Xinjun Jiang,1 Hua Jiang,2 Mingzi Li2 

1International Nursing School, Hainan Medical University, Haikou, Hainan, People’s Republic of China; 2School of Nursing, Peking University, Beijing, People’s Republic of China

Correspondence: Mingzi Li, Email limingzi@bjmu.edu.cn

Background: The effectiveness of a self-efficacy-focused structured education program for patients with diabetes mellitus has been verified. However, changes in self-efficacy for the behavior change mechanism in patients who participated in the program require clarification.
Aim: To analyze the mechanism of self-management behavioral variations in patients with type 2 diabetes mellitus who underwent a self-efficacy-focused structured education program.
Methods: A secondary analysis of patients who received a self-efficacy-focused structured education program was conducted using data from a multicenter randomized controlled trial. The relationships among the 3-, 6-, and 12-month changes in diabetes knowledge, self-efficacy, diabetes distress, and self-management behaviors in patients with type 2 diabetes mellitus were studied using a structural equation model.
Results: Enhancement of self-efficacy among patients receiving a self-efficacy-focused structured education program directly influenced improvements in self-management behaviors at 3, 6 and 12 months. The increase in diabetes knowledge directly and indirectly improved self-management behaviors at 3 months, but the direct effect on behavior disappeared at 6 months and the indirect effect on behavior by enhancing self-efficacy only lasted until 6 months. The decrease in diabetes distress directly influenced improvement in self-management behaviors at 3 months. While it did not directly influence self-management behavior improvement at 6 and 12 months, it indirectly affected behavior improvement by enhancing self-efficacy.
Conclusion: The enhancement of self-efficacy plays a core role in improving and maintaining self-management behaviors in patients with type 2 diabetes mellitus who receive self-efficacy-focused structured education programs. Patients’ behaviors can be improved by gaining more diabetes knowledge and mitigating diabetes distress at the 3- and 6-month follow-up. Improvements in behaviors at the 12-month follow-up could be achieved by mitigating diabetes distress.

Keywords: diabetes mellitus, type 2, self efficacy, self-management behaviors, structured education, China