The association between the availability of health guidance and self-management activities among patients with type 2 diabetes: a generalized linear mixed model incorporating patient- and GP-level factors

Abstract

The availability of health guidance (AHG) provided by general practitioners (GPs) may vary in complex primary care settings. This study aimed to assess the AHG for patients with type 2 diabetes mellitus (T2DM) in general practice setting and examine the association between AHG and the patients’ diabetes self-management activities. A cross-sectional study was conducted in seven community health service centers (CHSCs) in Beijing, China. Data on patient and GP characteristics, perceived AHG, and self-management measured by the Summary Diabetes Self-Care Activities (SDSCA) were collected through questionnaire surveys. The AHG included accessibility of health guidance from a GP and AHG on diet, exercise, psychological support, hypoglycemia prevention, and complication identification. A two-level generalized linear mixed model (GLMM) was used to examine the association between the AHG and diabetes self-management considering both patient- and GP-level characteristics. A total of 28 GPs and 716 patients were recruited. The mean AHG score was 3.97 ± 1.84 (range: 0–6). Among AHG domains, complication identification guidance showed the poorest availability (40.5%). AHG was significantly associated with diabetes self-management activities (P < 0.001). In the GLMM, higher AHG scores remained associated with better self-management activities after adjustment for both patient- and GP-level factors. In addition, T2DM duration of more than 10 years was positively associated with self-management activities, while the presence of comorbidities was negatively associated with self-management activities. Perceived GP-provided health guidance was significantly associated with self-management activities among patients with T2DM in primary care settings. Improving the capacity of GP-led primary care teams and promoting the active participation of team members in delivering individualized and comprehensive health guidance may contribute to better self-management activities among patients with T2DM and enhance the effectiveness of diabetes management in primary care.