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 (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.
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 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.