Email Alert | RSS

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

Previous Articles     Next Articles

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

RICH HTML

   

PDF (PC)

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%
1 American Diabetes Association .Prevention or delay of type 2 diabetes: Standards of medical care in diabetes—2020[J].Diabetes Care,2020,43(Suppl 1):S32-S36.
2 American Diabetes Association .Lifestyle management: Standards of medical care in diabetes—2019[J].Diabetes Care,2019,42(Suppl 1):S46-S60.
3 Burford SJ , Park S , Dawda P .Small data and its visualization for diabetes self-management: Qualitative study[J].JMIR Diabetes,2019,21(8):e10324.
4 李至韬, 李玟, 费宇, 等.职业人群的糖尿病及糖尿病前期患病现状及影响因素分析[J].现代预防医学,2021,48(12):2161-2165.
5 曹俊, 林琴, 付梦雪, 等.近10年我国糖尿病病人自我管理现状、热点与趋势的可视化分析[J].护理研究,2019,33(6):937-940.
6 Funnell MM , Anderson RM , Arnold MS , et al.Empowerment: An idea whose time has come in diabetes education[J].Diabetes Educ,1991,17(1):37-41.
doi: 10.1177/014572179101700108
7 叶会玲.授权理论在糖尿病教育中的应用现状[J].护理研究,2010,24(2):97-100.
8 King DK , Glasgow RE , Toobert DJ , et al.Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors[J].Diabetes Care,2010,33(4):751-753.
doi: 10.2337/dc09-1746
9 Lee AA , Piette JD , Heisler M , et al.Diabetes self-management and glycemic control: The role of autonomy support from informal health supporters[J].Health Psychol,2019,38(2):122-132.
doi: 10.1037/hea0000710
10 李超群, 井坤娟, 刘昱莹, 等.糖尿病自我管理量表的汉化及信效度评价[J].现代预防医学,2018,45(24):4477-4481.
11 Ritter PL , Lorig K , Laurent DD .Characteristics of the Spanish- and English-language self-efficacy to manage diabetes scales[J].Diabetes Educ,2016,42(2):167-177.
doi: 10.1177/0145721716628648
12 刘红云, 温忠麟, 张雷, 等.中介效应检验程序及其应用[J].心理学报,2004,36(5):614-620.
13 Chiou S , Liao K , Lin K , et al.Using patient health profile evaluation for predicting the likelihood of retinopathy in patients with type 2 diabetes: A cross-sectional study using latent profile analysis[J].Int J Environ Res Public Health,2022,19(10):6084.
14 Boussageon R , Pouchain D , Renard V .Prevention of complications in type 2 diabetes: Is drug glucose control evidence based?[J].Br J Gen Pract,2017,67(655):85-87.
15 麻倩, 郭玉芳, 井坤娟.糖尿病患者自我管理现状及影响因素研究[J].现代预防医学,2019,46(5):915-920.
16 Lee Y , Shin S , Wang R , et al.Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus[J].Patient Educ Couns,2016,99(2):287-294.
17 van Smoorenburg AN , Hertroijs DFL , Dekkers T , et al.Patients' perspective on self-management: Type 2 diabetes in daily life[J].BMC Health Serv Res,2019,19(1):605.
18 刘彩云, 尤莉莉.社会认知理论在促进糖尿病和糖尿病前期患者体力活动中的应用[J].中国健康教育,2021,37(11):1037-1040.
19 丁贤彬, 张春华, 沈卓之, 等.健康自我管理对糖尿病患者不同自我效能的影响[J].实用预防医学,2016,23(11):1322-1325.
20 张洁, 苏丹婷, 陆凤, 等.社区自我管理小组对糖尿病患者自我效能的远期影响研究[J].中国健康教育,2022,38(2):140-144.
[1] Hewei MIN, Yibo WU, Yuhui SHI, Mingzi LI, Xinying SUN. Analyzing the influential factors of dietary patterns and blood glucose control in type 2 diabetes patients based on the model of health action process approach model [J]. Journal of Peking University (Health Sciences), 2025, 57(6): 1145-1152.
[2] Ziyan CHEN, Xiaoyue ZHANG, Yiwu GU, Chun CHANG. Type 2 diabetes patients use E-health to manage disease willingness and influence mechanisms [J]. Journal of Peking University (Health Sciences), 2025, 57(3): 522-528.
[3] Ziyuan FU, Fei YANG, Mo ZHOU, Xinxuan LI, Ruoning WANG, Ningxuan CUI, Jing HUANG, Yixin ZHANG, Huafang JIANG, Yuhua GUO, Hong ZHOU. Influencing factors of responsive caregiving among infant mothers in Weifang City [J]. Journal of Peking University (Health Sciences), 2025, 57(3): 481-486.
[4] Li WANG, Chao GAO, Huanhuan REN, Yanping SHEN, Xiaowei HUANG, Hong YAO, Dandan HAN. Current status and influential factors of self-management ability in patients with systemic lupus erythematosus [J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1029-1035.
[5] Lei BAO,Xia-xia CAI,Ming-yuan ZHANG,Lei-lei REN. Effect of vitamin D3 on mild cognitive impairment in type 2 diabetic mice and its possible mechanism [J]. Journal of Peking University (Health Sciences), 2023, 55(4): 587-592.
[6] Huan YU,Ruo-tong YANG,Si-yue WANG,Jun-hui WU,Meng-ying WANG,Xue-ying QIN,Tao WU,Da-fang CHEN,Yi-qun WU,Yong-hua HU. Metformin use and risk of ischemic stroke in patients with type 2 diabetes: A cohort study [J]. Journal of Peking University (Health Sciences), 2023, 55(3): 456-464.
[7] CHEN Ping,LI Ze-ming,GUO Yi,SUN Xin-ying,Edwin B. FISHER. To explore medication adherence of patients with type 2 diabetes mellitus using the latent profile analysis based on the Big Five personality theory [J]. Journal of Peking University (Health Sciences), 2021, 53(3): 530-535.
[8] Ze-ming LI,Min GAO,Xue-ying CHEN,Xin-ying SUN. Relationship between the five-factor model of personality traits and self-management attitude of patients with type 2 diabetes [J]. Journal of Peking University (Health Sciences), 2020, 52(3): 506-513.
[9] Jiang XIE,Fei LI. Association of sleep overlap syndrome with type 2 diabetes in a cross-sectional study [J]. Journal of Peking University(Health Sciences), 2019, 51(2): 252-255.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd