1 Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences,

2 Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences

3 Department of Health Education and Health Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan

4 Department of Public Health, School of Public Health, Fars University of Medical Sciences, Fars, Iran


Introduction and Goal: In diseases and disorders such as diabetes, treatment and disease
management depends mostly on patient’s performance. So, self‑care is very important in these
patients and they can affect their own welfare, functional capabilities, and disease processes by
achieving self‑care skills. Nowadays, we know that self care follows individual, psychological
and social factors which its recognition can assist health care providing systems to carry out
educational programs. This study aimed to investigate the role of perceived benefits and barriers
in doing self‑care behaviors among diabetic patients. Materials and Methods: This study is a
narrative review and articles with sectional, cohort, and interventional, clinical trial, qualitative
and narrative designs were chosen using databases and academic search engines such as
PubMed, SCOPUS, ProQuest, Elsevier and key words like self‑care diabetes, perceived benefits
and barriers. Persian articles were also selected using databases like IRANMEDEX, MEDLIB,
as well as searching the articles in sites of domestic scientific magazines. Results: Reviewed
articles’ findings show the average situation of perceived benefits and barriers in diabetic
patients regarding self‑care. Qualified blood sugar (glucose) control, weight control, happiness
feeling and expenses reduction are the most important perceived benefits. The most significant
perceived barriers in self‑care consist of lack of family support, shame feeling, forgetfulness
and not being able to ignore foods’ flavor. Conclusion: Perceived benefits and barriers, as
central constructs in some patterns and theories of behavior change, were related to self‑care,
so that it was directly related to perceived benefits and reversely related to perceived barriers.
Therefore, these two constructs can be considered as strategies for promoting self‑care
behaviors in diabetic patients.


1. Tazakori Z, Zare M, Mirzarahimi M. The effect of nutrition education
on blood sugar level and macronutrients intake in IDDM patients in
Ardabil. J Ardabil Univ Med Sci 2003;2:17‑21.
2. Bate KL, Jerums G. 3: Preventing complications of diabetes. Med
J Aust 2003;179:498‑503.
3. Chan YM, Molassiotis A. The relationship between diabetes
knowledge and compliance among Chinese with non‑insulin
dependent diabetes mellitus in Hong Kong. J Adv Nurs
4. Alberti KG, Zimmet P, Shaw J. International diabetes federation:
A consensus on type 2 diabetes prevention. Diabet Med
5. Larijani B, Tabatabai A. The economics of diabetes mellitus. ISMJ
6. Metzger BE. American association guide to living with diabetes:
Preventing and treating type 2 diabetes. John Wiley and Sons;
2007. p. 17.
7. Shaw J, Sicree R, Zimmet P. Global estimates of the prevalence of
diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4‑14.
8. Odegard PS, Capoccia K. Medication taking and diabetes:
A systematic review of the literature. Diabetes Educ 2007;33:1014‑29.
9. Monahan FD, Sands JK, Neighbors M, Marek JF, Green CJ. Phipps’
medical‑surgical nursing: Health and illness perspectivs. St. Louis:
Mosby Elsevier; 2007.
10. American Diabetes Association (ADA). National standards for
diabetes self‑management education. Diabetes Care 2005;28:72‑9.
11. National Health Priority Action Council (NHPAC). National service
framework for diabetes. Canberra: Australian Government
Department of Health and Ageing; 2006.
12. Knowler W, Barrett‑Connor E, Fowler S, Hamman R, Lachin J,
Walker E, et al. Reduction in the incidence of type 2 diabetes with
lifestyle intervention or metformin. N Engl J Med 2002;346:393‑403.
13. Arzaghi M, Hakim Shoushtari M. In translation: Psychology in
diabetes care‑2005. In: Snoek FJ, Skinner TC, editors. 1st ed. Tehran:
Nashrevista; 2008. p. 105‑21.
14. Maizlish N, Shaw B, Hendry K. Glycemic control in diabetic patients
served by community health centers. Am J Med Qual 2004;19:172‑9.
15. Hertz R, Unger A, Lustik M. Adherence with pharmacotherapy
for type 2 diabetes: A retrospective cohort study of adults with
employer‑sponsored health insurance. Clin Ther 2005;27:1064‑73.
16. Janice Clarke RN. Evaluation of a comprehensive diabetes disease
management program: Progress in the struggle for sustained
behavior change. Dis Manag 2002;5:77‑86.
17. Amini M, Gooya MM, Delavari AR, Mahdavi AL, Tabatabaei A,
Haghighi S. Keifiyate edareye diabet dar Iran dar salhaye 2005‑2006.
JMCIRI Majaleye Sazmane Nezame Pezeshkie Iran 2008;26:20‑9.
18. Yamaguchi Y, Miura S, Urata H, Himeshima Y, Yamatsu K, Otsuka N,
et al. The effectiveness of a multicomponent program for nutrition
and physical activity change in clinical setting: Short‑term effects
of PACE+Japan. Inter J Spo and Hea Sci 2003;1:229‑37.
19. Simmons D, Weblemoe T, Voyle J, Prichard A, Leakehe L, Gatland B.
Personal barriers to diabetes care: Lessons from a multi‑ethnic
community in New Zealand. Diabet Med 1998;15:958‑64.
20. Simmons D, Lillis S, Swan J, Haar J. Discordance in perceptions
of barriers to diabetes care between patients and primary care and
secondary care. Diabetes Care 2007;30:490‑5.
21. Fisher KL. Assessing psychosocial variables: A tool for diabetes
educators. Diabetes Educ 2006;32:51‑8.
22. Vijan S, Stuart NS, Fitzgerald JT, Ronis DL, Hayward RA, Slater S,
et al. Barriers to following dietary recommendations in Type 2
diabetes. Diabet Med 2005;22:32‑8.
23. O’Dea AJ. Why do kids eat healthful food? Perceived benefits of
and barriers to healthful eating and physical activity among children
and adolescents. J Am Diet Assoc 2003;103:497‑500.
24. Brekke HK, Sunesson A, Axelsen M, Lenner RA. Attitudes and
barriers to dietary advice aimed at reducing risk of type 2 diabetes
in first‑degree relatives of patients with type 2 diabetes. J Hum Nutr
Diet 2004;17:513‑21.
25. Marzilli G, Cossege W. The effects of social support on eating
behavior in patients whit diabetes. Available from: (http://www.
insulin‑ pdf). [Last accessed on
2010 May 5].
26. Rafique GH, Shaikh F. Identifying needs and barriers to
diabetes education in patients with diabetes. J Pak Med Assoc
27. Charron‑Prochownik D, Sereika SM, Becker D, Jacober S,
Mansfield J, White NH, et al. Reproductive health beliefs and
behaviors in teens with diabetes: Application of the expanded health
belief model. Pediatr Diabetes 2001;2:30‑9.
28. Glasgow RE, Toobert DJ, Gillette CD. Psychosocial barriers to
diabetes self‑management and quality of life. Diabetes Spectr
29. Aljasem LI, Peyrot M, Wissow L, Rubin RR. The impact of barriers
and self_ efficacy on self_care behaviors in type 2 diabetes. Diabetes
Educ 2001;27:393‑404.
30. Polly RK. Diabetes health beliefs, self‑care behaviors, and
glycemic control among older adults with non‑insulin‑dependent
diabetesmellitus. Diabetes Educ 1992;18:321‑7.
31. Daniel M, Messer LC. Perceptions of disease severity and barriers to
self‑care predict glycemic control in Aboriginal persons with type 2
diabetes mellitus. Chronic Dis Can 2002;23:130‑8.
32. Mollem ED, Snoek FJ, Heine RJ. Assessment of perceived barriers
in self‑care of insulin‑requiring diabetic patients. Patient Educ Couns
33. Tan MY. The relationship of heath beliefs and complication
prevention behaviors of Chines individuals with type 2 diabetes
mellitus. Diabetes Res Clin Pract 2004;66:71‑7.
34. Wen LK, Shepherd MD, Parchman ML. Family support, diet, and
exesice among older Mexican Americans with type 2 diabetes.
Diabetes Educ 2004:30:980‑93.
35. Koch J. The role of exercise in the African‑ American woman with
type 2 diabetyes mellitus: Application of the health belief model.
J Am Acad Nurse Pract 2002;14:126‑9.
36. Pham DT, Fortin F, Thibaudeau MF. The role of the health belief
model in amputees’ self‑evaluation of adherence to diabetes
self‑care behaviors. Diabetes educ 1996;22:126‑32.
37. Lioyd CE, Wing RR, Orchard TJ, Becker DJ. Psychosocial correlates
of glycemic control: Pittsburgh epidemiology of diabetes
complications (EDC) study. Diabetes Res Clin Pract 1993;21:187‑95.
38. Nagelkerk J, Reick K, Meengs L. Perceived barriers and effective
strategies to diabetes selfmanagement. J Adv Nurs 2006;54:151‑8.
39. Rothman RL, Mulvaney S, Elasy TA, VanderWoude A, Gebretsadik T,
Shintani A, et al. Selfmanagement behaviors, racial disparities, and
glycemic control among adolescents with type 2 diabetes. Pediatrics
40. Krichbaum K, Aarestad V, Buethe M. Exploring the connection
between self‑efficacy and effective diabetes self‑management.
Diabetes Educ 2003;29:653‑62.
41. Chapman KM, Ham JO, Liesen P, Winter L. Applying behavioral
models to dietary education of elderly diabetic patients. J Nutr Educ
42. Robin W. Strategies to facilitate lifestyle change associated with
diabetes mellitus. J Nurs Scholarsh 2000;32:225‑8.
43. Kamel MN, Badawy YA, Merdan LA. Diabetic’s knowledge of the
disease and their management behavior. East Mediterr Health J
44. Corina G, Michael PR, James JD. Diabetes education program use
and patient‑perceived barriers to attendance. J Cli Resh and Meth
45. Adams AS, Mah C, Soumerai SB, Zhang F, Barton MB,Ross‑Degnan D. Barriers to self‑monitoring of blood glucose
among adults with diabetes in an HMO: A cross sectional study.
BMC Health Serv Res 2003;3:1‑8.
46. Karter AJ, Ferrara A, Darbinian JA, Ackerson LM, Selby JV. Self
monitoring of blood glucose: Language and financial barriers
in a managed care population with diabetes. Diabetes Care
47. Gagliardino JJ. A model education program for people with type 2
diabetes. Diabetes Care 2001;24:1001‑7.
48. Rickheim PL, Weaver TW, Flader JL, Kendall DM. Assessment of
group versus individual diabetes education: A randomized study.
Diabetes Care 2002;25:269‑74.
49. Gillibrand R, Stevenson J. The extended health belief model applied
to the experience of diabetes in young people. Br J Health Psychol
50. Aalto AM, Uutela A. Glycemic control, self‑care behaviors, and
psychosocial factors among insulin treated diabetics: A test of an
extended health belief model. Int J Behav Med 1997;4:191‑214.
51. Pinto SL, Lively BT, Siganga W, Goodman MH, Kamm G. Using
the health belief model to test factors affecting patient retention
in diabetes‑related pharmaceutical care services. Res Social Adm
Pharm 2006;2:38‑55.
52. Patino AM, Sanchez J, Eidson M. Health beliefs and regimen
adherence in minority adolescents with type 1 diabetes. J Pediatr
Psychol 2005;30:503‑12.
53. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes
self‑care activities measure. Diabetes Care 2000;23:943‑50.
54. Abood D, Black DR, Feral D. Nutrition education worksite
intervention for university staff: Application of thehealth belief
model. J Nutr Educ Behav 2003;35:260‑7.
55. Coates VE, Boore JR. The influence of psychological factors on the
self‑management of insulin‑dependent diabetes mellitus. J Adv Nurs
56. Bond GG, Aiken LS, Somerville SC. The health belief model and
adolescents with insulin‑dependent diabetes mellitus. Health
Psychol 1992;11:190‑8.
57. Morowatisharifabad MA, Rouhani Tonekaboni N. Diabetes
self‑care determinants model of diabetic patients referred to yazd
diabetes research center. Daneshvar, scientific‑research. JSHU
58. Sharifirad GH, Entezari MS, Kamran A, Azadbakhat L. Effectiveness
of nutrition education to patients with type 2 diabetes: The health
belief model. IJDLD 2008;7:379‑86.
59. Morowatisharifabad MA, Rouhani Tonekaboni N. The relationship
between perceived benefits/barriers of self‑care behaviors and self
management in diabetic patients. JFNM 2007;13:17‑27.
60. Shakibazadeh E, Rashidian A, Larijani B, Shojaeezadeh D,
Forouzanfar MH, Karimi Shahanjarini A. Perceived barriers and
self‑efficacy: Impact on self‑care behaviors in adults with type 2
diabetes. JFNM 2010;15:69‑78.
61. Jahanloo AS, Ghofranipour F, Vafaei M, Kimiagar M, Heydarnia AR,
Sobhani A. Health Belief Model constructs measured with
HbA1c in diabetic patients with good control and poor. JHUMS
62. Shamsi M, Sharifirad G, Kachoyee A, Hassanzadeh A. The effect
of educational program walking based on health belief model on
control suger in woman by type 2 diabetics. IJEM 2010;11:490‑9.
63. Bernal H, Woolly S, Schensul JJ, Dickinson JK. Correlates of
self‑efficacy in diabetes self‑care among hispanic adults with
diabetes. Diabetes Educ 2000;26:673‑80.
64. Keshavarz Z, Simbar M, Ramezankhani A. Effective factors on
nutritional behavior of female workers based on “integrated model
of planned behavior and self‑efficacy”: A qualitative approach.
Hakim 2010;13:199‑209.
65. Schreurs KM, Colland VT, Kuijer RG, de Ridder DT, van Elderen T.
Development, content, and process evaluation of a short
self‑management intervention in patients with chronic diseases
requiring self‑care behaviors. Patient Educ Couns 2003;51:133‑41.
66. Park H, Hong YS, Lee H, Ha E, Sung Y. Individuals with type 2
diabetes and depressive symptoms exhibited low adherence with
self‑care. J Clin Epidemiol 2004;57:978‑84.
67. Bell RA, Arcury TA, Snively BM. Diabetes foot self‑care practices
in a rural triethnic population. Diabetes Educ 2005;31:75‑83.
68. Pender NJ, Murdaugh CL, Parsons MA. Health‑promotion in nursing
practice. 4th ed. USA: Prentice Hall; 2002. p. 60.
69. Glanz K, Rimer BK, Lewis FM. Health behavior and health education:
Theory, research, and practice. 3rd ed. Jossey‑Bass; 2002.
70. Nutbeam D, Harris E. Theory in a nutshell: A practical guide to health
promotion theories. 2nd ed. Mc Graw‑ Hill Australia Pty Ltd; 2004.