Information-Motivation-Behavioral Skills Analysis Advances Understanding of Barriers to Self-Monitoring of Blood Glucose

Utilization of Information-Motivation-Behavioral Skills Model for Understanding Self-Monitoring of Blood Glucose May Be Useful for Overcoming Obstacles to Adherence

Jun 26, 2010, 11:30 ET from Bayer Diabetes Care

ORLANDO, Fla., June 26 /PRNewswire/ -- An estimated 75 percent of adults with type 1 and type 2 diabetes say they believe they know what their blood sugar levels are without testing, according to data presented at the American Diabetes Association (ADA) 70th Scientific Sessions. These results are important to consider because self-monitoring with a blood glucose meter is essential for people with diabetes to obtain accurate blood sugar results that guide adjustments to meal planning, exercising and, most importantly for insulin users, accurately dosing their insulin. It is one of a number of key learnings from a study representing the first-ever use of the well-established information-motivation-behavioral skills (IMB) model of health behavior practice to understand barriers to self-monitoring of blood glucose (SMBG) among type 1 and type 2 diabetes patients.  

Bayer Diabetes Care undertook the study to identify basic social and psychological factors that may be related to SMBG utilization in individuals with type 1 or type 2 diabetes and to better understand the reasons why some people have difficulty adhering to SMBG as recommended by their health care providers. Another objective of the study was to determine whether the IMB model, which has been applied effectively in several health behavior domains, may be effective in helping to understand and promote adherence to SMBG. The study was conducted by a co-developer of the IMB model, Dr. William Fisher, distinguished university professor in the Department of Psychology and the Department of Obstetrics and Gynecology at the University of Western Ontario in London, Canada.

The study findings revealed substantial information gaps, motivational obstacles and behavioral skills limitations that stand in the way of adherence to SMBG. Additionally, they suggest that an IMB skills model for understanding SMBG may be conceptually and empirically worthwhile and may provide a basis for supportive educational and clinical interventions to assist individuals with diabetes to adhere to SMBG recommendations.

"There is a considerable amount of medical literature about adherence in diabetes, and a wide range of interventions have been shown to have a positive effect on knowledge, frequency and accuracy of SMBG. Maintaining change in SMBG over time has been variable, however, and may be dependent upon regular reinforcement. What's been lacking is a well-integrated behavioral science model of factors that influence SMBG adherence," said Dr. Fisher. "We are gratified to see that the IMB for understanding and promoting health behavior change has worked well in a number of areas, including the prediction and promotion of safer sexual behavior, medication adherence, and other areas, providing evidence of utility in understanding SMBG in diabetes."

According to the IMB model, information about SMBG that is directly translatable into adherence and appropriate glycemic control based on blood sugar results, motivation to act on this information, and behavioral skills for acting effectively are the fundamental determinants of SMBG adherence. Well-informed and well-motivated individuals will apply their behavioral skills to affect adherence to SMBG over the long run. Health outcomes of SMBG form a feedback loop that can strengthen or weaken SMBG information, motivation and behavioral skills, and moderating factors in an individual's environment—such as competing demands from family and work—may also influence a person's ability to engage in SMBG.

Dr. Fisher presented the study in a poster, "Understanding Self-Monitoring of Blood Glucose: An Information-Motivation-Behavioral Skills Analysis," at the ADA meeting. The poster was also highlighted during the ADA's first ever guided audio poster tour – a new and innovative session added this year.

Additional Findings

A substantial number of individuals in the analysis reported information deficits with respect to SMBG. In a research sample of 416 adults with type 1 or type 2 diabetes, 46% and 53%, respectively, did not know that they should test after meals, and 21% and 40% did not know how to look for patterns in blood sugar readings. Further, as noted above, 75% say they don't need to test because they believe they can gauge what their blood sugar levels are without testing.

Motivational obstacles to testing reported by adults with type 1 and type 2 included reports that testing constantly reminds them that they have diabetes (45 and 53% respectively), is painful (34 and 35%), frustrating (26 and 25%) and time consuming (25% and 25%).

Behavioral skill limitations reported include difficulty testing without others knowing they are testing (29% and 20% for type 1 and type 2, respectively), difficulty downloading information from their blood sugar meter (27% and 24%), difficulty testing without too much pain (21% and 22%) and difficulty remembering to test (17% and 27%).

Importantly, findings from this research show a significant relationship between the presence of SMBG information gaps, SMBG motivational obstacles and SMBG behavioral skills limitations with reported frequency of SMBG for individuals with type 1 and type 2 diabetes.

"SMBG is increasingly seen as a behavioral tool in the management of diabetes," said Dr. David Simmons, chief medical officer for Bayer Diabetes Care. "Bayer Diabetes Care was interested in determining whether the IMB model was appropriate to evaluate SMBG adherence in patients with diabetes. The depth of understanding of information gaps, motivational obstacles and behavioral skills limitations has helped us identify areas of patient education, professional education and development to improve products and services that Bayer can provide to customers."

Study Design

The current research applied the IMB skills model of health behavior to identify correlations of frequency and adherence to recommended frequency of SMBG in a sample of 426 adults with type 1 and type 2 diabetes (type 1=208 and type 2=218).  Participants were enrolled in the Chronic Illness Panel of Harris Interactive and completed the survey online. Thirty-five SMBG information questions were rated on a 5-point like scale. Twenty-five SMBG motivation items were queried on 5-point and 7-point scales, and 34 SMBG behavioral skills items were rated on a 5-point scale. This was a cross-sectional study, which is a study done at one point in time, not over the course of time, and can measure the distribution and current relationships of characteristics of interest in a defined population.

Respondents who indicated strong disagreement, disagreement or neutral responses to correct information, or strong agreement, agreement or neutral responses to incorrect SMBG information were considered "uninformed." Motivational items evaluating attitudes to personal performance of SMBG were assessed on a 5-point or 7-point scale and respondents on the negative side of the scale were coded as unmotivated.  On the SMBG behavioral skills scales, those who responded on the very difficult or difficult side of the scale were coded as "unskilled."

Correlational analyses were conducted to assess the relationship between SMBG information, motivation and behavioral skills with average testing frequency. In both type 1 and type 2 diabetes, all three correlated with testing frequency, with stronger correlations seen in the type 1 population.

Significant greater limitations, with respect to SMBG information and SMBG motivation (p<0.05), were reported among individuals with type 2 compared to type 1 diabetes. Item selection procedures that resulted in formation of internally consistent scales assessing the SMBG IMB were reported (alphas >0.80), and the pattern of significant relationships among SMBG IMB and frequency of SMBG in the samples of individuals with type 1 and type 2 diabetes were reported as well.  

About Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin. Approximately 23.6 million children and adults in the United States have diabetes, which puts them at risk for developing serious health complications over time, such as heart disease, kidney disease, blindness and stroke.(1) Type 1 diabetes, also called juvenile diabetes, is usually diagnosed in children and young adults. In persons with type 1 diabetes, the body makes little or no insulin, which may result in many complications if glucose levels are not controlled.(2) Type 2 diabetes is usually diagnosed in adults, although increasingly, children are being diagnosed with this disease. Type 2 is associated with obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity and race/ethnicity.(3) An estimated 30% of people with diabetes require insulin to manage their disease. Those who require insulin must closely monitor their blood sugar with a blood glucose meter to plan their meals, exercise regimens and insulin dosage.

Bayer Diabetes Care

Bayer Diabetes Care is a worldwide leader in diabetes care, supporting customers in 100 countries and, for more than 40 years, has led the way in diabetes care product innovation. Today, Bayer Diabetes Care offers an unparalleled choice in diabetes management systems and comprehensive support including education, tools and resources designed to simplify life with diabetes. Bayer Diabetes Care is a business of the Bayer HealthCare LLC, Medical Care Division and has its global headquarters located in Tarrytown, New York. Find more information at

Bayer HealthCare

The Bayer Group is a global enterprise with core competencies in the fields of health care, nutrition and high-tech materials. Bayer HealthCare, a subsidiary of Bayer AG, is one of the world's leading, innovative companies in the healthcare and medical products industry and is based in Leverkusen, Germany. The company combines the global activities of the Animal Health, Consumer Care, Medical Care and Pharmaceuticals divisions. The pharmaceuticals business operates under the name Bayer Schering Pharma. Bayer HealthCare's aim is to discover and manufacture products that will improve human and animal health worldwide. Find more information at  

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(1) Last accessed June 11, 2010

(2) Last accessed June 11, 2010

(3) Last accessed June 11, 2010

SOURCE Bayer Diabetes Care