Khosrovaneh Katherine, Kalesnikava Viktoryia A, Mezuk Briana
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA.
BMJ Open. 2025 Feb 5;15(2):e089922. doi: 10.1136/bmjopen-2024-089922.
Efforts to increase engagement with diabetes prevention programmes largely focus on increasing diabetes awareness, with the logic that risk knowledge will motivate behaviour change. However, the salience of perceived risk as it relates to diabetes prevention is contested. The goal of this cross-sectional, embedded mixed-methods study was to examine the relationships between perceived risk, diabetes beliefs and prevention behaviours among adults at elevated risk of type 2 diabetes.
Data come from the Richmond Stress and Sugar Study (n=125). Diabetes beliefs (ie, internal, chance, powerful others) were assessed using the Multidimensional Health Locus of Control. Preventive behaviours (eg, changing diet, exercise, tobacco, alcohol) were measured by self-report. Perceived risk of developing diabetes was measured using a probability scale (0%-100%). Logistic and Poisson regression models quantified the relationships between beliefs, behaviours and perceived risk. Qualitative themes regarding challenges and facilitators to preventive behaviours were abstracted from open-ended questions and summarised using content analysis.
Perceived risk of developing diabetes was low (median: 35% likelihood) and only 10% of participants had ever attended a prevention class. None of the diabetes belief domains were significantly associated with either engagement in preventive behaviours or perceived diabetes risk. Perceived diabetes risk was not associated with engagement in preventive behaviours; however, having a family history of diabetes was strongly related to perceived risk (OR: 3.35, 95% CI: 1.42 to 7.86). Qualitative facilitators and barriers of preventive behaviours reflected psychosocial factors (eg, determination, stress, preferences) and resources (eg, social support, time, overall health).
Perceptions of risk and health beliefs are not correlated with engagement in preventive behaviours among adults at clinically elevated risk of diabetes. Awareness campaigns may benefit from incorporating family health history information. Diabetes prevention programmes should address barriers beyond health beliefs to promote engagement in behaviour change.
提高糖尿病预防项目参与度的努力主要集中在提高糖尿病意识上，其逻辑是风险知识将促进行为改变。然而，与糖尿病预防相关的感知风险的显著性存在争议。这项横断面嵌入式混合方法研究的目的是探讨2型糖尿病高危成年人中感知风险、糖尿病信念与预防行为之间的关系。
数据来自里士满压力与糖分研究（n = 125）。使用多维健康控制点评估糖尿病信念（即内控、机遇、他人强大）。通过自我报告测量预防行为（如改变饮食、锻炼、吸烟、饮酒）。使用概率量表（0%-100%）测量患糖尿病的感知风险。逻辑回归和泊松回归模型量化了信念、行为和感知风险之间的关系。从开放式问题中提取有关预防行为挑战和促进因素的定性主题，并使用内容分析进行总结。
患糖尿病的感知风险较低（中位数：35%的可能性），只有10%的参与者曾参加过预防课程。没有一个糖尿病信念领域与预防行为的参与或感知糖尿病风险显著相关。感知糖尿病风险与预防行为的参与无关；然而，有糖尿病家族史与感知风险密切相关（比值比：3.35，95%置信区间：1.42至7.86）。预防行为的定性促进因素和障碍反映了心理社会因素（如决心、压力、偏好）和资源（如社会支持、时间、整体健康）。
在临床糖尿病高危成年人中，风险认知和健康信念与预防行为的参与无关。提高意识的活动可能受益于纳入家族健康史信息。糖尿病预防项目应解决健康信念之外的障碍，以促进行为改变的参与。
