Toward a Theory of Diabetes Self-Care Management

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Abstract:

This paper synthesizes knowledge about self-care, identifies factors that affect self-care, and proposes a conceptual framework and research model for diabetes self-care management. Concepts derived from Orem's Self-Care and Bandura's Self-Efficacy theories and review of empirical work on relationships among concepts derived from those theories formed a foundation for the conceptual framework. The framework describes relationships that can be tested to determine utility of various personal and environmental factors in nursing practice when self-care management is the care modality for individuals with chronic diseases. A test of the framework using a research model for diabetes self-care management suggested that individuals who have diabetes knowledge and social support build capacities for self-care (self-care agency) and confidence in those capacities (self-efficacy), forming a pattern of factors which leads to better diabetes self-care management and glycemic control.

Key Words: Theory, Conceptual Framework, Research Model, Self-Care, Diabetes Mellitus

Self-care management is the appropriate modality of care for people with many types of chronic disease. Effective control of diabetes, a leading chronic disease, depends on self-care activities such as diet, exercise, glucose monitoring, and medication administration (Agurs-Collins, Kumanyika, Have, & Adams-Campbell, 1997; Ohkubo et al., 1995; The Diabetes Control and Complication Trial Research Group [DCCT], 1993; The United Kingdom Prospective Diabetes Study [UKPDS], 1998). Because people must be sufficiently capable and reliable to take care of themselves (Anderson, 1996; Moon & Baker, 2000; Wang, 1997), they need to have personal and environmental resources such as knowledge about the disease, social support, financial support, self-efficacy or belief in their capacity to engage in self-care, and self-care agency or capacity to engage in self-care. When people have these resources and engage in self-care management of their disease, they are more likely to achieve desired health outcomes. The authors of this article synthesize knowledge about self-care, identify factors affecting self-care management, propose a conceptual framework, and report testing a research model for examining diabetes self-care management.

THEORETICAL BACKGROUND

Key constructs and concepts from Orem's Self-Care (1985, 1991, 1995) and Bandura's Self-Efficacy (1986, 1997) theories and a review of empirical work on the relationship among those concepts served as a foundation for the development of the conceptual framework and research model for diabetes self-care management.

Orem's Self-care Theory

According to Orem's Theory...