How do values affect self-care of type 2 diabetes patients? Results from a multi-centre observational study

Background. Available self-care theories and qualitative research has identified values as an important influence on self-care in type 2 diabetes (T2DM) patients. However, values have never been quantitatively described in the T2DM population and the association between values and self-care has not been assessed. Aims. To investigate the association between values and self-care in adults with T2DM. Methods. A cross-sectional multicentre study was conducted in 6 outpatient diabetes services in a sample of 390 Italian T2DM patients. The Portrait Values Questionnaire (PVQ) was used to assess patients’ values, according to the Schwartz’s Theory of Basic Human Values. The PVQ measures 4 value dimensions in opposition: Self-Enhancement Vs Self-Transcendence, and Openness to Change Vs Conservation. A centred score is used to estimate individual priority between these dimensions; a positive score in one dimension means that this dimension is prioritized by the individual over the opposite one. The Self-care of Diabetes Inventory was used to measure self-care maintenance, self-care monitoring, self-care management and self-care confidence, according to the middle-range theory of self-care of chronic illness. Multiple quantile regression models were used to assess the associations between the 4 value dimensions and the 4 self-care dimensions, adjusting for clinical and sociodemographic variables. Results. The higher value dimensions were Self-Transcendence (centred score= 0.4) and Conservation (centred score= 0.3) while the lower were Self-Enhancement (centred score= -1.1) and Openness to Change (centred score= -0.1). Self-Enhancement was negatively associated with self-care maintenance (beta=-2.4; p=0.0085) and self-care monitoring (beta= -5.4; p=0.0005). Openness to Change was (borderline) negatively associated with self-care management (beta=-3.9; p=0.06). Conclusions. T2DM patients who value self-enhancement and openness to change may be less likely to adopt self-care behaviours then those who value conservation and self-transcendence. Interventions designed to maximize the values of conservation and self-transcendence may improve the self-care of T2DM patients