Diabetes Mellitus and the Health Belief Model

Introduction
Diabetes mellitus is a chronic illness that results in high blood sugar. Diabetes can either
result due to the inability of the pancreas to produce enough insulin or the inability of the body to
respond to the insulin produced by the pancreas. Diabetes mellitus is a serious condition and
could damage various body organs if left untreated. Organs that could suffer damage due to
diabetes include kidneys, the heart, and blood vessels. Patients who are diagnosed with diabetes,
especially type 2 diabetes have to make certain fundamental lifestyle changes. Diabetes poses a
significant challenge to patients as they have to make adjustments to their living habits and have
to live in fear about complications that may arise as a result of diabetes. Adjustments made by
the patients are founded on how well a patient understands the disease. The health belief model
(HBM) can be used to examine lifestyle changes as a result of a patient being diagnosed with
diabetes. HBM helps in predicting how a patient will react to the disease and whether or not they
will make the necessary adjustment. According to HBM, a patient must believe that diabetes
poses a severe risk to their life. A patient must also believe that adopting changes poses various
benefits. Barriers to action must be minimized. The health belief model is, therefore, useful in
the analysis of coping with diabetes mellitus.
Impact of Diabetes Mellitus on Friends and Family
Diabetes is seen as a family disease because it affects the family members of the
individual diagnosed with the disease. A diabetes patient is expected to adjust their routines
across various areas in life. Disease management calls for the patient to adopt a different lifestyle
to ensure that they guarantee their physical health and wellbeing. Patients have to change their

DIABETES MELLITUS AND THE HEALTH BELIEF MODEL 3
diets, and this means that there are certain foods that the patients must avoid (Miller & DiMatteo,
2013). The implication is that the larger family has to make changes together with the patients.
Many families are unwilling to cook two different meals, and this means that the whole family
has to eat the food that is being eaten by the patient. Diet is the foundation of diabetes
management. Patients with diabetes must eat food that aims to provide all essential nutrients,
meets the energy needs, and ensures that the patient maintains an ideal weight. A patient must
also ensure that they eat food that achieves the normal glucose levels as well as decreased the
level of lipids in the blood (Miller & DiMatteo, 2013). Friends and family members must
provide diabetes patients with the much-needed support to ensure that the patients adhere to the
dietary requirements. Support from friends and family is a major determinant of dietary
adherence. In addition to dietary changes, patients with diabetes are required to exercise on a
regular basis (Miller & DiMatteo, 2013). Family members and friends are required to exercise
together with the patient to encourage the patients to adhere to the recommended physical
exercise guidelines. Offering the needed support to diabetes patients requires one to sacrifice
their time and resources.
Diabetes Mellitus Coping Strategies
Coping is a complex process that needs the individual involved to adapt to the changes as
a result of the chronic condition. Diabetes is chronic in nature, and this means that patients
cannot totally eliminate diabetes. Studies indicate that there are two types of coping mechanisms,
namely problem-focused coping and emotion-focused coping. Problem-focused coping aims to
eliminate the problem that one faces. In the case of diabetes, problem-focused coping aims at
eliminating difficult and tempting situations that may make one eat foods that are rich in sugar.
On the other hand, emotion-focused coping ensures that one appraises the experiences when

DIABETES MELLITUS AND THE HEALTH BELIEF MODEL 4
nothing can be done about the stressor. Emotion-focused coping may be maladaptive and may
include not performing glucose tests so as not to feed different from one’s peers.
Problem-focused coping strategies are associated with successful medical outcomes.
Better self-care is associated with problem-focused coping strategies. The Center for Disease
Control (CDC) recommends that diabetes patients should pay attention to their feelings. Diabetes
can be stressful, and one may feel overwhelmed (Center for Disease Control and Prevention,
2019). When one feels stressed, they should get the necessary help to avoid compounding the
problems associated with diabetes. It is also important to talk to healthcare providers about one’s
feelings (Center for Disease Control and Prevention, 2019). Healthcare providers are best suited
to help an individual cope with the stress associated with diabetes management. In addition,
talking to family and friends can be an effective way of coping with diabetes (Center for Disease
Control and Prevention, 2019). One needs to allow their close friends and family members to
take care of them. Friends and family members help one by reminding them when to take
medicine and to remain physically active (Center for Disease Control and Prevention, 2019).
Talking to other people with diabetes can also help one to cope. A diabetes support group
ensures that one talks to people who may be going through similar problems. Talking to other
diabetic patients helps eliminate feelings of loneliness.
Social and Psychological Factors Involved in the Illness Experience
There are various psychological factors that are associated with diabetes. One central
factor is emotional distress. When one is diagnosed with diabetes, they are likely to get stressed
(Kalra, Jena, & Yeravdekar, 2018). One may also show elevated depressive symptoms when
dealing with the disease. When one is stressed, there are various metabolic changes that occur as
a result of emotional distress. One feels vulnerable, and the body may activate the flight-fight

DIABETES MELLITUS AND THE HEALTH BELIEF MODEL 5
response. The response to stress varies from patient to patient. For example, in patients with type
1 diabetes, stress hormones, and the presence of insulin may have an impact on how the patient
reacts. Studies have indicated that patients with diabetes are linked to poor glycemic control
(Kalra, Jena, & Yeravdekar, 2018). In addition, emotional distress is associated with poor
medication adherence. Patients who are emotionally distressed may show exhibit poor self-care.
Reduction in depressive symptoms is associated with improved glycemic control as well as
improved self-management.
The patient’s perception of the severity of diabetes is a major defining factor of how well
they cope with the disease. There are various psychological factors that are related to how a
patient reacts to diabetes from a psychological perspective (Kalra, Jena, & Yeravdekar, 2018).
One psychological factor that plays an important role in dealing with diabetes is the degree to
which an individual accepts their diagnosis. How the individual deals with the demands of the
self-care routine also play an important role in dealing with diabetes. In addition to psychological
factors, there are various social factors that affect how one deals with the illness (Kalra, Jena, &
Yeravdekar, 2018). Income is one of the factors that define how one deals with diabetes (Hill et
al., 2013). Purchasing the medication can be expensive. The result is that people who hail from
poor households may be unable to purchase the drugs. Access to nutritious food is also another
important factor (Hill et al., 2013). When one is dealing with diabetes, they need access to
nutritious food. Family and social support also play an important role when one is dealing with
diabetes.
Long-term Social and Psychological Implications of Chronic Illness
One of the long-term psychological reactions to diabetes may be denial. As a defense
measure, one may refuse to accept the diagnosis of diabetes. Denial may interfere with the ability

DIABETES MELLITUS AND THE HEALTH BELIEF MODEL 6
of the patient to seek treatment (Kalra, Jena, & Yeravdekar, 2018). They may be able to manage
the illness in the long run. The absence of physical symptoms in the short run may compound the
patient’s illness in the long run. Another problem stems from guilt. A patient may react to the
diagnosis of diabetes through feelings of guilt. In case the guilt is not controlled, in the long run,
it could result in the patient’s quality of life being adversely affected. Depression could also be a
long-term psychological problem (Kalra, Jena, & Yeravdekar, 2018). Living with diabetes may
be a tall order for some patients. Patients may get depressed and may feel a deep sense of
sadness. In the long run, depression may affect the patient’s life. The patient may start
experiencing changes in sleep and may lose interest in daily activities.
One social impact of diabetes is that it may impoverish an individual. Diabetes requires a
patient to dedicate a huge pool of resources to purchase medicine and meet the dietary
requirements. For individuals who hail from poor households, the constant struggle to make ends
meet may result in stress and depression (Hill et al., 2013). The increase in the financial burden
as a result of the illness could intensify the effects of poverty. Diabetes can also result in
decreased productivity in the workplace. The result is that it can create employment-related
problems (Hill et al., 2013). Diabetes could also affect educational attainment, which may
compound the effects of poverty.
Therapeutic Interventions Based on the Health Belief Model
One of the interventions is the education of diabetic patients. Education helps ensure that
patients have the necessary information on diabetes. Through educational intervention, perceived
susceptibility to diabetic complications is increased. In addition, education intervention helps in
improving perceived severity (Shabibi et al., 2017). Perceived severity is the belief that the
disease poses a serious threat to one’s life. When diabetic patients are educated, they are likely to

DIABETES MELLITUS AND THE HEALTH BELIEF MODEL 7
adhere to the medications as well as the dietary guidelines. Educational intervention increases the
perceived severity of diabetes in patients. In addition, through education, patients are likely to
engage in self-care behavior (Shabibi et al., 2017). Through education, perceived barriers are
also broken down. Education unlocks various opportunities and thus enables patients to engage
in self-care. Patients are likely to design self-care behaviors that suit their lifestyles after they are
educated thoroughly about the disease.
Conclusion
The health belief model is an important theoretical model that can be used in the
promotion of healthy behaviors as well as the prevention of diseases. The health belief model
explains how individual beliefs affect health outcomes. The model examines several key factors
that affect health-related behavior. In examining diabetes, there are certain health behaviors that
could promote one’s health as well as risky behaviors that could put one at risk. The health belief
model can be used to explain a patient’s adherence to medical prescriptions as well as dietary
prescriptions. The first variable in the health belief model is perceived vulnerability. If
individuals perceive that they are vulnerable to developing complications due to diabetes, they
are likely to adhere to the medication and dietary requirements. The second variable is the
perceived severity. If patients believe that diabetes is a serious illness, they are likely to engage
in self-care behavior. If patients do not perceive diabetes to be a serious illness, they are unlikely
to engage in positive behavior. The third variable is the perceived benefits. If patients believe
that there are benefits associated with healthy behavior, they are likely to practice healthy
behaviors. The final variable is the barriers. When patients believe that there are no costs
associated with adhering to the self-care behavior, they are likely to engage in the behavior.

DIABETES MELLITUS AND THE HEALTH BELIEF MODEL 8

References

Center for Disease Control and Prevention. (2019, October 8). 10 tips for coping with diabetes
distress. Centers for Disease Control and
Prevention. https://www.cdc.gov/diabetes/managing/diabetes-distress/ten-tips-coping-
diabetes-distress.html
Grey, M. (2000). Coping and diabetes. Diabetes Spectrum, 13(3), 167.
Hill, J., Nielsen, M., & Fox, M. H. (2013). Understanding the social factors that contribute to
diabetes: a means to informing health care and social policies for the chronically ill. The
Permanente Journal, 17(2), 67.
Kalra, S., Jena, B. N., & Yeravdekar, R. (2018). Emotional and psychological needs of people
with diabetes. Indian journal of endocrinology and metabolism, 22(5), 696.
Miller, T. A., & DiMatteo, M. R. (2013). Importance of family/social support and impact on
adherence to diabetic therapy. Diabetes, metabolic syndrome and obesity: targets and
therapy, 6, 421.
Shabibi, P., Zavareh, M. S. A., Sayehmiri, K., Qorbani, M., Safari, O., Rastegarimehr, B., &
Mansourian, M. (2017). Effect of educational intervention based on the Health Belief
Model on promoting self-care behaviors of type-2 diabetes patients. Electronic
physician, 9(12), 5960.

DIABETES MELLITUS AND THE HEALTH BELIEF MODEL 9
Appendix: The Health Belief Model
CONCEPT POTENTIAL CHANGE STRATEGIES
Perceived
susceptibility (beliefs
about the chances of
acquiring an illness of
condition)

Why is the diabetic at risk of specific complications of the condition
(kidney damage, blindness, increased risk of stroke and heart attack,
loss of limb, and other functional losses)?
The diabetic is at risk of various complications if they do not
monitor their blood sugar levels. Non-compliance to the medication
as well as dietary recommendations may put one at risk of serious
life threating problems. If the patient does not believe that they are
susceptible to serious complications, they may fail to adhere to the
recommended lifestyle changes.

Perceived severity
(beliefs about the
seriousness and
consequences of an
illness or condition)

What are the consequences of developing a diabetic complication?
A patient may have to be admitted in hospital and this may increase
their healthcare expenditure. The patient may also suffer a heart
attack, stroke, or suffer irreparable damage on their blood vessels.

Perceived benefits
(beliefs about the
effectiveness of taking
action to reduce risk or
severity)

How can the diabetic individual take action (how, where, when) and
what benefits will be achieved in adhering to self-care
recommendations?
The patient can start by monitoring their blood sugar levels. Regular
monitoring of blood sugar levels can help the patient to determine
when to get insulin injections. The patient can also engage in regular
exercise as well as ensure that they stick to the dietary
recommendations.

Perceived barriers
(beliefs about the
actual and
psychological costs of
taking action)

What methods can reassure, inform, and assist diabetic individuals
to take action in adhering to self-care recommendations?
Support from family members is one of the methods that can assist a
diabetic patient. Support from healthcare professionals as well as
social workers can help the patient get the relevant information on
how to manage diabetes. Patient support groups can also ensure that
the patients get the relevant support to help them overcome the
barriers.

Cues to Action (factors
that activate readiness
to change)

What methods can promote awareness in the diabetic individual and
support decisions to take action in adhering to self-care
recommendations?

DIABETES MELLITUS AND THE HEALTH BELIEF MODEL 10

Support groups can help the patient become aware about diabetes
and the important lifestyle adjustments that they need to take.
Educational intervention from healthcare workers can also be an
important cue to action. Through education, the patient will have a
deeper understanding of diabetes and the impact it has on the body.
In so doing the patient will take the necessary steps towards
achieving a healthy lifestyle.

Self-efficacy (factors
affecting confidence in
the ability to take
action)

How can the diabetic individual be encouraged and assisted to
adhere to self-care recommendations?
A positive support system can help ensure that the patient adheres to
the self-care recommendations. Emotional support from family and
friends can help ensure that the patient adheres to the self-care
recommendations. Healthcare professionals also need to ensure that
they give the patient the much-needed support.

DIABETES MELLITUS AND THE HEALTH BELIEF MODEL