The role of illness schemata in self-care behaviors and glycemic control among patients with type 2 diabetes in Iran.

Abstract

The diabetes illness perception domains outlined by Leventhal's common-sense model may be weakly associated with hemoglobin A1c (HbA1c) and adherence to diabetes self-care behaviors. However, type 2 diabetes patients' illness schemata identified by clustering the illness perception domains remain to be explained. This study aimed to describe type 2 diabetes patients' illness schemata and to examine their association with self-care behaviors and glycemic control in Iran. A cross-sectional survey was conducted with 200 patients (mean age 59.5±10.3; 70% female) who attended self-management classes at the Iranian Diabetes Society in Tehran. Illness perceptions and self-care behaviors were assessed using the Persian version of the Illness Perception Questionnaire Revised and the Summary of Diabetes Self-Care Activity. Three clusters of diabetes illness beliefs were identified: "empowered," "self-condemned," and "powerless." "Empowered" participants adhered most rigorously to general diet, fruit and vegetable intake, and exercise, and had the best glycemic control (HbA1c=7.2%, SD=0.2), followed by "self-condemned" and then "powerless" participants, who had the lowest adherence and the worst glycemic control (p<0.0001). The clustering method for identifying type 2 diabetes patients' illness schemata is useful for selecting patients who need further care and assistance with adhering to self-care behaviors and glycemic control.