Theory of Planned Behavior and Social Cognitive Theory on the Effect of the Community Health Center Tertiary Preventive Behavior among Patients with Type 2 Diabetes Mellitus: A Multilevel Analysis
Background: Type 2 diabetes mellitus (DM) accounts for 90% to 95% of all diabetes cases. Complications of type 2 diabetes increase the risk of death for sufferers. Complications and deaths from type 2 diabetes can be prevented by changes in behavior. This study aimed to determine the effect of health centers and other factors on the prevention of tertiary diabetes type 2, using the theory of planned behavior and social cognitive theory.
Subjects and Method: This was an analytic observational study with cross sectional design, conducted at 25 community health centers, in Bantul Regency, Yogyakarta, Indonesia. A sample of 200 type 2 DM patients was selected by exhaustive sampling. The dependent variable was type 2 DM tertiary prevention. The independent variables at level 1 are intention, attitude, subjective norm, perceived behavior control/ self-efficacy, experience, modelling, self-regulation, and outcome expectation. Community health center was an independent variable at level 2. The data were collected by questionnaire and analyzed by a multilevel multiple linear regression.
Results: Tertiary preventive behavior in type 2 DM patients increased with strong intention (b= 1.19; 95% CI= 0.62 to 1.76; p <0.001), positive attitude (b= 1.19; 95% CI= 0.58 to 1.80; p <0.001), supportive subjective norm (b= 0.79; 95% CI= 0.12 to 1.45; p= 0.019), perceived behavior control (b= 1.16; 95% CI= 0.60 to 1.72; p <0.001), abundant experience (b= 0.65; 95% CI= 0.62 to 1.25; p<0.001), strong modelling (b= 1.07; 95% CI= 0.53 to 1.67; p= 0.030), strong self-regulation (b= 0.87; 95% CI= 0.34 to 1.40; p= 0.001), and positive outcome expectation (b= 0.82; 95% CI= 0.25 to 1.38; p = 0.004). Community health center had contextual effect on the tertiary preventive behavior in type 2 DM patients with ICC= 19.18%.
Conclusion: Tertiary preventive behavior in type 2 DM patients increases with strong intention, positive attitude, supportive subjective norm, perceived behavior control, abundant experience, strong modelling, strong self-regulation, and positive outcome expectation. Community health center has contextual effect on the tertiary preventive behavior in type 2 DM patients.
Keywords: tertiary prevention behavior, type 2 diabetes, TBP, SCT, multilevel analysis.
Yudi Andriyaningtiyas. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami No. 36A, Surakarta. Email: firstname.lastname@example.org. Mobile: +6281392704899
Journal of Health Promotion and Behavior (2020), 05(01): 59-71
Ajzen I (2002). Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior. J ApplSoc Psychol, 32(4): 665–683. doi: 10.1111/j.-1559-1816.2002.tb00236.x.
Alramadan MJ, Magliano DJ, Alhamrani HA, Alramadan AJ, Alameer SM, Amin GM, Alkharras WA, et al(2019). Lifestyle factors and macro and microvascular complications among people with type 2 diabetes in Saudi Arabia. Diabetes Metab Syndr,13(1): 484491.doi: 10.1016/j.dsx.2018.11.007.
Amelia R, Lelo A, Lindarto D, Mutiara E (2018). Quality of life and glycemic profile of type 2 diabetes mellitus patients of Indonesian: A descriptive study. Ictromi, 125(1): 0–5. doi: 10.1088/1755-1315/125/1/012171.
Asif M (2014). The prevention and control the type 2 diabetes by changing lifestyle and dietary pattern. JEHP, 3:1-8. doi: 10.4103/2277-9531.127541.
Bandura A (1986). Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, NJ: PrenticeHall.
Bandura A (1988). organizational application of social cognitive theory. Aust J Manag 13 (2): 275–302. doi:10.1177/031289628801300210.
Banerjee S, Ho SS (2019). Applying the theoryof planned behavior: Examining how communication, attitudes, social norms, and perceived behavioral control relate to healthy lifestyle intention in Singapore. Int J Health Manag, 1–8. doi: 10.1080/20479700.2019.1605687.
Bekele BB (2019). The prevalence of macro and microvascular complications of DM among patients in Ethiopia 1990e2017: Systematic review. Diabetes Metab Syndr, 13(1): 672–677. doi: 10.1016/j.dsx.2018.11.046.
Borhaninejad V, Tahami AN, Yousefzadeh G, Shati M, Iranpour A, Fadayevatan R (2017). Predictors of selfcare among the elderly with diabetes type 2: using social cognitive theory. Diabetes and metabolic syndrome: clinical research and reviews. Diabetes Metab Syndr, 11(3): 163–166. doi: 10.1016/j.dsx.2016.08.017.
Boston School of Public Health (2018): The social cognitive theory. Retrieved from http://sphweb.bumc.bu.edu/otlt/MPModules/SB/BehavioralChangeTheories/BehavioralChangeTheories5.html.
Castonguay A, Miquelon P and Boudreau F. (2018). Self-regulation resources and physical activity participation among adults with type 2 diabetes. HPO, 5(1). doi: 10.1177/2055102917750331.
CDC (2017). National diabetes statistics report 2017, estimates of diabetes and its burden in the United States. Retrieved from https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf.
Damayanti A, Tamtomo D, Indarto D (2018). Theory of planned behavior implementation on the factors affectting self-care management in type 2 diabetes mellitus patients. JHealth Promot Behav, 3(2): 139–145. doi: 10.26911/thejhpb.2018.03.02.08.
Dilekler I, Dogulu C and Bozo O. (2019). A test of theory of planned behavior in type II diabetes adherence: The leading role of perceived behavioral control. Current Psychology. doi: 10.1007/s12144-019-00309-7.
Dirik G, Gocek YE. (2018). Positive sides of the disease: Posttraumatic growth in adults with type 2 diabetes.Transl Behav Med, 44(1): 1–10. doi: 10.1080/08964289.2016.1173635.
Esmaeily H, Peyman N, Taghipour A, Khorashadizadeh F, Mahdizadeh M (2014). A structural equation model to predict the social-cognitive determinants related to physical activity in iranian women with diabetes mellitus. JRHS, 14(4): 296–302.
Ferreira G, Pereira MG (2017). Physical activity: The importance of the extended theory of planned behavior, in type 2 diabetes patients. J Health Psychol, 22(10): 1312–1321. doi: 10.1177/1359105315626787.
Ghoreishi MS, Shahroodi MV, Jafari A, Tehranid H (2019). Self-care behaviors in patients with type 2 diabetes: Education intervention base on social cognitive theory. Diabetes Metab Syndr,13(3): 2049–2056. doi: 10.1016/j.dsx.2019.04.045.
IDF (2017). New IDF clinical practice recommendations for managing type 2 diabetes in primary care. Diabetes Res Clin Pract, 132: 169–170. doi: 10.1016/j.diabres.2017.09.002.
IDF (2017). IDF diabetes atlas, Eighth edition 2017. Brussels: International Diabetes Federation. Retrieved from https://www.idf.org/ouractivities/advocacyawareness/resources-and-tools/134-idf-diabetes-atlas-8th-edition.html.
Jannuzzi FF, Cornelio ME, Sao Joao TM, Gallani MC, Godin G, Rodrigues RCM (2019). Psychosocial determinants of adherence to oral antidiabetic medication among people with type 2 diabetes. J Clin Nurs. doi: 10.1111/jocn.15149.
Menti D, Limbert C, Lyrakos, G (2019). Investigating the effectiveness of theory based interventions for improving treatment adherence of patients with type 2 Diabetes Mellitus: A systematic review of randomised controlled clinical trials. J Health
Soc Sci. doi: 10.19204/2019/nvst9.
Murti B (2018). Teori promosi dan perilaku kesehatan (Promotion theory and health behavior). Colomadu, Karanganyar, Jawa Tengah: Bintang Fajar Offset.
Nazari LN, Javazdzade H, Tahmasebi R, Reisi M (2019). Predictors of physical activity related energy expenditure among overweight and obese middleaged women in south of Iran: An application of social cognitive theory. Obes Med Elsevier, 14: 100078. doi: 10.1016/j.obmed.2019.01.002.
Ningrum VDA, Ikawati Z, Sadewa AH, Ikhsan MR (2018). Glycemic control and prevalence of chronic kidney disease in type 2 diabetes mellitus patients at primary healthcare centers in Yogyakarta Province 2015. IJCP, 6(2): 78–90. doi: 10.15416/ijcp.2017.6.2.78.
Palareti G, Legnanai C, Antonucci E, Erba N, Poli D, Testa S, et al (2016). Comparison between different Dimer cutoff values to assess the individual risk of recurrent venous thromboembolism: Analysis of results obtained in the Dulcis study. Int J Lab Hematol, 38(1): 42–49. doi: 10.1111/ijlh.12426.
Perkumpulan Endokrinologi Indonesia (Perkeni) (2015). Konsensus pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia 2015 (Consensus on the management and prevention of type 2 diabetes mellitus in Indonesia 2015). Retrieved from https://pbperkeni.or.id/wpcontent/uploads/2019/01/4.Konsensus-Pengelolaan-dan-Pencegahan-Diabe-tes-melitus-tipe-2-di-Indonesia-PER-KENI-2015.pdf.
Petosa RL, Silfee V (2016). Construct validation of a program to increase use of self-regulation for physical activity among overweight and obese adults with type 2 diabetes mellitus. Am J Health Educ, 47(6): 379–384. doi: 10.1080/19325037.2016.1219284
Riset Kesehatan Dasar (Riskesdas) (2018). Badan penelitian dan pengembangan kesehatan kementerian RI (Indonesian Ministry of Health's Health Research and Development Agency). Retrieved from https://www.depkes.go.id/resources/download/info-terkini/hasil-riskesdas2018.pdf.
Seaborn C, Suther S, Lee T, Kiros GE, Becker A, Campbell E, Robinson JC (2016). Utilizing genomics through family health history with the theory of planned behavior: Prediction of type 2 diabetes risk factors and preventive behavior in an African American Population in Florida. Public Health Genomics, 19(2): 69–80. doi: 10.1159/000443471.
Thojampa S, Sarnkhaowkhom, C. (2019). The Social Cognitive Theory with Diabetes: Discussion. Int J Caring Sci, 12(2): 2. Retrieved from www.internationaljournalofcaringsciences.org.
WHO (2017). Country and regional data on diabetes. Retrieved from https://www.who.int/diabetes/facts/world_figures/en/index5.html.
Wongrith P (2019). Predicting diabetic selfcare management based on the theory of planned behavior among elderly with type 2 diabetes in Thailand. Diabetes Mellitus. 22(4): 367–376. doi: 10.14341/DM10290.