The Effect of Depression on Diabetes Self-Management Behaviors in Older Adults with Type 2 Diabetes Mellitus: An Empirical Test of the Information-Motivation-Behavioral Skills Model
Song, Mi Soon
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Purpose: The purpose of this study was to empirically test the Information-Motivation-Behavioral Skills (IMB) model to predict diabetes self-management, and to examine the effect of depression on diabetes self-management behaviors in older adults with type 2 diabetes mellitus. Methods: 'A descriptive and cross-sectional study was done of 247 community-dwelling older adults with type 2 diabetes mellitus from a senior center in Seoul, Korea. Data were collected using a structured questionnaire through one-on-one interviews. Structural equation modeling was used to evaluate model fit and interrelationship between the IMB model constructs, and to compare the IMB model with modified IMB model adding depression as an external variable to the IMB model. Results: The modified IMB model provided better fit, explanatory power, and paths significance than IMB model. Diabetes self-management behaviors were significantly predicted by diabetes knowledge (information), diabetes self-management skills confidence (behavioral skills), and depression. Significant indirect predictors of diabetes self-management behaviors mediated through behavioral skills included diabetes attitudes (motivation) and depression. Among the significant predictors, depression had the strongest influence on the diabetes self-management behaviors. Conclusion: The results suggest that the modified IMB model could be used to predict and explain diabetes self-management behaviors among older adults with type 2 diabetes mellitus in Korea. Also, depression impedes the diabetes self-management behaviors directly and indirectly through a decrease behavioral skills confidence. Therefore, diabetes education program should consider screening and managing depression in older adults as well as providing information, motivation, and behavioral skills to improve self-management behaviors.