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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (3): 450-455. doi: 10.19723/j.issn.1671-167X.2023.03.010

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Mediating effect of self-efficacy on self-management ability and self-management behavior in patients with type 2 diabetes mellitus

Xiao-yue ZHANG1,Yu-xin LIN1,Ying JIANG2,Lan-chao ZHANG1,Mang-yan DONG3,Hai-yi CHI4,Hao-yu DONG5,Li-jun MA6,Zhi-jing LI1,Chun CHANG1,*()   

  1. 1. Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
    2. Bee Technology Limited Company, Beijing 100020, China
    3. Department of Endocrinology, Houma People' s Hospital, Houma 043011, Shanxi, China
    4. Department of Endocrinology, Hohhot First Hospital, Hohhot 010030, China
    5. Department of Endocrinology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi, China
    6. Department of Endocrinology, People' s Hospital of Xinrong District, Datong 037002, Shanxi, China
  • Received:2023-03-02 Online:2023-06-18 Published:2023-06-12
  • Contact: Chun CHANG E-mail:changchun@bjmu.edu.cn

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Abstract:

Objective: To investigate the mechanism of self-efficacy between self-management ability and self-management behavior and its differences among patients with different disease courses through mediation tests. Methods: In the study, 489 patients with type 2 diabetes who attended the endocrinology departments of four hospitals in Shanxi Province and Inner Mongolia Autonomous Region from July to September 2022 were enrolled as the study population. They were investigated by General Information Questionnaire, Diabetes Self-Management Scale, Chinese version of Diabetes Empowerment Simplified Scale, and Diabetes Self-Efficacy Scale. Mediation analyses were performed using the linear regression model, Sobel test, and Bootstrap test in the software Stata version 15.0 and divided the patients into different disease course groups for subgroup analysis according to whether the disease course was > 5 years. Results: In this study, the score of self-management behavior in the patients with type 2 diabetes was 6.16±1.41, the score of self-management ability was 3.99±0.74, and the score of self-efficacy was 7.05±1.90. The results of the study showed that self-efficacy was positively correlated with self-management ability (r=0.33) as well as self-management behavior (r=0.47) in the patients with type 2 diabetes (P < 0.01). The mediating effect of self-efficacy accounted for 38.28% of the total effect of self-management ability on self-management behaviors and was higher in the behaviors of blood glucose monitoring (43.45%) and diet control (52.63%). The mediating effect of self-efficacy accounted for approximately 40.99% of the total effect for the patients with disease course ≤ 5 years, while for the patients with disease course > 5 years, the mediating effect accounted for 39.20% of the total effect. Conclusion: Self-efficacy enhanced the effect of self-management ability on the behavior of the patients with type 2 diabetes, and this positive effect was more significant for the patients with shorter disease course. Targeted health education should be carried out to enhance patients' self-efficacy and self-management ability according to their disease characteristics, to stimulate their inner action, to promote the development of their self-management behaviors, and to form a more stable and long-term mechanism for disease management.

Key words: Type 2 diabetes, Self-management behavior, Self-management ability, Self-efficacy, Mediation effect

CLC Number: 

  • R193.3

Table 1

Sociodemographic and disease characteristics in patients with type 2 diabetes"

Characteristics Value
Age/years, $\bar x \pm s$ 50.8±11.2
Gender, n (%)
  Male 305 (62.4)
  Female 184 (37.6)
Ethnicity, n (%)
  Han 466 (95.3)
  Other 23 (4.7)
Marriage, n (%)
  Unmarried 16 (3.3)
  Married 439 (89.8)
  Other 34 (7.0)
Education attainment, n (%)
  Middle school or lower 229 (46.8)
  High school 118 (24.1)
  Bachelor and above 142 (29.0)
Occupational status, n (%)
  Yes 319 (65.2)
  Other 170 (34.8)
Disease course/years, M (P25, P75) 4.00 (1.00, 7.88)
Disease course, n (%)
  ≤5 years 286 (58.5)
  >5 years 203 (41.5)
Diabetes complications, n (%)
  Yes 173 (35.4)
  No 316 (64.6)
Family history of diabetes, n (%)
  Yes 193 (39.5)
  No 296 (60.5)

Table 2

Scores of self-management behavior, self-efficacy and self-management ability in patients with type 2 diabetes"

Variable Course≤ 5 years Course> 5 years Total t P
Self-management behavior, $\bar x \pm s$ 6.30±1.50 5.95±1.25 6.16±1.41 2.71 0.007
  Blood glucose monitoring 5.98±2.33 5.44±1.76 5.76±2.13 2.83 0.005
  Medication adherence 7.09±2.37 6.73±2.22 6.94±2.32 1.70 0.090
  Diet control 6.43±1.92 6.19±1.69 6.33±1.83 1.48 0.140
  Physical activity 6.34±2.09 5.92±2.05 6.16±2.08 2.22 0.027
  Physician contact 5.98±1.42 5.73±1.46 5.88±1.44 1.91 0.056
Self-management ability, $\bar x \pm s$ 4.02±0.76 3.94±0.72 3.99±0.74 1.29 0.197
Self-efficacy, $\bar x \pm s$ 7.02±1.96 7.09±1.81 7.05±1.90 -0.41 0.679

Figure 1

Mediating effect of the self-efficacy in the association between self-management ability and self-management behaviors in patients ** P < 0.01. SMA, self-management ability; SMB, self-management behavior; SE, self-efficacy. Model controlled for age, gender, marriage, ethnicity, occupational status, education attainment and household registration."

Figure 2

Mediating effect of the self-efficacy in the association between self-management ability and various dimensions of self-management behaviors * P < 0.05, ** P < 0.01. SMA, self-management ability; BGM, blood glucose monitoring; SE, self-efficacy; MA, medication adherence; DC, diet control; PA, physical activity; PC, physician contact. Model controlled for age, gender, marriage, ethnicity, occupational status, education attainment and household registration."

Table 3

Sobel tests and Bootstrap tests of mediating effect for self-efficacy"

Sobel test Total effect Direct effect Indirect effect Bootstrap 95%CI Proportion of mediating effect
Model 1
  SMA→SMB 0.66** 0.41** 0.25** 0.17, 0.35 37.58%
  SMA→BGM 0.66** 0.40* 0.27** 0.16, 0.41 40.27%
  SMA→MA 0.83** 0.52** 0.31** 0.19, 0.45 37.51%
  SMA→DC 0.69** 0.33** 0.35** 0.25, 0.49 51.45%
  SMA→PA 0.76** 0.51** 0.25** 0.16, 0.40 33.13%
  SMA→PC 0.38** 0.32** 0.06 0.00, 0.12 15.01%
Model 2 (Controlled for social-demographic variables)
  SMA→SMB 0.64** 0.39** 0.24** 0.17, 0.34 38.28%
  SMA→BGM 0.62** 0.35* 0.27** 0.17, 0.43 43.45%
  SMA→MA 0.75** 0.45* 0.30** 0.19, 0.45 40.32%
  SMA→DC 0.67** 0.32* 0.35** 0.26, 0.49 52.63%
  SMA→PA 0.76** 0.52** 0.24** 0.14, 0.37 31.82%
  SMA→PC 0.37** 0.31* 0.05 -0.001, 0.12 14.88%

Table 4

Sobel tests and Bootstrap tests of mediating effect for self-efficacy in patients with different disease courses"

Sobel test Total effect Direct effect Indirect effect Bootstrap 95%CI Proportion of mediating effect
Course ≤ 5 years
  SMA→SMB 0.68** 0.40** 0.28** 0.18, 0.42 40.99%
  SMA→BGM 0.77** 0.40* 0.37** 0.21, 0.58 47.51%
  SMA→MA 0.72** 0.38* 0.34** 0.18, 0.56 47.60%
  SMA→DC 0.66** 0.24 0.42** 0.27, 0.62 64.25%
  SMA→PA 0.78** 0.52* 0.26** 0.15, 0.46 33.89%
  SMA→PC 0.44** 0.44** 0.01 -0.07, 0.10 2.04%
Course > 5 years
  SMA→SMB 0.51** 0.31* 0.20** 0.08, 0.34 39.20%
  SMA→BGM 0.31 0.18 0.14* 0.02, 0.31 43.75%
  SMA→MA 0.45** 0.28* 0.16* 0.12, 0.53 36.45%
  SMA→DC 0.63** 0.35* 0.28* 0.10, 0.47 44.54%
  SMA→PA 0.74** 0.47* 0.27* 0.09, 0.38 36.46%
  SMA→PC 0.20 0.11 0.10* 0.01, 0.20 47.54%
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