, Eds. New York, Springer-Verlag, 1991, p. 247-272).


METHODS
This research involved secondary analysis of a mailed survey completed by 296 adults (ages 20-90 years). Structural equation modeling was conducted to investigate relationships among cognitive representations, diabetes-specific health behaviors, and quality of life. Model differences by diabetes type were also investigated.


RESULTS
Findings indicated that certain cognitive representation constructs were related to increased diabetes-specific health behaviors, decreased sense of burden, and positive quality-of-life outcomes. Individuals levels of understanding of diabetes and their perceptions of control over diabetes were the most significant predictors of outcomes. However, diabetes-specific health behaviors were related to an increased sense of burden that was negatively associated with quality of life. Multigroup analyses indicated that this self-regulatory model provided a good fit for individuals with type 1 diabetes, those with type 2 diabetes who take insulin, and those with type 2 diabetes who do not take insulin.


CONCLUSIONS
These findings advance what is known about cognitive representations of illness and the self-regulation of diabetes as well as the relationships between cognitive representations of illness, quality of life, and behavioral factors. In particular, results from this study suggest the need for further study to address ways of reducing the burden of diabetes associated with health behaviors and decreased quality of life.
Watkins
K W
KW
Department of Health Promotion and Education, School of Public Health, University of South Carolina, Columbia, USA. kwatkins@sph.sc.edu
Connell
C M
CM
Fitzgerald
J T
JT
Klem
L
L
Hickey
T
T
Ingersoll-Dayton
B
B
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003071:Cognition; D003920:Diabetes Mellitus / Q000523:psychology* / Q000534:rehabilitation*; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology / Q000534:rehabilitation; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000534:rehabilitation; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D011788:Quality of Life; D012044:Regression Analysis; D015203:Reproducibility of Results; D012648:Self Care; D011795:Surveys and Questionnaires
D007328:Insulin