Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Nov 8, 2023
Date Accepted: Aug 6, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Structural Equation Model for Social Support, Self-Efficacy, Diabetes Self-Management, and Quality of Life among Rural Individuals with Type 2 Diabetes in Eastern China
ABSTRACT
Background:
Type 2 diabetes (T2D) patients in rural China often demonstrate inadequate diabetes self-management (DSM) and a lower quality of life (QoL). Social support and self-efficacy can influence DSM or QoL. However, the causal pathway linking social support, self-efficacy, DSM, and QoL among T2D patients in rural China has yet to be fully elucidated.
Objective:
The objectives of the study are to explore the direct and indirect influences of social support on DSM and QoL and to investigate the mediating role of self-efficacy.
Methods:
Based on a survey among rural T2D patients in eastern China, we employed structural equation model (SEM) to conduct a path analysis to explore the direct and indirect influences of social support on DSM and QoL and to investigate the mediating role of self-efficacy.
Results:
It was found that the DSM score was less than half of the maximum theoretical score. The dimension of medication adherence behaviors exhibited the highest score (5.92) and blood glucose monitoring behaviors showed the lowest score (1.23). The QoL score accounted for 36% of the maximum theoretical score. The dimension of social relationships demonstrated the lowest score (1.33) and physiological function garnered the highest score (2.03). Social support directly and positively affected the DSM and QoL of Chinese rural T2D patients; an increase of 1 unit in social support was associated with a direct increment of 0.339 units in DSM and 0.397 units in QoL. Self-efficacy played a positive mediating role, further increasing DSM and QoL by 0.147 and 0.159 units respectively. The mediating effect of self-efficacy accounted for 30.2% and 28.6% of the total impact of social support on DSM and QoL.
Conclusions:
The study confirmed the direct and indirect influences of social support on DSM and QoL and elucidated the mediating effect of self-efficacy among rural T2D patients in eastern China. Interventions aimed at both fostering social support and self-efficacy should be developed to create a positive cycle of mutual reinforcement to improve DSM and QoL among this group.
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