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

Abstract

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. 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. 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. The final model provided a good fit to the data (χ2 [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. 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. Self-efficacy plays a direct contributing and mediating role in shaping DSM behaviors. The results of the model can help to develop evidence- and theory-based 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.