Theory of Change: Relationship between Distress, Self-Efficacy, Perceived Social and Self-Care on Self-Management Behaviours of People with Type 2 Diabetes

This study evaluates the relationship between distress, self-efficacy, perceived social and self-care on self-management behaviours of people with type 2 diabetes. It applies social cognitive theory to link the relationship between self-management behaviours and psychosocial factors.

Running head: THEORY OF CHANGE
Theory of change
Name of the student:
Name of the University:
Author’s note

1THEORY OF CHANGE
Purpose of the article:
The main purpose of the study by Rabiei et al. (2018) was to evaluate the relationship
between distress, self-efficacy, perceived social and self-care on self-management behaviours of
people with type 2 diabetes. As no studies evaluated self-management behaviours using social
cognitive theory in Iran, the present study applied social cognitive theory to link relationship
between self-management behaviours of diabetic patient and psychosocial factors.
Methods:
Study sample:
The sample for this study included patients who received diabetes related health care
service in Imam Ali Clinic of Shahrekord during the period from 2016-2017. The study was done
with sample size of 228 patients. The sample group included in the study included patients above
30 years old and one year elapsed time for diabetes diagnosis. Care was also taken not to take
participants with confirmed mental illness. The participants were also categorized based on
gender, marital status, educational attainment and history of the disease (Rabiei et al., 2018).
However, detail on race or ethnicity was missing.
Study design:
The study by Rabiei et al. (2018) was done using cross-sectional descriptive analytical
research design. Cross-sectional studies are types of observational studies where information
related to the subject is taken without manipulating the study environment. The main strength of
using cross-sectional research design is that it is inexpensive and can be conducted in less time

2THEORY OF CHANGE
compared to prospective cohort study. In addition, focus on analytical research design can help
to compare health outcome and different research variables (Grjibovski & Ivanov, 2015).
Recruitment strategy:
The participants for the study were recruited from one of the health care services in Iran
(Imam Ali Clinic of Shahrekord). The recruitment strategy was based on estimation of sample
size that would be appropriate for the research design. Hence, as the period of analysis was from
2016 to 2017, Rabiei et al. (2018) considered standard deviation and 95% confidence level to
estimate appropriate sample size. The initial sample size was 190. However, it was increased to
228 based on attrition rate. Binu, Mayya and Dhar (2014) revealed that sample size calculation is
done in a study to estimate the value of research parameters under prefixed precision and level of
confidence. Hence, it can be said that purposive sampling technique was followed.
Data collection:
As Rabiei et al. (2018) aimed to evaluate the relation between different research
variables, multi-part tool was used for data collection. The first part tool consisted of 13 items
related to personal and disease information of patient. The second part tool consisted of 17 item
questionnaire on measurement of distress level in diabetic patient. In this case, the 6-point Likert
scale was used for scoring. The significance of the second tools is that the researcher mentioned
about the developer of the tool and efficiency of the tool in measuring overall distress level.
However, details regarding validity and consistency were missing. The third part of tool
measured self-efficacy of the patients using 8 items and fourths part used 12 items to measure
perceived social support. For all the tools, the scores based on which high self-efficacy values
could be interpreted were defined. For the fourth tool, the reliability parameter was also

3THEORY OF CHANGE
discussed. The fifth tool measured self-care using 14 items questionnaire and the sixth part
measured self-management behaviour of diabetic patients.
Independent and dependent variables:
The independent variable for the research included health of diabetes patient and the
dependent variable includes factors like distresses, self-efficacy, perceived social support, self-
care and self-management.
Data analysis:
The data obtained from different questionnaires were statistically analysed using
descriptive test, Pearson correlation test, analysis of variance and regression analysis. They were
based on statistical program SPSS software version 22.0. Use of statistical approach helped to
identify significance of the scores and the importance of association between different research
variables.
Construct definition and operationalization:
The following table defines the constructs used for analysis:
Construct Example of constructs No. of items Method of scoring the
items
Personal information Age, gender, job,
marital status, and
educational status
13 items Not provided
Distress of diabetic
patient
I feel my life is in the
hands of diabetes
17 items 6-point Likert scale
(from never: 1 to

4THEORY OF CHANGE
always: 6)
Self-efficacy How confident are you
when your diabetes is
controlled?
10 items 10-point Likert scale
(from I’m not sure: 1 to
I’m pretty sure: 10)
Perceived social suppprt “Does social support
play a role in controlling
diabetes?”
12 items 7-point Likert scale
(from completely agree:
7 to completely
disagree: 1
Self-care “Have you followed a
healthy diet during the
week?’
14 item 0-7 times a week
Self-management
behaviours of patients
‘I control my weight
effectively’
35 item 5 scales with minimum
and maximum score of
35 and 175
Major findings:
In relation to the above mentioned constructs, Rabiei et al. (2018) revealed that self-
management score had a significant relationship with distress, self-care, social support and self-
efficacy. Self-efficacy and self-care was found to have a statistically significant value. Thus high
level of self-efficacy was found to positively influence self-management behaviours like physical
activity and adherence to diet. In addition, self-care behaviour improved when participants had
good perception about the quality of life. Direct relationship between social support and self-
management behaviours were also found. Hence, on the whole, the study conclude that use of

5THEORY OF CHANGE
important elements of cognitive theory such as personal, environment and behaviour can
improve self-management behaviours.
Implications:
From the evaluation and critical appraisal of the study by Rabiei et al. (2018), it can be
said that article was successful in shoring relationship of distress, self-efficacy, perceived social
support and self-care on self-management behaviour of diabetic patient. It gives the implication
that the concept of social cognitive theory can be best applied for diabetes management by
focusing on self-care and self-efficacy skills of patient. However, on the limitation of this study
is that it was single centre study which might affect the generalizability of the research findings.
Hence, there is a need to conduct the same study in multiple centres to predict whether same
outcome is achieved even in case of diverse sample group. However, the significance of this
paper is that it gives an idea about type of intervention that can be implemented for self-
management of diabetes. This includes education in the area of self-care and self-efficacy skills.
Evaluation of the effectiveness of theory application (Conclusion):
The social cognitive theory mainly defines that learning occurs by interaction of the
person, environment and the behaviour (Nabi, 2015). In conclusion, it can be said that () has
effectively used the important elements of the theory as a construct to understand its effect on
self-management behaviours. For example, the construct related to social support deals with the
environment. The construct related to self-efficacy, self-care, distress and self-management deals
with person and behaviour. By using set of questionnaires to assess each construct, the researcher
successfully applied the social cognitive theory concept to understand its relationship with self-

6THEORY OF CHANGE
management behaviour of staffs. This research can favour application of the theory on future
health programs for people with diabetes.

7THEORY OF CHANGE
References:
Binu, V. S., Mayya, S. S., & Dhar, M. (2014). Some basic aspects of statistical methods and
sample size determination in health science research. Ayu, 35(2), 119.
Grjibovski, A. M., & Ivanov, S. V. (2015). Cross-sectional studies in health sciences. Science &
Healthcare, (2), 5-18.
Nabi, R. L. (2015). Social cognitive theory. The International Encyclopedia of Interpersonal
Communication, 1-6.
Rabiei, L., Lotfizadeh, M., Abbasi, M., Babaei Heydarabadi, A., & Masoudi, R. (2018).
Psychosocial Factors and Their Relationship With Selfmanagement in People With Type
2 Diabetes Mellitus: A Conceptual Framework Based on Socio-Cognitive
Theory. International Journal of Epidemiologic Research, 5(4), 133-138.