Illness representations, emotional distress, coping strategies, and coping efficacy as predictors of patient outcomes in type 2 diabetes

hart pl & grindel cg (2010)  Journal of Nursing and Healthcare of Chronic Illness 2 , 225–240
 Illness representations, emotional distress, coping strategies, and coping efficacy as predictors of patient outcomes in type 2 diabetes Aim.  To examine the relationship between illness representations, emotional distress, coping strategies, and coping efficacy as predictors of self‐care behaviour and A1c levels in individuals with type 2 diabetes. Background.  Diabetes mellitus affects 23·6 million Americans and is the seventh leading cause of death in the United States. Reduction in complications can be best achieved by individuals’ adhering to appropriate lifestyle changes and maintaining tight glycemic control. Understanding the degree of influence that psychosocial factors have on individuals’ decisions to perform self‐regulation activities will give insight on strategies to encourage better decision‐making to prevent acute and chronic complications. Methods.  A descriptive, correlational design examined the psychosocial factors to determine the predictive relationships with self‐care behaviour and A1c levels. Participants were 119 men and women recruited from physician offices, medical clinics, and diabetes education centers. The research was conducted from March–December 2007. Results.  Participants perceived their diabetes to be a chronic, moderately cyclical condition with negative consequences and with moderate amounts of symptomatology that greatly influenced their emotional status. Hierarchical multiple linear regression analyses revealed that a) coping efficacy uniquely accounted for 9% of the variance in self‐care behaviour and b) illness representations, particularly timeline‐cyclical, uniquely accounted for 12% of the variance in A1c levels. Conclusions.  The findings confirm how illness representations, emotional distress, coping strategies, and coping efficacy influence self‐care behaviour and health outcomes. Psychosocial factors can influence lifestyle behaviour changes and outcomes of individuals with diabetes mellitus. Relevance to clinical practice.  Findings from the study have implications for nurses in the areas of assessment, diabetes management, coping skills training, and cognitive behavioural therapy. Nurses should incorporate these strategies into their daily practice to help individuals identify successful coping strategies, enhance coping efficacy, and change misconceptions about diabetes mellitus to improve self‐care behaviour and health outcomes.