Tip 2 Diyabet Yönetiminde Bilgi-Motivasyon ve Davranış Becerileri (IMB) Modelinin Kullanımı

Yıl 2021, , 408 - 417, 26.12.2021

Eda Kılınç , Asiye Kartal

https://doi.org/10.38108/ouhcd.901975

Öz

Tip 2 Diyabet (T2DM), yüksek mortalite ve morbidite oranları nedeniyle küresel bir halk sağlığı sorunudur. Yaygın görülen bu hastalığın öz-yönetiminin sağlanması için bireylerde olumlu sağlık davranışları geliştirilmelidir. Hemşireler, diyabetli bireylerde olumlu davranış değişimi sağlayabilmek için teori ve modellerden destek almaktadır. Bu modellerden biri de Bilgi, Motivasyon ve Davranış Becerileri Modeli’dir (IMB). Diyabet yönetiminde yeni kullanılan bu model, yüksek kaliteli diyabet bakımının niteliklerini, öz-bakım süreçlerini ve sağlık çıktılarını birbirine bağlayarak kapsamlı bir çerçeve sunmaktadır. IMB modeli bilgi, motivasyon ve davranış becerileri bileşenlerinden oluşur. Model, diyabetli bireyde davranış değişikliğinin başlatılması ve sürdürülmesi için bilgi ve motivasyonun oluşması gerektiğini savunur. IMB modeli temelli diyabet öz-yönetimi ile ilişkili bilgiler, diyabet hakkında sağlık eğitimi ve eğitici-hasta iletişimini içermektedir. Bireysel motivasyon, bireyin diyabeti ile ilgili bir davranışın sonuçları hakkındaki diyabet sağlık inançlarını ve öz-yönetim davranışlarına karşı algıladığı tutumları ifade etmektedir. Sosyal motivasyon, öz-yönetim davranışı için bireyin algıladığı sosyal desteği içermektedir. Diyabetli bireylerde motivasyonun artması diyet kontrolü, ilaçlara uyum, düzenli egzersiz, düzenli kan şekeri takibi, diyabetik ayak bakımı ve hiper/hipoglisemi yönetimini pozitif yönde artırmaktadır. Davranışsal beceriler, diyabet öz-etkililiği ve olumlu başa çıkma stratejisini içermektedir. Tip 2 diyabetli bireylerde IMB modeli temelli yapılan araştırmaların müdahaleleri incelendiğinde bireylerin hem metabolik kontrol düzeylerinde (HbA1c) hem de öz-bakım davranışlarında (beslenme ve egzersiz) olumlu gelişmeler saptanmıştır. Gelecek araştırmalarda hemşireler tarafından Tip 2 diyabetli bireylerde IMB modeline dayalı müdahalelerin bilgi bileşeni için bireysel veya grup halinde diyabet öz-yönetim eğitimi verilmesi, motivasyon ve davranış becerileri bileşeni için diyabette etkililiği kanıtlanan Motivasyonel Görüşme Tekniklerinin uygulanması önerilmektedir.

Anahtar Kelimeler

Tip 2 Diyabetes Mellitus, model, bilgi, motivasyon, davranış becerileri

Use of the Information-Motivation and Behavioral Skills (IMB) Model in Type 2 Diabetes Management

Öz

Type 2 Diabetes Mellitus (T2DM) is a global public health problem due to its high mortality and morbidity rates. To provide self-management of this common disease, positive health behaviors should be developed in individuals. Nurses receive support from theories and models to provide positive behavioral change in individuals with diabetes. One of these models is the Information, Motivation and Behavioral Skills (IMB) Model. This new model of diabetes management offers a comprehensive framework by linking the attributes of high-quality diabetes care, self-care processes and health outcomes. The IMB model consists of information, motivation, and behavioral skills components. The model argues that information and motivation must be formed to initiate and maintain behavioral change in the individual. It includes information related to the IMB model-based diabetes self-management, health education about diabetes, and educator-patient communication. Individual motivation refers to an individual's diabetes health beliefs about the consequences of a behavior related to diabetes and perceived attitudes towards self-management behaviors. Social motivation includes the individual's perceived social support for self-management behavior. Increasing motivation in individuals with diabetes improves diet control, adherence to medications, regular exercise, regular blood sugar monitoring, diabetic foot care and hyper/hypoglycemia management positively. Behavioral skills include diabetes self-efficacy and positive coping strategy. When studies conducted on individuals with type 2 diabetes were examined, positive improvements were found in both metabolic control levels (HbA1c) and self-care behaviors (nutrition and exercise). In future studies, it is recommended that nurses provide individual or group diabetes self-management education for the information component of IMB model-based interventions in individuals with Type 2 diabetes, and Motivational Interviewing techniques, which have proven effective in diabetes, for the motivation and behavioral skills component.
Keywords: Type 2 Diabetes Mellitus, model, information, motivation, behavioral skills

Anahtar Kelimeler

Type 2 Diyabetes Mellitus, model, information, motivation, behavioral skills

Kaynakça

• American Association of Diabetes Educators (AADE). (2009). AADE guidelines for the practice of diabetes self-management education and training (DSME/T). The Diabetes Educator, 35, 85-107.
• American Diabetes Association (ADA). (2021). 5. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes—2021. Diabetes Care, 44, 53-72.
• Azami G, Soh KL, Sazlina SG, Salmiah M, Aazami S, Mozafari M, Taghinejad H. (2018). Effect of a nurse-led diabetes self-management education program on glycosylated hemoglobin among adults with type 2 diabetes. Journal of Diabetes Research.
• Bezo BH, Huang YT, Lin CC. (2020). Factors influencing self‐management behaviours among patients with type 2 diabetes mellitus in the Solomon Islands. Journal of Clinical Nursing, 29, 852-862.
• Chang SJ, Choi S, Kim SA, Song, M. (2014). Intervention strategies based on information-motivation-behavioral skills model for health behavior change: a systematic review. Asian Nursing Research, 8, 172-181.
• Cheng LJ, Wang W, Lim ST, Wu VX. (2019). Factors associated with glycaemic control in patients with diabetes mellitus: a systematic literature review. Journal of Clinical Nursing, 28, 1433-1450.
• Cochran J, Conn VS. (2008). Meta-analysis of quality of life outcomes following diabetes self-management training. The Diabetes Educator, 34, 815-823.
• Dunning T. (2014). Diabetes education. Care of People with Diabetes: A Manual of Nursing Practice. UK: John Wiley & Sons. p. 483-511.
• Egede LE, William JS, Voronca DC, Gebregziabher M, Lynch CP. (2017). Telephone-delivered behavioral skills intervention for African American adults with type 2 diabetes: a randomized controlled trial. Journal of General Internal Medicine, 32, 775-782.
• Ekong G, Kavookjian J. (2016). Motivational interviewing and outcomes in adults with type 2 diabetes: a systematic review. Patient Education and Counseling, 99, 944-952.
• Fisher JD, Fisher WA. (1992). Changing AIDS-risk behavior. Psychological Bulletin, 111, 455-474.
• Fisher JD, Fisher WA. (2002). The information-motivation-behavioral skills model. DiClemente RJ, Crosby RA, Kegler MC, editors. Emerging Theories in Health Promotion Practice and Research. San Francisco: John Wiley & Sons, p. 40-70.
• Fisher WA, Fisher JD, Harman J. (2003). The information-motivation-behavioral skills model: A general social psychological approach to understanding and promoting health behavior. Social Psychological Foundations of Health and Illness, 22, 82-106.
• Fisher WA, Fisher JD. (1993). A general social psychological model for changing AIDS risk behavior. Pryor JB, Reeder GD, editors. The Social Psychology of HIV Infection. London: Psychology Press, p. 127–153.
• Gao J, Wang J, Zhu Y, Yu J. (2013). Validation of an information–motivation–behavioral skills model of self-care among Chinese adults with type 2 diabetes. BMC Public Health, 13, 1-6.
• Gavgani RM, Poursharifi H, Aliasgarzadeh A. (2010). Effectiveness of Information-Motivation and Behavioral skill (IMB) model in improving self-care behaviors & Hba1c measure in adults with type2 diabetes in Iran-Tabriz. Procedia-Social and Behavioral Sciences, 5, 1868-1873.
• Gottwald M, Goodman- Brown J. (2012). Health belief model. A Guide to Practical Health Promotion. England: McGraw-Hill Education, p. 73-78.
• Huang J, Liu Y, Zhang Y, Yao H. (2013). Correlation between self-management and knowledge of and attitude to diabetes in type 2 diabetic patients in Changsha. Journal of Central South University. Medical Sciences, 38, 176-181.
• International Diabetes Federation (IDF) (2019). IDF Diabetes Atlas 9th ed. Erişim tarihi: 18.08.2020, https://www.diabetesatlas.org/en/
• Kılınç E, Gür K. (2018). Okul yaralanmalarını önlemede sağlık inanç modeli temelli girişimlerin etkisi. HSP, 5, 467-475.
• Kılınç E, Kartal A. (2019). Akut miyokard infarktüsü geçirmiş genç erişkin bireye Pender’in sağlığı geliştirme modeli temelli hemşirelik bakımı. Turkiye Klinikleri Jourrnal of Nursing Sciences, 11, 219-230.
• Liu T, Wu D, Wang J, Li C, Yang R, Ge S ve ark. (2018). Testing the information-motivation-behavioural skills model of diabetes self-management among Chinese adults with type 2 diabetes: a protocol of a 3-month follow-up study. BMJ Open, 8, e020894.
• Luo X, Liu T, Yuan X, Ge S, Yang J, Li C ve ark. (2015). Factors influencing self-management in Chinese adults with type 2 diabetes: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 12, 11304-11327.
• McElfish PA, Hallgren E, Henry LJ, Ritok M, Rubon-Chutaro J, Kohler P. (2016). Health beliefs of Marshallese regarding type 2 diabetes. American Journal of Health Behavior, 40, 248-257.
• Meunier S, Coulombe S, Beaulieu MD, Côté J, Lespérance F, Chiasson JL ve ark. (2016). Longitudinal testing of the Information-Motivation-Behavioral Skills model of self-care among adults with type 2 diabetes. Patient Education and Counseling, 99, 1830-1836.
• Newman S, Steed E, Mulligan K. (2008). Chronic Physical Illness: Self-Management and Behavioural İnterventions: Self Management and Behavioural Interventions. 1. Edition, New York, McGraw-Hill Education, p. 47-55.
• Osborn CY, Amico KR, Cruz N, O'Connell AA, Perez-Escamilla R, Kalichman SC ve ark. (2010). A brief culturally tailored intervention for Puerto Ricans with type 2 diabetes. Health Education & Behavior, 37, 849-862.
• Osborn CY, Egede LE. (2010). Validation of an Information–Motivation–Behavioral Skills model of diabetes self-care (IMB-DSC). Patient Education and Counseling, 79, 49-54.
• Pender NJ. (2011). Heath promotion model manual. University of Michigan Deep Blue, p. 17.
• Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH ve ark. (2017). Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 43, 40-53.
• Świątoniowska N, Sarzyńska K, Szymańska-Chabowska A, Jankowska-Polańska B. (2019). The role of education in type 2 diabetes treatment. Diabetes Research and Clinical Practice, 151, 237-246.
• Taskinen MR, Barter PJ, Ehnholm C, Sullivan DR, Mann K, Simes J ve ark. (2010). Ability of traditional lipid ratios and apolipoprotein ratios to predict cardiovascular risk in people with type 2 diabetes. Diabetologia, 53, 1846-1855.
• Vas A, Devi ES, Vidyasagar S, Acharya R, Rau NR, George A ve ark. (2017). Effectiveness of self‐management programmes in diabetes management: A systematic review. International Journal of Nursing Practice, 23(5), e12571.
• Viner R, White B, Christie D. (2017). Type 2 diabetes in adolescents: a severe phenotype posing major clinical challenges and public health burden. The Lancet, 389, 2252-2260.
• Zare S, Ostovarfar J, Kaveh MH, Vali M. (2020). Effectiveness of theory-based diabetes self-care training interventions; A systematic review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14, 423-433.
• Zhao FF, Suhonen R, Koskinen S, Leino‐Kilpi H. (2017). Theory‐based self‐management educational interventions on patients with type 2 diabetes: a systematic review and meta‐analysis of randomized controlled trials. Journal of Advanced Nursing, 73, 812-833.