International Journal of Endocrinology and Metabolism

Published by: Kowsar

Factors Affecting Self-Care Performance in Adolescents with Type I Diabetes According to the PEN-3 Cultural Model

Hasan Shahbazi 1 , Fazlollah Ghofranipour 1 , * , Parisa Amiri 2 and Asadollah Rajab 3
Authors Information
1 Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
2 Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Pediatrician, Iranian Diabetes Association, Tehran, Iran
Article information
  • International Journal of Endocrinology and Metabolism: October 2018, 16 (4); e62582
  • Published Online: September 18, 2018
  • Article Type: Research Article
  • Received: July 10, 2017
  • Revised: July 11, 2018
  • Accepted: September 5, 2018
  • DOI: 10.5812/ijem.62582

To Cite: Shahbazi H, Ghofranipour F, Amiri P, Rajab A . Factors Affecting Self-Care Performance in Adolescents with Type I Diabetes According to the PEN-3 Cultural Model, Int J Endocrinol Metab. 2018 ; 16(4):e62582. doi: 10.5812/ijem.62582.

Copyright © 2018, International Journal of Endocrinology and Metabolism. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Methods
4. Results
5. Discussion
  • 1. Lin K, Yang X, Yin G, Lin S. Diabetes self-care activities and health-related quality-of-life of individuals with type 1 diabetes mellitus in Shantou, China. J Int Med Res. 2016;44(1):147-56. doi: 10.1177/0300060515597933. [PubMed: 26658458]. [PubMed Central: PMC5536571].
  • 2. Patton SR. Adherence to diet in youth with type 1 diabetes. J Am Diet Assoc. 2011;111(4):550-5. doi: 10.1016/j.jada.2011.01.016. [PubMed: 21443987]. [PubMed Central: PMC3066432].
  • 3. Lempainen J, Tauriainen S, Vaarala O, Makela M, Honkanen H, Marttila J, et al. Interaction of enterovirus infection and cow's milk-based formula nutrition in type 1 diabetes-associated autoimmunity. Diabetes Metab Res Rev. 2012;28(2):177-85. doi: 10.1002/dmrr.1294. [PubMed: 21922634].
  • 4. Loghmani E. Diabetes mellitus: type 1 and type 2. Guidelin adolescent nutr serv. 2005:167-82.
  • 5. Samadi N, Allahyari I, Zamanzadeh V, Dadkhah B, Mohammadi MA, Mozaffari N. Educational points for prevention of type 1diabetes and its complications: a systematic review. J Clin Cell Immunol. 2012;2(1-4). doi: 10.4172/2155-9899.S2-004.
  • 6. Patton SR, Odar C, Midyett LK, Clements MA. Pilot study results for a novel behavior plus nutrition intervention for caregivers of young children with type 1 diabetes. J Nutr Educ Behav. 2014;46(5):429-33. doi: 10.1016/j.jneb.2013.11.007. [PubMed: 24438850]. [PubMed Central: PMC4098019].
  • 7. Sakane N, Kotani K, Tsuzaki K, Nishi M, Takahashi K, Murata T, et al. Fear of hypoglycemia and its determinants in insulin-treated patients with type 2 diabetes mellitus. J Diabetes Investig. 2015;6(5):567-70. doi: 10.1111/jdi.12340. [PubMed: 26417415]. [PubMed Central: PMC4578497].
  • 8. Razavi Z, Karimpourian A, Aramian LM, Bazmamoun H. Demographic characteristics of type 1 diabetic children and adolescents in Hamadan, Iran. J Res Health Sci. 2015;15(3):196-9. [PubMed: 26411667].
  • 9. Maslakpak MH, Ahmadi F, Anoosheh M. [Spiritual beliefs and quality of life: A qualitative research about diabetic adolescent girls' perception]. Koomesh. 2011;12(2):144-51. Persian.
  • 10. Rezasefat Balesbaneh A, Mirhaghjou N, Jafsri Asl M, Kohmanaee S, Kazemnejad Leili E, Monfared A. [Correlation between self-care and self-efficacy in adolescents with type 1 diabetes]. J Holistic Nurs Midwif. 2014;24(2):18-24. Persian.
  • 11. Wiley J, Westbrook M, Long J, Greenfield JR, Day RO, Braithwaite J. Diabetes education: the experiences of young adults with type 1 diabetes. Diabetes Ther. 2014;5(1):299-321. doi: 10.1007/s13300-014-0056-0. [PubMed: 24519150]. [PubMed Central: PMC4065294].
  • 12. Costa Flora M, Goncalves Henriques Gameiro M. [Self-care of adolescents with type 1 diabetes mellitus: Knowledge about the disease]. Nurs Rev Ref. 2016;4(8). Portuguese. doi: 10.12707/RIV15024.
  • 13. Saeidinejat S, Chahipour M, Esmaily HV, Ghonche H, Fathalizadeh S, Omidbakhsh R. [Role of family support in self care of type II diabetic patients]. Iran J Endocrinol Metabol. 2014;16(2):95-102. Persian.
  • 14. Zargham A, Yazdani M, Yazdannik A. [Association between behavioral patterns of parents with depression and suicidal thoughts among adolescents]. Shahrekord Univ Med Sci J. 2001;3(2):46-54. Persian.
  • 15. Didarloo A, Shojaeizadeh D, Eftekhar Ardebili H, Niknami S, Hajizadeh E, Alizadeh M. [Assessment of factors affecting self-care behavior among women with type 2 diabetes in Khoy City Diabetes Clinic using the extended theory of reasoned action]. J School Pub Health Insti Pub Health Res. 2011;9(2):79-92. Persian.
  • 16. Rostami S, Parsa-Yekta Z, Najafi Ghezeljeh T, Vanaki Z. Supporting adolescents with type 1 diabetes mellitus: a qualitative study. Nurs Health Sci. 2014;16(1):84-90. doi: 10.1111/nhs.12070. [PubMed: 23692212].
  • 17. Grillo Mde F, Neumann CR, Scain SF, Rozeno RF, Gross JL, Leitao CB. Effect of different types of self-management education in patients with diabetes. Rev Assoc Med Bras (1992). 2013;59(4):400-5. doi: 10.1016/j.ramb.2013.02.006. [PubMed: 23850026].
  • 18. Rosen I. The impact of culture on health: A study of risk perception on unhealthy lifestyles in Babati town. Tanzania: Sodertorn University; 2015. [Dissertation].
  • 19. Airhihenbuwa CO, Webster JD. Culture and African contexts of HIV/AIDS prevention, care and support. SAHARA J. 2004;1(1):4-13. doi: 10.1080/17290376.2004.9724822. [PubMed: 17600995].
  • 20. BeLue R, Diaw M, Ndao F, Okoror T, Degboe A, Abiero B. A cultural lens to understanding daily experiences with type 2 diabetes self-management among clinic patients in M'bour, Senegal. Int Q Community Health Educ. 2012;33(4):329-47. doi: 10.2190/IQ.33.4.b. [PubMed: 24044925].
  • 21. Cowdery JE, Parker S, Thompson A. Application of the PEN-3 model in a diabetes prevention intervention. J Health Disparit Res Pract. 2010;4(1):3.
  • 22. Iwelunmor J, Newsome V, Airhihenbuwa CO. Framing the impact of culture on health: a systematic review of the PEN-3 cultural model and its application in public health research and interventions. Ethn Health. 2014;19(1):20-46. doi: 10.1080/13557858.2013.857768. [PubMed: 24266638]. [PubMed Central: PMC4589260].
  • 23. Sofolahan YA, Airhihenbuwa CO. Childbearing decision making: a qualitative study of women living with HIV/AIDS in Southwest Nigeria. AIDS Res Treat. 2012;2012:478065. doi: 10.1155/2012/478065. [PubMed: 23320152]. [PubMed Central: PMC3539429].
  • 24. Williams M, Moneyham L, Kempf MC, Chamot E, Scarinci I. Structural and sociocultural factors associated with cervical cancer screening among HIV-infected African American women in Alabama. AIDS Patient Care STDS. 2015;29(1):13-9. doi: 10.1089/apc.2014.0063. [PubMed: 25514125]. [PubMed Central: PMC4281874].
  • 25. Reis JCGD, Amorim MPC, Melao NFR. [Breaking barriers with qualitative multi-method research for engineering studies: pros, cons and issues]. Proelium. 2017;7(12):275-92. Portuguese.
  • 26. Coenen M, Stamm TA, Stucki G, Cieza A. Individual interviews and focus groups in patients with rheumatoid arthritis: A comparison of two qualitative methods. Qual Life Res. 2012;21(2):359-70. doi: 10.1007/s11136-011-9943-2. [PubMed: 21706128].
  • 27. Haghighian Roudsari A, Vedadhir A, Amiri P, Kalantari N, Omidvar N, Eini-Zinab H, et al. Psycho-socio-cultural determinants of food choice: A qualitative study on adults in social and cultural context of Iran. Iran J Psychiatry. 2017;12(4):241-50. [PubMed: 29472950]. [PubMed Central: PMC5816913].
  • 28. Morrison G, Weston P. Self-efficacy: A tool for people with diabetes managed by continuous subcutaneous insulin infusion. J Diabet Nurs. 2013;17(1):32-7.
  • 29. Hapunda G, Abubakar A, van de Vijver F, Pouwer F. Living with type 1 diabetes is challenging for Zambian adolescents: Qualitative data on stress, coping with stress and quality of care and life. BMC Endocr Disord. 2015;15(1):20. doi: 10.1186/s12902-015-0013-6. [PubMed: 25928592]. [PubMed Central: PMC4411790].
  • 30. Ismail H, Wright J, Rhodes P, Small N. Religious beliefs about causes and treatment of epilepsy. Br J Gen Pract. 2005;55(510):26-31. [PubMed: 15667762]. [PubMed Central: PMC1266239].
  • 31. Adejumo H, Odusan O, Sogbein O, Laiteerapong N, Dauda M, Ahmed O. The impact of religion and culture on diabetes care in Nigeria. Africa J Diabet Med. 2015;23(2):17-9.
  • 32. Sachmechi I, Wang A, Kim P, Reich D, Payne H, Salvador VB. Impact of diabetes education and peer support group on the metabolic parameters of patients with diabetes mellitus (type 1 and type 2). Br J Med Pract. 2013;6(4). a635.
  • 33. Irani MD, Abdoli S, Bijan I, Parvizy S, Fatemi NS, Amini M. Strategies to overcome type 1 diabetes-related social stigma in the Iranian society. Iran J Nurs Midwifery Res. 2014;19(5):456-63. [PubMed: 25400672]. [PubMed Central: PMC4223961].
  • 34. Barbosa DFM, Heleno MGV. [Health beliefs of parents of children with type 1 diabetes]. Psycholog Health Dis. 2014;15(3):769-77. Portuguese.
  • 35. Sales-Peres SH, Guedes Mde F, Sa LM, Negrato CA, Lauris JR. Lifestyle of patients with diabetes mellitus type 1: A systematic review. Cien Saude Colet. 2016;21(4):1197-206. doi: 10.1590/1413-81232015214.20242015. [PubMed: 27076018].
  • 36. Borus JS, Laffel L. Adherence challenges in the management of type 1 diabetes in adolescents: Prevention and intervention. Curr Opin Pediatr. 2010;22(4):405-11. doi: 10.1097/MOP.0b013e32833a46a7. [PubMed: 20489639]. [PubMed Central: PMC3159529].
  • 37. Zysberg L, Lang T. Supporting parents of children with type 1 diabetes mellitus: A literature review. Patient Intelligence. 2015:21. doi: 10.2147/pi.s77566.
  • 38. Jaser SS. Psychological problems in adolescents with diabetes. Adolesc Med State Art Rev. 2010;21(1):138-51. x-xi. [PubMed: 20568561]. [PubMed Central: PMC3721971].
  • 39. Lewandowski A, Drotar D. The relationship between parent-reported social support and adherence to medical treatment in families of adolescents with type 1 diabetes. J Pediatr Psychol. 2007;32(4):427-36. doi: 10.1093/jpepsy/jsl037. [PubMed: 17056638].
  • 40. Schilling LS, Knafl KA, Grey M. Changing patterns of self-management in youth with type I diabetes. J Pediatr Nurs. 2006;21(6):412-24. doi: 10.1016/j.pedn.2006.01.034. [PubMed: 17101399].
  • 41. Roblin DW, Ntekop E, Becker ER. Improved intermediate clinical outcomes from participation in a diabetes health education program. J Ambul Care Manage. 2007;30(1):64-73. [PubMed: 17170639].
  • 42. Qin ZY, Yan JH, Yang DZ, Deng HR, Yao B, Weng JP, et al. Behavioral analysis of Chinese adult patients with type 1 diabetes on self-monitoring of blood glucose. Chin Med J (Engl). 2017;130(1):39-44. doi: 10.4103/0366-6999.196574. [PubMed: 28051021]. [PubMed Central: PMC5221109].
  • 43. Martyn-Nemeth P, Quinn L, Penckofer S, Park C, Hofer V, Burke L. Fear of hypoglycemia: Influence on glycemic variability and self-management behavior in young adults with type 1 diabetes. J Diabetes Complications. 2017;31(4):735-41. doi: 10.1016/j.jdiacomp.2016.12.015. [PubMed: 28143733]. [PubMed Central: PMC5350014].
  • 44. Johnston-Brooks CH, Lewis MA, Garg S. Self-efficacy impacts self-care and HbA1c in young adults with Type I diabetes. Psychosom Med. 2002;64(1):43-51. [PubMed: 11818585].
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments