Carrillo-Álvarez S, Martínez-Díaz GJ

Language: Spanish
References: 26
Page: 61-74
PDF size: 848.56 Kb.

ABSTRACT

Introduction. Type II diabetes mellitus is the most common endocrine disease and one of the leading causes of morbidity and mortality of our days. It is a complex disease which requires an integral approach.
Objective. To determine the behavioral stage and the decisional balance of change of conduct in patients with type II diabetes who fulfill the insulin therapy criteria by using the trans- theoretical model with a qualitative focus at Ekmul, Health Center in Yucatan Materials and Methods. Eight patients, with dual oral hypoglycemic drug therapy, at a maximum dose and with no glycemic control, were chosen with a convenience sampling. In order to obtain Personal information and to know the stages of change we used questionnaires along with a cause-effect diagram and a problem tree.
Results. Five women completed the proposed activities, three (60%) of them where identified in the pre-contemplation stage and two in the contemplation stage. A total of 16 answers from the cause-effect diagram, related to insulin usage, showed that ten (62.5%) is against it and six (37.5%) in favor of it.
Conclusions. The decisional balance within the identified stages gives greater weight to the disadvantages of insulin therapy which generates resistance to short-term behavioral change. The misinformation of the elemental physiology of the disease causes false concepts of the insulin usage which is reinforced by psychological factors, such as the fear of the unknown and the social stigma. These contribute to form a vicious circle that prevents the timely initiation of insulin therapy.

REFERENCES

1. Diagnóstico y tratamiento de la Diabetes mellitus tipo 2. Guía de práctica clínica. Instituto Mexicano del Seguro Social 2009.

2. Standards of Medical Care in Diabetes 2015. Diabetes Care 2015; 38(1):1-2.

3. Instituto Nacional de Salud Pública. Encuesta Nacional de Salud y Nutrición 2012. Resultados por entidad federativa, Yucatán. Cuernavaca, México: Instituto Nacional de Salud Pública 2013.

4. Gutiérrez JP, Rivera-Dommarco J, Shamah-Levy T, Villalpando-Hernández S, Franco A, Cuevas- Nasu L, Romero-Martínez M, Hernández-Ávila M. Encuesta Nacional de Salud y Nutrición 2012. Resultados Nacionales. Cuernavaca, México: Instituto Nacional de Salud Pública 2012. Disponible en: www.ensanut.insp.mx/ENSANUT2012Resultados Nacionales.pdf

5. Rodriguez-Lay G. Insulinoterapia. Rev Med Hered 2003; 14:3.

6. Ortiz M, Ortiz E, Galicia A, Gómez D. Factores psicosociales asociados a la adherencia al tratamiento de la Diabetes Mellitus Tipo 2. Ter Psicol 2011; 29(1): 5-11.

7. Quiroz-Morales D, Villalobos-Pérez A. Comparación de Factores vinculados a la adherencia al tratamiento en Diabetes Mellitus tipo II entre una muestra urbana y otra rural en Costa Rica. Univ Psychol Bogotá, Colombia 2007; 6 (3): 679-688.

8. Kantún-Fernandez CA. Apoyo social y adherencia al tratamiento en adultos mayores con Diabetes Mellitus 2 de San Jose Tecoh. Tesis para obtener el título de Médico cirujano. Facultad de Medicina. Universidad Autónoma de Yucatán. Mérida, México. 2013.

9. Maza-Collí RJ. Falta de adherencia al tratamiento farmacológico en pacientes con Diabetes y factores de riesgo asociados en la comunidad rural. Tesis para obtener el título de Médico cirujano. Facultad de Medicina. Universidad Autónoma de Yucatán. Mérida, México 2013

10. Fonseca-Pech, KA. Retraso en el inicio del tratamiento con insulina en pacientes con Diabetes Mellitus tipo 2 en el municipio de Abalá. Tesis para obtener el título de Médico cirujano. Facultad de Medicina. Universidad Autónoma de Yucatán. Mérida, México. 2012.

11. Amaral-Figueroa MI, Pacheco KW, Rodriguez M. Exploración de una estrategia alterna para la integración activa del paciente en el tratamiento de la diabetes: investigación en acción participativa, educación y actividad física. Revista Umbral 2014; 8.

12. Álvarez C. Teoría transteorética de cambio de conducta: Herramienta importante en la adopción de estilos de vida activos. Revista MHSalud 2008; 5(1).

13. Cabrera GA. El modelo transteórico del comportamiento en salud. Rev Fac Nac Salud Pública 2000; 18(2): 129-138.

14. Johnson SS, Driskell MM, Johnson JL, Prochaska JM, Zwick W, Prochaska JO. Efficacy of a Transtheoretical Model-Based Expert System For Antihypertensive Adherence. Dis Manag 2006; 9(5).

15. Johnson SS, Driskell MM, Johnson JL, Prochaska JM, Dyment SJ, Prochaska JO, et al Transtheoretical Model Intervention for Adherence to Lipid-Lowering Drugs. Disease Management 2006; 9(2).

16. Velicer WF, Prochaska JO. Stage and non-stage theories of behavior and behavior change: a comment on Schwarzer Appl psychol 2008; 57(1): 75-83.

17. Prochaska JO, DiClemente CD. Stages and Processes of Self-Change of Smoking: Toward An Integrative Model of Change. J Consult Clin Psychol 1983; 51(3):390-395.

18. Prochaska JO, DiClemente CD. Transtheoretical

19. analysis: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice 1982; 19:276-288.

20. Prochaska JO, DiClemente CD. Stages of change in the modification of problem behaviors. Prog Behav Modif 1992;28:183-218.

21. Hersen, Eisler, Miller. Progress in behavior modifications. Academic Press Inc. EEUU. 1986.

22. Lipschitz JM, Fernández AC, Larson HE, Blaney CL, Meier KS, Redding CA, et al. Validation of decisional balance and self-efficacy measures for HPV vaccination in college women. Am J Health Promot 2013; 27(5).

23. Guo B, Aveyard P, Fielding A, Sutton S. The factor structure and factorial invariance for the decisional balance scale for adolescent smoking. Int J Behav Med 2009; 16:158-163.

24. Pickering MA, Plotnikoff RC. Factor structure and measurement invariance of a 10-Item decisional balance scale: longitudinal and subgroup examination within an adult diabetic sample. MPEES 2009; 13: 206-226.

25. Prochaska JO, Velicer WF, Rossi JS, Goldstein MG, Marcus BH, Rakowski W, et al. Stages of Change and Decisional Balance for 12 Problem Behaviors. Health Psychology 1994; 13(1): 39-46.

26. American diabetes Association. Standards of Medical Care in Diabetes-2014. Diabetes Care. 2014; 37(1):S14-80.