title: Associations of changes in psychosocial factors and their interactions with diabetes distress in patients with type 2 diabetes: a longitudinal study.
abstract: OBJECTIVE
  To assess the associations of changes in self-management behaviours, diabetes self-efficacy, resilience, social support, patient empowerment and their interactions with changes in diabetes distress in patients with type 2 diabetes mellitus.
  
  
  BACKGROUND
  Many patients with type 2 diabetes mellitus experience diabetes distress. Few longitudinal studies have investigated the associations of changes in various psychosocial factors with changes in diabetes distress in patients with type 2 diabetes mellitus.
  
  
  METHODS
  This study adopted a longitudinal design. Data were collected at baseline and 12 months later.
  
  
  METHODS
  Overall, 304 patients with type 2 diabetes were recruited from four hospitals in southern Taiwan by convenience sampling. A self-report questionnaire and medical record were used to collect demographic data, clinical indicators, self-management behaviours, diabetes self-efficacy, resilience, social support, patient empowerment, and diabetes distress. Data were collected from February 2014-March 2015.
  
  
  RESULTS
  An increase in resilience or diabetes self-efficacy significantly associated with a decrease in diabetes distress, whereas an increase in patient empowerment significantly associated with an increase in diabetes distress. The interactions between increase in patient empowerment and increase in self-management behaviours significantly associated with decrease in diabetes distress.
  
  
  CONCLUSIONS
  Nurses could endeavour to improve the diabetes self-efficacy and resilience to reducing diabetes distress. Arbitrarily empowering patients may increase diabetes distress. Increasing self-care management behaviours and patient empowerment might need to be simultaneously addressed to reduce the diabetes distress in patients with type 2 diabetes.
authors.affiliation: College of Nursing, Kaohsiung Medical University, Taiwan.
authors.forename: Ruey-Hsia
authors.identifier: http://orcid.org/0000-0001-9323-7389
authors.initials: RH
authors.lastname: Wang
authors.affiliation: Department of Diabetes Management, Lee's Endocrinology Clinic, Pingtung, Taiwan.
authors.forename: Hui-Chun
authors.initials: HC
authors.lastname: Hsu
authors.affiliation: Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Chia-Chan
authors.initials: CC
authors.lastname: Kao
authors.affiliation: College of Nursing, Kaohsiung Medical University, Taiwan.
authors.forename: Yung-Mei
authors.initials: YM
authors.lastname: Yang
authors.affiliation: Lee's Endocrinology Clinic, Pingtung, Taiwan.
authors.forename: Yau-Jiunn
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan.
authors.forename: Shyi-Jang
authors.initials: SJ
authors.lastname: Shin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011209:Power, Psychological; D055500:Resilience, Psychological; D012648:Self Care / Q000379:methods / Q000523:psychology; D020377:Self Efficacy; D012944:Social Support; D013315:Stress, Psychological / Q000209:etiology*; D013624:Taiwan; D055815:Young Adult
keywords: diabetes distress; interaction; nurses; patient empowerment; prospective study; resilience; self-efficacy; self-management; social support; type 2 diabetes