| dc.description.abstract | Aim:To test the interactive effects of the constructs of Modified Social Learning
Theory (MSLT) in relation to predicting health behaviour in Type 2
Diabetes. Methods: The study is mixed methods and employs an exploratory
sequential design. Qualitative Phase: (N=12) Semi-structured interviews with adults
with insulin-treated type 2 diabetes, explored how beliefs and values influence self-management
behaviour. Interim Phase: Thematic analysis allowed development of
an adapted Health Value Measure. Quantitative phase: (N=107) Valid
questionnaires measured Health Value, Health Locus of Control (HLC) and Self-efficacy
(SE). Health Value was measured pre and post diagnosis in order to
compare any changes with time. Anxiety and depression was controlled for using the
Hospital Anxiety and Depression(HAD) scale. Five subscales measured diabetes
outcome behaviour: general diet, specific diet, exercise, blood sugar and foot care.
Hierarchical Multiple Regression(HMR) analyses consisted of four blocks, including
three two-way interaction terms and one three-way interaction term to test the
interactive effects of the three-predictor variables on outcome behaviours. ANOVA’s
were conducted in an effort to add support to HMR results.
Results: The interviews suggest that people may hold terminal (beliefs about desired
end states)/instrumental health values (beliefs about desired modes of action) pre-diagnosis
but these are mainly instrumental post-diagnosis in order to meet their new
needs and maintain quality of life. The qualitative data also drew attention to the way
in which LOC and SE beliefs impact on behaviour. Additionally, differing
dimensions of various emergent themes highlight the demands Type 2 diabetes
places on a person and how this influences beliefs and values.Interim phase results
resulted in the new items being removed from the adapted health value measure prior
to the quantitative data analysis, as item 5 was deemed problematic.Sensitivity
analysis was carried out to increase the robustness of the quantitative findings due to
removing 29 cases with missing data from Dataset 1. Dataset 1 includes 78 complete
cases and Dataset 2 contains 107 cases, 29 of which had missing values and were
replaced using regression imputation. HMR analyses produced significant results that
support MSLT when the three-way interaction variable was added to block 4.
ANOVA results produced minimum support for MSLT.
Conclusion: Support for MSLT has been found and can be used to inform
interventions to change self-management behaviours of patients with poor
diabetes control. Change in health value orientation post-diagnosis purports further
investigation, as it is supported by qualitative results but not quantitative. | en |
