Patient Factors

The most important factors in developing self-management goals are the patient's perspective on the diabetes regimen and what changes she/he considers reasonable and realistic. Two important beliefs are that patients: (a) consider their diabetes to be serious; and (b) believe that what they do makes a difference62-64. Patients who do not hold these beliefs will likely not be motivated to engage in diabetes self-management behaviours. Such patients may need additional personalized feedback on the specific implications of diabetes for their health, as well as education on the potential benefits of specific self-management behaviours. The books The Human Side of Diabetes by Michael Raymond15 and Psyching Out Diabetes by Rubin et al.65 are useful resources for both patients and practitioners in illustrating how common experiences in living with diabetes can either promote or interfere with

Figure 6.3. Multiple influences on diabetes self-management

establishment of such beliefs. In particular, it is important to see if a patient considers lifestyle aspects of diabetes management (e.g. diet and exercise) as important as medical aspects (e.g. medication taking and glucose testing). If they do not, they will be unlikely to follow-through with the challenges of lifestyle modification. Other important and related cognitive factors are a patient's readiness to adopt different self-management guidelines66 and his/her self-efficacy or confidence that he/she can achieve specific goals.

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