基于ITHBC模型的糖尿病知识、自我效能对农村2型糖尿病患者自我管理和生存质量的影响路径研究

BackgroundThe elderly population in rural China is substantialand health services are insufficientleading to a lower level of self-management and a higher risk of mortality among patients with type 2 diabetes mellitusT2DM. Improving diabetes knowledge can enhance self-efficacydiabetes self-managementDSMand quality of lifeQoL. Thereforediabetes knowledge and self-efficacy are pivotal for DSM and QoL of T2DM patients. ObjectiveTo elucidate the pathways through which diabetes knowledge and self-efficacy influence DSM and QoL among rural T2DM patients. MethodsA cross-sectional study design was used to sample 2 193 rural T2DM patients from Binhai CountyJiangsu Provincein August 2022employing randomized whole-cluster sampling. The Diabetes Patient Knowledge ScaleADKnowlthe Self-Efficacy Scale for Chronic DiseasesSECD6the Self-Management Behavioral Scale for Diabetic PatientsSDSCAand the Diabetes Survival Quality Specificity ScaleDSQL were utilized to assess the participants. A total of 2 01091.66% valid questionnaires were obtained. A model was developed based on the Integrated Theory of Health Behavior ChangeITHBC and multiple linear regression analyses were conducted to explore the impact of the ADKnowl and SECD6 scores on the SDSCA and DSQL scores. ResultsThe ADKnowlSECD6SDSCAand DSQL scores of rural T2DM patients were52.516.5 6.41.237.96.9and48.38.6. The results of multiple linear regression analysis showed that the direct effect of ADKnowl scores on SDSCA scores was 0.156P<0.05the mediating effect of SECD6 scores in it was 0.012P<0.05 and the indirect effect accounted for 7.1% of the total effect; the direct effect of ADKnowl scores on DSQL scores was -0.048 P<0.05in which the indirect effects of SECD6 score and SDSCA score were -0.041 and -0.012P<0.05accounting for 40.6% and 11.9% of the total effectrespectively. In additionfoot care=0.352 and diet=0.161 dimension scores in ADKnowl had a positive effect on SDSCA scoresP<0.05and reducing the risk of complications=-0.213 exercise=-0.117and diet=-0.197 dimension scores had a negative effect on DSQL scoresP<0.05. Symptom management self-efficacy=-0.115and disease co-management self-efficacy=-0.397 dimension scores in SECD6 had a negative effect on DSQL scoresP<0.05. ConclusionDiabetes knowledge improves the level of DSM and QoL in rural T2DM patientswith a positive mediating effect of self-efficacy and self-management. Additionallythe acquisition of diabetesrelated knowledgesuch as dietexerciseand foot caresignificantly improves the level of DSM and QoL of patients. It is recommended that multisectoral collaborationlong-term health educationand social support resources be provided to enhance healthcare professionals' attention to the knowledge and self-efficacy of diabetic patientseffectively improving DSM and QoL of rural T2DM patients.