Family Support as a Significant Factor in Facilitating Adherence to Diabetes Self–Care and Glycemic Control

Background and Purpose: Adherence to self-care behaviors in diabetes is important for prevention of diabetes complications, but is generally poor. Adherence is complex and determined by diverse personal, social and environmental factors. The family is the most significant social support system for the patient's adherence to diabetes self-care guidelines. This study aimed to evaluate the unique contribution of family structure and family support to adherence with diabetes self-care behaviors and glycemic control beyond that of the patient's personal attributes.

Methods: Study design ¨C cross-sectional. A random sample of adult non-insulin dependent diabetes patients, aged 35-55 years, insured with Maccabi Health Care Services in Israel and registered in the Diabetes Registry for at least two years, were selected from three patient groups: 1) Well controlled (HbA1c <7). 2) Poorly controlled HbA1c ≥8.5. 3) Did not undergo testing for HBA1c in the previous year. Total N=475. Data were collected by telephone interviews, using a structured questionnaire. Study variables included family structure, family support in diabetes self-care; Patient's cognitive and psychological characteristics (beliefs about illness severity and outcome expectations, diabetes-related self-efficacy, diabetes-related stress, depression); Outcome variables - adherence to self-care (six behaviors - dietary care, exercise, blood-glucose testing, foot care, medications, smoking, and an overall score); glycemic control group. Bivariate associations and multivariate analyses were conducted controlling for gender and duration of diabetes.

Findings: Using ANOVA, statistically significant associations were found between family support and several self-care behaviors, but not with glycemic control. Family structure (not married) was significantly associated only with smoking behavior. Personal cognitive factors (such as perception of illness, self-efficacy) and depression were significantly associated with several self-care behaviors. Using regression models, diabetes-related self-efficacy was strongly associated with most self-care behavior and family support remained significantly and positively associated with the overall self-care score and with dietary care.

Conclusions and implications: The findings suggest that diabetes-related family support is a significant factor in addition to personal self-efficacy in adherence to diabetes self-care behavior. Implications: Social workers in health care services need to develop individual and family psychosocial interventions to enhance the patient's self-efficacy and enhance family support. Such interventions have a potential to improve self-care and reduce future complications. Further research is required to evaluate family-centered interventions. The findings have implications for health policy suggesting that an ongoing psychosocial evaluation of patients with diabetes by a social worker should be included consistently as a component of a multidisciplinary team approach in order to identify patients at elevated risk for poor adherence.