Developing a Causal Model of Self-Care Behaviors Based on Self-Compassion with Psychological Distress Mediation in Women and Men with Type 2 Diabetes
Keywords:
Self-care behaviors, Self-compassion, Psychological distress, Type 2 diabetesAbstract
Type 2 diabetes mellitus is a common disease of the endocrine glands characterized by chronic hyperglycemia due to disturbances in insulin secretion and function. The metabolic complications of this disease lead to an increased burden of disease in society, and patients require lifelong special self-care behaviors. Psychological factors play a significant role in adherence to self-care programs and treatment outcomes in patients with type 2 diabetes. The present study was conducted with the aim of "developing a causal model of self-care behaviors based on self-compassion with psychological distress mediation in women and men with type 2 diabetes." This study was applied in objective, quantitative in data type, survey in data collection method, and descriptive-analytical based on correlation analysis in analysis type. The study population consisted of individuals aged 40 to 60 years with type 2 diabetes in Tehran, from whom 640 participants were selected using convenience sampling. Data collection tools were the Self-Compassion Scale (Neff, 2003), the Psychological Distress Scale (Kessler et al., 2003), and the Self-Care Behaviors Scale (Toobert & Glasgow, 2000). Data were analyzed using structural equation modeling and the software SPSS26 and Smart PLS 3.2. The results showed that all model fit indices were within acceptable limits (GOF for men = 0.725 and for women = 0.733), indicating the model's adequate fit with the data. Both direct and indirect effects of self-compassion with psychological distress as a partial mediator on self-care behaviors were confirmed (P < 0.01). The moderating role of gender in the relationship between self-care behaviors and self-compassion with psychological distress mediation was confirmed (P < 0.01), with the effect of self-compassion through psychological distress mediation on self-care behaviors being greater in men (β for men = 0.914) than in women (β for women = 0.855). Given the confirmed role of psychological factors on self-care behaviors in patients with type 2 diabetes, the presence of psychological counselors in the diabetes treatment team is essential. Therefore, psychological counselors are advised to pay more attention to the effective role of self-compassion and psychological distress in supportive and therapeutic interventions for patients with type 2 diabetes.
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References
1. Suryasa IW, Rodríguez-Gámez M, Koldoris T. Health
and treatment of diabetes mellitus. International journal of health
sciences. 2021;5(1):i-v. [DOI]
2. Mirshahi M, Nahbandani S. The statistical Facts of
Diabetes in 2022 (Why is diabetes statistics increasing and
becoming the fastest growing chronic disease?). Journal of
Diabetes Nursing. 2022;10(2):1886-8.
3. Paudel G, Vandelanotte C, Dahal PK, Biswas T, Yadav
UN, Sugishita T, Rawal L. Self-care behaviours among people
with type 2 diabetes mellitus in South Asia: A systematic review
and meta-analysis. Journal of global health. 2022;12. [PMID:
35916498] [PMCID: PMC9346342] [DOI]
4. Mohammadi S, Nazari A, Mohammadi M. The
Predictive Role of Repetitive Negative Thoughts, Emotion
Regulation and Self-Care Strategies on the Acceptance and
Adherence Therapy of People with Type 2 Diabetes. Iranian
Journal of Diabetes and Lipid Disorders. 2023;23(1):34-43.
5. Phipps WJ. Medical-surgical nursing: Health and illness
perspectives. 2003.
6. Nagelkerk J, Reick K, Meengs L. Perceived barriers and
effective strategies to diabetes self-management. Journal of
Advanced Nursing. 2006;54(2):151-8. [PMID: 16553701] [DOI]
7. Zare' Shahabadi A, Ebrahimi Sadrabadi F. Impact of
Cognitive Factors on Treatment of Type 2 Diabetes in Yazd.
Clinical Psychology Studies. 2013;4(13):1-22.
8. Ostadzadeh A, Ebrahimi A, Mozaffari M. Investigating
the relationship between quality of life with adherence and history
of treatment (drug therapy) without psychotherapy and
demographic characteristics in patients with type 2 diabetes.
Journal of Fundamentals of Mental Health. 2017;19(special
issue):273-9.
9. Mehraeen E, Mehrtak M, Janfaza N, Karimi A, Heydari
M, Mirzapour P, Mehranfar A. Design and Development of a
Mobile-Based Self-Care Application for Patients with Type 2
Diabetes. Journal of Diabetes Science and Technology.
2022;16(4):1008-15. [PMID: 33840235] [PMCID: PMC9264443]
[DOI]
10. da Rocha BR, Silva SC, Cardoso SV. Self-Care in
Adults with Type 2 Diabetes Mellitus: A Systematic Review.
Current Diabetes Reviews. 2020;16(6):598-607. [PMID:
31267873] [DOI]
11. Solhi M, Hazrati S, Nejaddadgar N. Analysis of Selfcare Behaviors and their Related Factors in Patients with Type II
Diabetes. Journal of Diabetes Nursing. 2017;5(3):223-31.
12. Lee J-E, Han H-R, Song H, Kim J, Kim KB, Ryu JP,
Kim MT. Correlates of self-care behaviors for managing
hypertension among Korean Americans: a questionnaire survey.
International journal of nursing studies. 2010;47(4):411-7.
[PMID: 19863959] [DOI]
13. Heydari Aghdam B, Khademi Al, Zahedi R. Prediction
Of Self-Care Behaviors Based On Self-Compassion And Health
Locus Of Control Among Diabetic Patients. Nursing and
Midwifery Journal. 2021;18(12):977-85.
14. Dagnew B, Debalkie Demissie G, Abebaw Angaw D.
Systematic Review and Meta-Analysis of Good Self-Care Practice
among People Living with Type 2 Diabetes Mellitus in Ethiopia:
A National Call to Bolster Lifestyle Changes. Evidence-Based
Complementary and Alternative Medicine. 2021;2021:8896896.
[PMID: 33688368] [PMCID: PMC6986481] [DOI]
15. Edraki M, Zarei A, Soltanian M, Moravej H. The effect
of peer education on self-care behaviors and the mean of
glycosylated hemoglobin in adolescents with type 1 diabetes: a
randomized controlled clinical trial. International journal of
community based nursing and midwifery. 2020;8(3):209.
16. Kooshyar H, Shoorvazi M, Dalir Z, Hosseini M. Health
literacy and its relationship with medical adherence and healthrelated quality of life in diabetic community-residing elderly.
Journal of Mazandaran University of Medical Sciences.
2013;22(1):134-43.
17. Andrade LF, Rapp T, Sevilla-Dedieu C. Exploring the
determinants of endocrinologist visits by patients with diabetes.
The European Journal of Health Economics. 2016;17(9):1173-84.
[PMID: 27038624] [DOI]
18. Benbassat J, Taragin M. Hospital Readmissions as a
Measure of Quality of Health Care: Advantages and Limitations.
Archives of Internal Medicine. 2000;160(8):1074-81. [PMID:
10789599] [DOI]
19. Holaway RM, Heimberg RG, Coles ME. A comparison
of intolerance of uncertainty in analogue obsessive-compulsive
disorder and generalized anxiety disorder. Journal of anxiety
disorders. 2006;20(2):158-74. [PMID: 16464702] [DOI]
20. Ayoubi J, Bigdeli I, Mashhadi A. The Effect of
Mindfulness-Integrated Cognitive Behavior Therapy on Quality of
Life, Psychological Distress and Adherence in Patients with Type
2 Diabetes Mellitus. Health Psychology. 2020;9(34):75-94.
21. Ferrari M, Dal Cin M, Steele M. Self-compassion is
associated with optimum self-care behaviour, medical outcomes
and psychological well-being in a cross-sectional sample of adults
with diabetes. Diabetic Medicine. 2017;34(11):1546-53. [PMID:
28799282] [DOI]
22. Kazemi A, Ahadi H, Nejat H. Effectiveness of
compassion focused therapy on loneliness, self-care behaviors and
blood sugar in diabetes patients. IJRN. 2020;6(3):42-9.
23. Hajigadirzadeh A, Taheri A, Babakhani N. Comparing
the effectiveness of cognitive rehabilitation and compassion-based
therapy on self-care behaviors of the elderly with mild cognitive
impairment. Iranian Journal of Rehabilitation Research.
2023;9(4):1-9.
24. Jalali-Farahani S, Amiri P, Olazadeh K, Panahi R, Azizi
F. Comparison of Anxiety, Stress, and Depression in Type 2
Diabetes Patients Before and after the Covid-19 Pandemic
Considering Perceived Social Support: Tehran Lipid and Glucose
Study (TLGS). Iranian Journal of Endocrinology and Metabolism.
2022;24(5):301-10.
25. Hoogendoorn CJ, Schechter CB, Llabre MM, Walker
EA, Gonzalez JS. Distress and Type 2 Diabetes Self-Care: Putting
the Pieces Together. Annals of Behavioral Medicine.
2020;55(10):938-48. [PMID: 32914829] [PMCID: PMC8489306]
[DOI]
26. Bagheri Sheykhangafshe F, Saeedi M, Ansarifar N,
Jalili P, Savabi Niri V. Quality of Life and Psychological Distress
in Diabetic Patients During the Covid-19 Pandemic: A Systematic
Review Study. 2022;9:1752-65.
27. Bala R, Srivastava A, Ningthoujam GD, Potsangbam T,
Oinam A, Anal CL. An observational study in Manipur State,
India on preventive behavior influenced by social media during
the COVID-19 pandemic mediated by cyberchondria and
information overload. Journal of Preventive Medicine and Public
Health. 2021;54(1):22. [PMID: 33618496] [PMCID:
PMC7939751] [DOI]
28. Javadi M, Maghsoudi Z, Rastegarmoghadam R, Shahedi
M, Kazeminasab M, Mezerji M. The Relationship Between SelfCare And Emotional Distress In Patients With Type 2 Diabetes
Referred To The Yazd Diabetes Research Center In 2018. Nursing
and Midwifery Journal. 2020;17(11):871-7.
29. Gao Y, Xiao J, Han Y, Ji J, Jin H, Mawen DG, et al.
Self-efficacy mediates the associations of diabetes distress and
depressive symptoms with type 2 diabetes management and
glycemic control. General Hospital Psychiatry. 2022;78:87-95.
[PMID: 35932599] [DOI]
30. Arabi A, Hasani J, Akbari M, Hatami M, Sherbafchi
Zadeh MR. Effectiveness of Self-Compassion Therapy on
Psychological Distress and Quality of Life of Psoriasis Skin
Patients. Journal of Research in Behavioural Sciences.
2021;18(4):605-15. [DOI]
31. Kavousi L, Abbasi G, Mirzaian B. The effectiveness of
Compassion- Focused Therapy on Psychological Distress, SelfConcept, and Social Support for People with Binge Eating
Disorder. Journal of Nursing Education. 2021;9(3):50-62.
32. Chio FH, Mak WW, Ben C. Meta-analytic review on
the differential effects of self-compassion components on wellbeing and psychological distress: The moderating role of
dialecticism on self-compassion. Clinical Psychology Review.
2021;85:101986. [PMID: 33667941] [DOI]
33. Baroni I, Caruso R, Dellafiore F, Ausili D, Barello S,
Magon A, et al. Self-care and type 2 diabetes mellitus (T2DM): a
literature review in sex-related differences. Acta Bio Medica:
Atenei Parmensis. 2022;93(4).
34. Ashfaq F, Manzoor I, Zafar T, Irfan H, Masood H,
Ashfaq H. Gender Differences in Self-Care Practices Among
Diabetics Presenting at Tertiary Care Hospital in Lahore.
Biomedica. 2019;35(3):138.
35. Mathew R, Gucciardi E, De Melo M, Barata P. Selfmanagement experiences among men and women with type 2
diabetes mellitus: a qualitative analysis. BMC Family Practice.
2012;13(1):122. [PMID: 23249410] [PMCID: PMC3538503]
[DOI]
36. Islam A, Tahir MZ. Health sector reform in South Asia:
new challenges and constraints. Health policy. 2002;60(2):151-69.
[PMID: 11897374] [DOI]
37. Keyes J, Yankouskaya A, Panourgia C. Selfcompassion, coping strategies and gender differences in
psychology, counselling and psychotherapy practitioners during
COVID-19: Lessons learnt. Counselling and Psychotherapy
Research. 2023;23(4):1052-62. [PMID: 36247723] [PMCID:
PMC9537790] [DOI]
38. Yarnell LM, Neff KD, Davidson OA, Mullarkey M.
Gender Differences in Self-Compassion: Examining the Role of
Gender Role Orientation. Mindfulness. 2019;10(6):1136-52.
[DOI]
39. Muris P, Petrocchi N. Protection or Vulnerability? A
Meta-Analysis of the Relations Between the Positive and
Negative Components of Self-Compassion and Psychopathology.
Clinical Psychology & Psychotherapy. 2017;24(2):373-83.
[PMID: 26891943] [DOI]
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Copyright (c) 2024 Zeynab Eshraghi (Author); Fatemeh Golshani (Corresponding Author); Anita Baghdasarians, Susan Emamipour (Author)
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