Impact of a Booklet about Diabetes Genetic Susceptibility and Its Prevention on Attitudes towards Prevention and Perceived Behavioral Change in Patients with Type 2 Diabetes and Their Offspring

Table 5

Details of a booklet about diabetes prevention for people with a family history of diabetes.

Page	Core elements of Health Belief Model and component details
1	Perceived Seriousness; Type 2 diabetes is an illness that shows a high blood glucose level. Blood glucose level is raised by defects in the ability of insulin secretion and/or use of insulin. Diabetes is a cause of serious complications: eye complications (sometimes causes blindness), nephropathy (sometimes requires dialysis), and neuropathy (sometimes requires foot amputation). Diabetes is a significant risk factor of critical macrovascular complications such as stroke or myocardial infarction.
2	Perceived Susceptibility; Diabetes is one of the most common diseases in Japan. The estimated number of possible/probable diabetes patients was 22 million in 2007, which is a 1.6-fold increase compared to 10 years ago (13.7 million).; Such rapid increase in the number of diabetes patients is mainly due to lifestyle changes in the past decades: physical activity became considerably less due to technological progress in transportation and/or automation; dietary habits have changed. The usual meal consists of more fat and less fiber compared to a traditional Japanese meal.; In addition, there is genetic susceptibility that of being unable to adjust to environmental change.
3	Perceived Susceptibility; Genetic predispositions are mainly characterized by two biological features: decreased insulin secretion, and decreased insulin sensitivity easily caused by high-fat meals. People with such a predisposition are more prone to experiencing insulin resistance and hyperinsulinemia, which would connect to beta cell function loss. These predispositions would be characterized by variants in disease susceptible gene. The vast of recent research try to explicate genetics in diabetes, but its application to preventive medicine still remains under development.
4	Perceived Susceptibility; On the other hand, an epidemiological study has clearly shown that individuals with an affected first-degree relative display a 2.3–5.5-fold higher risk of type 2 diabetes. First-degree relatives share half of their genes. Moreover, the family (not limited to first degree relative) may share a similar lifestyle to that of the patients. Thus family history is a significant risk factor for diabetes from the viewpoint of both environmental/genetic predisposition.
5	Perceived benefits; Although family history indicates a possible genetic predisposition, which cannot be modified, this does not imply a definite future occurrence of diabetes. Since diabetes occurs due to a complicated interaction between genetic/environmental factors, you can act against diabetes by modifying your lifestyle even if you have a genetic predisposition.; For example: adequate energy intake that meets the low ability of insulin secretion would protect your beta cell function; adequate calorie intake and low-fat meals would prevent the development of insulin resistance; regular physical activity is useful for controlling energy consumption and increasing insulin sensitivity.
6	Perceived barriers; Lifestyle modification is useful in diabetes prevention. However, a concrete method of modifying one’s lifestyle is not necessarily understood. A summary of concrete methods of modifying diet and physical activity is shown (e.g., low-fat, high-fiber meals and regular exercise (3 or more days/week and over 30 minutes/each time)). It is important to take professional advice to find the most effective treatment and tailor preventive behavior to your lifestyle. Health professionals can help you learn how to integrate a favorable diet and/or physical activity into your daily life.