The Discrepancy Between Ideal And Real Selfmanagement

The ultimate aim is that people with diabetes enjoy the best possible quality of life with minimum disruption. Health care professionals have identified a set of behaviours to which an individual 'should' comply (Table 5.1), although the emphasis will vary according to the service. Patients fall significantly short of staff ideals, as illustrated in column two of Table 5.1. There are difficulties inherent in attempting to measure compliance, the main being that self-report measures overestimate actual behaviour3. People may also look after some aspects of their regimen, but neglect others. This has given rise to the notion of 'levels of self care'4 a more helpful concept than traditional categories which label individuals as those that either do or do not self-manage.

Research suggests that lower levels of compliance are associated with regimens that are complex, life-long and prophylactic17. This helps to explain low levels of compliance, although there is a variation across diabetic conditions and variables18. A greater understanding of the psychological issues involved is needed in order for staff to develop the necessary skills to

Table 5.1. Levels of compliance to recommended self-care behaviours


Level of compliance (%) (%)


All aspects of the regimen

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