Self-management behavior among patients with diabetic retinopathy in the community: a structural equation model

Abstract

Diabetic retinopathy (DR) is an important, chronic complication of diabetes, requiring competent self-management that depends on adherence to behavioral regimens. This study attempted to identify factors influencing self-management behaviors and develop a model illustrating the interdependence of several factors associated with DR patients. In June-December 2012, 368 patients with DR completed questionnaires assessing self-management behavior, diabetes knowledge, health beliefs, social support, and treatment adherence. Structural equation modeling was used to test predicted pathways linking self-management behavior to diabetes knowledge, health beliefs, social support, and treatment adherence. The results indicated that health beliefs, treatment adherence, and duration of diabetes each had a direct impact on diabetes self-management (p<0.05). Diabetes knowledge only indirectly influenced diabetes self-management, through health beliefs. Social support had a direct impact on diabetes self-management (β=0.35, p<0.01), and an indirect influence on diabetes self-management, through treatment adherence (β=0.77, p<0.01). Health beliefs, treatment adherence, and social support directly affect diabetes self-management, and diabetes knowledge indirectly affects diabetes self-management. This suggests that enhancing DR patients' health beliefs, treatment adherence, and social support would facilitate their diabetes self-management. Meanwhile, improved health education can strengthen diabetes knowledge, which in turn, can positively affect diabetes self-management.