|Year : 2016 | Volume
| Issue : 2 | Page : 153-157
Social support influencing diabetes self-management behaviors: A cross-sectional study in Udupi Taluk
Edison Khymdeit1, P Arathi Rao2, Prakash Narayanan2, Shreemathi Mayya3
1 Department of Anesthesiology, Manipal University, Manipal, Karnataka, India
2 Department of Public Health, Manipal University, Manipal, Karnataka, India
3 Department of Biostatistics, Manipal University, Manipal, Karnataka, India
|Date of Web Publication||29-Sep-2016|
P Arathi Rao
Department of Public Health, Manipal University, Udupi, Manipal - 576 104, Karnataka
Source of Support: None, Conflict of Interest: None
Background: India is witnessing an increase in diabetic cases as peoples' lifestyle change. This rapid increase of cases has led to an increase in the healthcare burden of the country with a considerable financial strain occurring due to the cost spent on diabetes treatment annually. Proper management of diabetes is based on good self-management behaviors (diet control, physical activity, glucose monitoring, and adherence to medication). Globally, studies have indicated the link between self-management behaviors and social support. Proper self-management behaviors could be the key to reducing the healthcare burden arising due to diabetes.
Objective: The objective of this study was to estimate the prevalence of compliance to treatment among diabetes patients and to assess the influence of social support on the self-management behaviors of diabetes patients.
Materials and Methods: A two-stage cluster sampling technique was employed to recruit 330 patients with Type 2 diabetes. A validated questionnaire was used to collect data on social support and self-management behaviors.
Results: Prevalence of compliance to treatment among diabetic patients was found to be 82.1%. This study showed that diabetes patients received highest social support for glucose monitoring (69.4%) followed by diet control (46.7%) and physical activity (31.2%). Chi-square test showed a statistical association between social support and diet control (P < 0.001), social support and physical activity (P < 0.001), and social support and glucose monitoring (P = 0.001).
Conclusion: Presence of good social support was found to positively influence the self-management behavior of diabetes patients. Higher level of evidence can be generated to place interventions in this regard.
Keywords: Diabetes, self-management behavior, social support
|How to cite this article:|
Khymdeit E, Rao P A, Narayanan P, Mayya S. Social support influencing diabetes self-management behaviors: A cross-sectional study in Udupi Taluk. Indian J Health Sci Biomed Res 2016;9:153-7
|How to cite this URL:|
Khymdeit E, Rao P A, Narayanan P, Mayya S. Social support influencing diabetes self-management behaviors: A cross-sectional study in Udupi Taluk. Indian J Health Sci Biomed Res [serial online] 2016 [cited 2019 Aug 24];9:153-7. Available from: http://www.ijournalhs.org/text.asp?2016/9/2/153/191255
| Introduction|| |
Globally, countries are witnessing an increase in diabetic cases which is regarded as one of the most common noncommunicable diseases. These numbers are expected to only rise as people's lifestyle changes. The worldwide prevalence was estimated to be 6.4% in 2010, and it is projected to be 7.7% by 2030.  The societal and healthcare burden of diabetes is ever increasing particularly for India and China.  There is no country as India whose diabetic epidemic is so well profound with more than 50 million Indians living with the disease with the prevalence around 7.1% in 2010 and set to increase to 8.6% by 2030. , The Southern population of India is reported to have a prevalence of 12.1% with the coastal part of Karnataka having a high prevalence of 16%. ,
Diabetes self-management is defined as the daily tasks or behaviors that an individual performs daily to manage his diabetes. These behaviors include frequently taking multiple medications, maintaining an optimal diet, physical activity, weight control, and measuring blood glucose levels regularly. Social support has been defined as an exchange of resources between at least two persons aimed at increasing the well-being of the receiver.  Social support consists of two components: Functional (qualitative) and structural (quantitative). Functional support is the degree of interpersonal relationships to an extent that the relationships provide emotional, informational, or instrumental quality supports for an individual. Structural support represents the types and numbers of social relationship (marital status and a number of friends) and the level of linkage among these relationships (social network). , For chronic disorder such as diabetes which requires patients to consistently maintain recommended self-management behaviors, the availability of functional support (interpersonal relationship with family, friends, and healthcare providers) as well as social networks is crucial to patients practicing their self -management behaviors.  Patients need support to bring upon changes in their lifestyle habits (diet control, physical activity, blood glucose monitoring, etc.), social support (functional and structural) is perceived to be helpful in bringing these changes and thus giving a chance to the patients to better control their diabetes. 
There are very few studies which have been done to understand the importance of social support in the self-management behaviors of diabetic patients in Indian settings, especially in Udupi Taluk of Karnataka; hence, this study was undertaken to fill this void and provide literature on the role of social support in the self-management behaviors of diabetes patients.
| Materials and Methods|| |
This cross-sectional study was conducted in 15 urban wards and 15 rural villages of Udupi Taluk, Karnataka. Ethical clearance for the study was obtained from Institutional Ethics Committee (IEC 29/2015) and written informed consent was taken from all the participants.
The sample size was calculated to obtain a 95% confidence interval with 5% precision around a prevalence estimate of 84% as the compliance to treatment among diabetes patients. This prevalence estimate was taken from a study done by Rao et al.  Sample size was computed to allow for an anticipated 10% nonresponse rate and adjusted for cluster sampling, taking a design effect of 1.5. A total of 330 individuals diagnosed with Type 2 diabetes were included in the study.
A two-stage cluster random sampling was employed to recruit participants. Fifteen urban wards and 15 rural villages were randomly selected for this study. The selected villages and wards were visited, the first house was chosen at random, the houses were then asked if there was a diabetes patient, if the answer was yes, the interview would continue after obtaining written informed consent. If the answer was no, the next house adjacent to the first house was visited, this would continue until a sample of 11 was achieved from each ward and villages.
Data collection tool
Data were gathered using a semi-structured questionnaire. The questionnaire has four sections:
The scale was modified to suit to the local settings. The scale had five items; these items included ten questions on social support for diet control, four questions for physical activity, two for glucose monitoring, three for foot care, and three questions on alcohol/smoking/tobacco. Each question has five types of responses never, rarely, sometimes, often, and always. Scores for each question were marked as 1, 2, 3, 4, and 5 for never, rarely, sometimes, often, and always, respectively. The scores for social support were calculated individually for diet control, physical activity, etc., and according to the scores, diabetes patients were categorized as receiving low social support, moderate social support, adequate social support, and good social support. For diet control scores of 40-50 were categorized as good social support, 30-40 as adequate social support, 20-30 as moderate social support, and < 20 as low social support. For physical activity scores of 17-20 were categorized as good social support, 13-16 as adequate social support, 8-12 as moderate social support, and < 8 as low social support. For glucose monitoring scores of 8-10, 6-8, 3-6, and < 3 were categorized as good social support, adequate social support, moderate social support, and low social support, respectively.
- Sociodemographic characteristics
- Respondents diabetes characteristics
- Self-management behaviors
- Validated social support scale designed by Naderimagham et al. 
The data collected were analyzed using the software SPSS version 15 (Chicago, SPSS INC). Sociodemographic information and respondent diabetes characterestics were summarised using frequency and percentages. Chi-square test was performed to find the association between self-management behaviors with social support. A P < 0.05 was considered to be statistically significant.
| Results|| |
The sociodemographic characteristics of participants are presented in [Table 1]. The age of the study participants ranged from 30 to 77 years with the mean age found to be 58 ± 9.51 years in the urban area and 60 ± 8.8 years in the rural area. Majority of our participants (52.1%) both in the rural and urban area were males. Around 90% of them were married and mostly follows Hindu religion in both the urban as well as rural area.
In both urban and rural area, nearly two-thirds have completed primary/secondary level of schooling and currently 64% were not working. Most of our respondents in the urban area (45.5%) had an income level between Rs. 10,000 and 20,000, whereas in the rural area, majority had income level < Rs. 10,000.
In the present study, the prevalence of compliance to treatment among diabetic patients was found to be 82.1%. Sixty percent regularly exercised and 45.2% monitored their glucose level monthly, almost 92% of respondents reported that they were following diet control advices [Figure 1]. Participants with a good level of social support had better self-management behaviors, they were more likely to report adhering to dietary advices, doing physical activity, and monitoring their blood glucose level monthly, these significant outcomes are presented in [Table 2]. Urban families were more supportive to diet (P < 0.05) and exercise issues (P < 0.05) as compared to rural families.
|Table 2: Association between social support and self-management behaviors|
Click here to view
| Discussion|| |
In this current study, 82.1% of respondents do not frequently miss their medications. Similar observation was reported by Rao et al. which reported that 83.6% of diabetes patients were taking medications regularly,  whereas a study done in Karnataka by Rajasekharan et al. reported that 60.6% of its respondents were adhering to their medicines.  Our study found that 60.0% of our respondents regularly exercised which is in contrast to the finding in the study done by Rajasekharan et al. which reported 43.4% of their participants to be following physical activity advices.  Furthermore, a study done in Ethiopia reported that 53.3% of the respondents showed adherence to physical activity advices. 
Our study found that from all the self-management behaviors a larger proportion of diabetic patients were receiving good social support for glucose monitoring (69.4%), followed by diet control (46.7%) and physical activity (31.2%). Similar observation was reported by Rosland et al., which observed that diabetes patients received strongest social support for glucose monitoring as compared to other self-management behaviors. 
Statistical association found in the study were between social support and diet control (P < 0.001), social support and physical activity (P < 0.001), and social support and glucose monitoring (P = 0.001). Those who received good social support were more likely to practice self-management behaviors. Similar kind of observations was seen in the study by SchiØtz et al. which reported self-management behaviors of diabetes patients to be significantly associated with social support.  Another study done in China by Zhong et al. reported glucose monitoring to be influenced by social support. 
A qualitative study undertaken by Ramal et al. in Hispanics residing in low-income areas of California identified major themes, namely self-efficacy, accessibility to resources, social support, and diet control as factors influencing diabetes self-management. The study also suggests family to be an enhancing factor and recommends that family should be included in diabetes management.  A systematic review done by Rad et al. to establish the relationship between social support and self-care behavior of diabetes patients showed that status of social support and self-care was inadequate and it concluded that not only social support can help in health promoting behavior but also it can significantly predict the self-care behavior of diabetes patients. 
A community perspective follow-up study done in rural and urban areas of New Delhi to assess the psychological reaction, attitude, and social support in patients with Type 2 diabetes reported that rural families were more supportive to diet and exercise issues which are in contrast to our findings that urban families were more supportive to both diet and exercise issues. 
| Conclusion|| |
Undoubtedly, diabetes is a burning public health issue, and it is important to realize that proper management of diabetes patients could decrease the financial strain and considerably reduce the burden of the disease in India. The result of this study showed social support to be associated and positively influencing self-management behaviors of diabetes patients (diet control, physical activity, and glucose monitoring). Those who received good social support were more likely to practice these self-management behaviors. This study highlights the need for good social support in the management of diabetes. To achieve this, social support could be incorporated as an integral part in the management of diabetes. By enhancing the awareness of family members in its positive influence, social support can be increased qualitatively. By recommending and enrolling socially deprived diabetic patients into organizations, which can help take care, quantitatively social support can be increased.
In this regard, the physicians need to understand that qualitative support is as important as quantitative support, i.e., social network. In addition, future research could design and identify the best sets of interventional approaches to increase social support.
In the present study, the presence of family members could have influenced participant's response to social support question. Furthermore, self-management behaviors were based on self-reporting of the participants and not based on direct observations.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4-14.
Ramachandran A, Snehalatha C, Shetty AS, Nanditha A. Trends in prevalence of diabetes in Asian countries. World J Diabetes 2012;3:110-7.
Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2 diabetes: Indian scenario. Indian J Med Res 2007;125:217-30.
Gupta M, Prabhu K, Parijathann BO, Kalaisevi VS, Rajendran SM, Rose J. Prevalence of diabetes in South India: A retrospective analysis. JIMSA 2012;25:239-40.
Rao CR, Kamath VG, Shetty A, Kamath A. A study on the prevalence of type 2 diabetes in coastal Karnataka. Int J Diabetes Dev Ctries 2010;30:80-5.
Kadirvelu A, Sadasivan S, Ng SH. Social support in type II diabetes care: A case of too little, too late. Diabetes Metab Syndr Obes 2012;5:407-17.
Broadhead WE, Gehlbach SH, deGruy FV, Kaplan BH. Functional versus structural social support and health care utilization in a family medicine outpatient practice. Med Care 1989;27:221-33.
Gamarra CJ, Paz EP, Griep RH. Social support and cervical and breast cancer screening in Argentinean women from a rural population. Public Health Nurs 2009;26:269-76.
Goetz K, Szecsenyi J, Campbell S, Rosemann T, Rueter G, Raum E, et al.
The importance of social support for people with type 2 diabetes - A qualitative study with general practitioners, practice nurses and patients. Psychosoc Med 2012;9:Doc02.
Rao CR, Kamath VG, Shetty A, Kamath A. Treatment compliance among patients with hypertension and type 2 diabetes mellitus in a coastal population of Southern India. Int J Prev Med 2014;5:992-8.
Naderimagham S, Niknami S, Abolhassani F, Hajizadeh E, Montazeri A. Development and psychometric properties of a new social support scale for self-care in middle-aged patients with type II diabetes (S4-MAD). BMC Public Health 2012;12:1035.
Rajasekharan D, Kulkarni V, Unnikrishnan B, Kumar N, Holla R, Thapar R. Self-care activities among patients with diabetes attending a tertiary care hospital in Mangalore Karnataka, India. Ann Med Health Sci Res 2015;5:59-64.
Wabe NT, Angamo MT, Hussein S. Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia. N Am J Med Sci 2011;3:418-23.
Rosland AM, Kieffer E, Israel B, Cofield M, Palmisano G, Sinco B, et al.
When is social support important? The association of family support and professional support with specific diabetes self-management behaviors. J Gen Intern Med 2008;23:1992-9.
Schiøtz M, Frølich A, Krasnik A, Taylor W, Hsu J. Social organization of self-management support of persons with diabetes: A health systems comparison. Scand J Prim Health Care 2012;30:189-94.
Zhong X, Tanasugarn C, Fisher EB, Krudsood S, Nityasuddhi D. Awareness and practices of self-management and influence factors among individuals with type 2 diabetes in urban community settings in Anhui Province, China. Southeast Asian J Trop Med Public Health 2011;42:185-6.
Ramal E, Petersen AB, Ingram KM, Champlin AM. Factors that influence diabetes self-management in Hispanics living in low socioeconomic neighborhoods in San Bernardino, California. J Immigr Minor Health 2012;14:1090-6.
Rad GS, Bakht LA, Feizi A, Mohebi S. Importance of social support in diabetes care. J Educ Health Promot 2013;2:62.
Kishore J, Kohli C, Gupta N, Kumar N, Gupta N, Ray PC. Initial psychological reaction and social support in patients of type 2 diabetes mellitus in Delhi. Int J Med Public Health 2013;3:244-9.
[Table 1], [Table 2]