Implementation Plans and Self-Monitoring of Blood Glucose in Diabetics.

Abstract

Background: Self-management strategies are effective in diabetes management yet studies reveal a lack of patient adherence. This study examined a volitional strategy to increase rates of self-monitoring of blood glucose (SMBG) and also examined the psychological processes that underlie goal striving and goal achievement. The study aims were 1) to evaluate the impact of implementation plans on SMBG, 2) to determine the relationship between goal desire, goal intentions, implementation desire and implementation intentions and 3) to determine the relationship between implementation intentions and SMBG. Methods: A randomized experimental-control study design over a two-week time was used. The study population was patients with diabetes with HbA1c greater than 7%, requiring insulin therapy. Patients were recruited from a southeastern Michigan healthcare system. The intervention was a self-administered tool designed to assist patients to formulate their SMBG plans. The SMBG behavior was measured using a two-week diary and a two-item recall measure of SMBG. Three control groups were used to control for testing effects. Control group 1 received all questionnaire questions minus the intervention, control group 2 received items related to sociodemographic information, the SMBG diary and recall measures, and control group 3 received the recall measures only. Hypotheses were tested using ANOVA and structural equation modeling (SEM) at a significance level of 0.05. Results: The overall response rate for the study was 15.65% (n = 402). Analyses indicated that making implementation plans increased SMBG rates as assessed by the diary and the two recall measures. The SEM analysis demonstrated that goal desire is an antecedent to goal intentions and that implementation desire and implementation intentions mediate the pathway between goal intentions and performance of health behavior in a chronically ill diabetic population. Further, implementation intentions were found to be a significant predictor of SMBG. Conclusion: Results from this study show that making specific plans to perform SMBG can be an effective strategy in increasing SMBG rates. Future research should examine the effectiveness of implementation plans in a variety of health behaviors that are required of chronically ill patients.