The Mediating Role of Self‐Efficacy in Shaping Self‐Management Behaviors Among Adults With Type 2 Diabetes

Abstract

Background: Self-efficacy, diabetes distress, knowledge, and education level are likely the important factors affecting diabetes self-management (DSM) behaviors. However, the theoretical mechanisms underlying these variables remain unclear. Aims:The study aimed to test a model including variables of self-efficacy, diabetes distress, knowledge, and education level and DSM behaviors that were informed by social cognitive theory and the literature review among adults with type 2 diabetes. Methods:A cross-sectional study design was employed. Among a convenience sample of 320 adults with type 2 diabetes, 265 eligible participants (response rate = 82.81%) were investigated, using the demographic information questionnaire, the Summary of Diabetes Self-Care Activities, the Self-Efficacy for Diabetes Scale, the Diabetes-Related Knowledge Questionnaire, and the Diabetes Distress Scale. Structural equation modeling was performed with 10,000 bootstrap samples using AMOS 23.0.Results: The final model provided a good fit to the data (χ 2 [22, N = 265] = 9.192, df = 5, p = .102, NFI = 0.972, RMSEA = 0.056). Self-efficacy had the strongest direct effect on DSM behaviors (β = 0.550, p = .000). Knowledge (β = 0.167, p = .004) and employment status (β = −0.130, p = .009) had a direct effect on DSM behaviors. The association between knowledge and DSM behaviors was partially mediated by self-efficacy (bootstrap mean = 0.160, 95% CI: 0.088, 0.237), explaining 49.08% of the total effect of knowledge on DSM behaviors. The association between diabetes distress and DSM behaviors (bootstrap mean = −0.113, 95% CI: −0.192, −0.043) and education level and DSM behaviors (bootstrap mean = 0.102, 95% CI: 0.047, 0.165) were completely mediated by self-efficacy.Conclusions: Self-efficacy plays an important role in the mediation of the association between knowledge and DSM behaviors, diabetes distress and DSM behaviors, and education level and DSM behaviors, as well as a direct contributing role in the predication of DSM behaviors.Linking Evidence to Action: Self-efficacy plays a direct contributing and mediating role in shaping DSM behaviors. The results of the model can help to develop evidence-and theorybased and culturally sensitive interventions. Strategies including goal setting, practicing, recording, peer models, persuasion, positive feedback, and encouragement can be used to address self-efficacy of patients. Interventions led by nurses that increase knowledge, reduce diabetes distress, and emphasize self-efficacy have the potential to promote changes in DSM behaviors.

An examination of the socio-demographic correlates of patient adherence to self-management behaviors and the mediating roles of health attitudes and self-efficacy among patients with coexisting type 2 diabetes and hypertension

“…In a further analysis of the mediating effect of self-efficacy, we found that a higher education level was related to greater self-efficacy, but this did not translate to improved adherence to self-management. This finding is different from that of a previous study where self-efficacy mediated the association between education level and self-management behaviors [ 31 ]. Further research into the role of self-efficacy in shaping patient adherence to self-management behaviors is warranted.…”

“…These findings suggest that self-efficacy in performing self-management may explain the observed differences in patient adherence across these socio-demographic groups. A study that examined the role of self-efficacy in shaping self-management behaviors among diabetic patients reported that self-efficacy partially explained the association of diabetes knowledge with adherence and fully explained the association of distress and education level with adherence [ 31 ].…”

Effect of Income Level and Perception of Susceptibility and Severity of COVID-19 on Stay-at-Home Preventive Behavior in a Group of Older Adults in Mexico City

“…The classic HBM has been use in research on the adoption of preventive health behavior in several chronic and contagious diseases [ 46 , 47 ]. This model suggests that individuals will take action when a disease poses a serious threat and there are practices that could prevent the disease.…”

“…For example, a follow-up study by Williams et al, demonstrated that smoking and physical activity partly mediated the association between education and the development of DMT2 [ 49 ]. Moreover, self-efficacy may mediate the effect between education and DMT2 self-management behaviors [ 46 ]. In a study of the influenza A virus subtype H [Hemagglutinin] 1 N [Neuraminidases] 1 (H1N1) epidemic in Canada, the association between hospitalization for the disease and known risk factors, such as high body mass index, smoking, and antiviral therapy could not fully mediate the association between H1N1 hospitalizations with socioeconomic variables.…”

Social Support, Self-Efficacy, and Psychological Wellbeing of Adults with Type 2 Diabetes

“…T2D self-management is thought to be associated with self-efficacy (Jiang et al, 2019). Jiang and colleagues found that self-efficacy has the strongest direct impact on T2D selfmanagement.…”