title: Adherence to Self-Care Behaviors among Patients with Type 2 Diabetes-The Role of Risk Preferences.
abstract: OBJECTIVE
  To examine whether the degree of risk aversion is associated with adherence to disease self-management among adults with type 2 diabetes.
  
  
  METHODS
  This was a cross-sectional study of patients with type 2 diabetes (n = 408) aged 21 to 70 years who presented for routine visits in the diabetes clinic at a university medical center in Beer-Sheva, Israel. The authors used validated questionnaires to estimate adherence, risk preferences, motivation, self-efficacy, impulsivity, perceptions about the disease and the interpersonal process of care, and demographic and socioeconomic characteristics, in addition to retrieving data from computerized patient medical records of clinical indicators of disease severity. Multivariable linear and ordered-logit models examined predictors of adherence to each self-care behavior.
  
  
  RESULTS
  Multivariable analyses revealed that, compared with others, risk-seeking patients reported lower general adherence (β = -0.32; P ≤ 0.05), and specifically, lower adherence to healthful eating plan (β = -0.48; P ≤ 0.1), consumption of low-fat food (β = -0.47; P ≤ 0.1), exercise (β = -0.73; P ≤ 0.05), blood glucose monitoring (β = -0.69; P ≤ 0.05), and foot care (β = -0.36; P ≤ 0.1). Risk-seeking patients did not report lower consumption of fruits and vegetables (β = -0.19; P > 0.1). Because 96% of the study population reported optimal adherence to medication, determinants of this behavior could not be analyzed.
  
  
  CONCLUSIONS
  Risk preference is associated with adherence to self-care behaviors. Identifying risk seekers may enable practitioners to target these patients with tailored strategies to improve adherence, thus more efficiently allocating scarce health care resources.
authors.affiliation: Department of Health Systems Management, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: simont@som.bgu.ac.il.
authors.forename: Tzahit
authors.initials: T
authors.lastname: Simon-Tuval
authors.affiliation: The Braun Hebrew University-Hadassah School of Public Health, Jerusalem, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Shmueli
authors.affiliation: Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Diabetes Clinic, Department of Internal Medicine C, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Ilana
authors.initials: I
authors.lastname: Harman-Boehm
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D015438:Health Behavior; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance; D057240:Patient Preference; D018570:Risk Assessment; D012648:Self Care; D020377:Self Efficacy; D055815:Young Adult
keywords: adherence; diabetes; risk preferences