Document Type : Original Article


1 Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran

2 Department of Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran

3 Social Determinants of Health Research Center, Department of Health Education and Health Promotion, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

4 Community-oriented Nursing and Midwifery Research Center, Nursing and Midwifery School, Shahrekord University of Medical Sciences, Shahrekord, Iran


Background and aims: Maintaining the health of diabetic people depends on the self-management of the disease. This study aimed to evaluate the relationship of distress, self-efficacy, perceived social support, and self-care with self-management behaviors in the patients with type 2 diabetes.
Methods: The present analytical-descriptive study was conducted on 228 diabetic patients, during 2016-2017. Most of the participants were male (60.6%) and the mean age of them was 51.95±15.04. The participants were selected based on a simple random sampling method after completing the consent form. The required data were collected through questionnaires of distress, self-efficacy, perceived social support, self-care, and self-management. The data were statistically analyzed using SPSS software version 22.0.
Results: Out of 228 participants, 77.3% were married and the highest frequency in terms of educational attainment was related to those with a high school diploma. The results indicated that the duration of affliction with diabetes was less than 10-15 years in 88.9% of the participants. Pearson correlation test demonstrated that the total score of self-management had a significant relationship with the total scores of distress, perceived social support, self-efficacy, and self-care (P<0.005). The results of regression analysis also indicated that distress, perceived social support, self-efficacy, and self-care had a predictive power of 0.43% for self-management. Among these variables, the predictive powers of self-efficacy and self-care were statistically significant, and the prediction rate of self-efficacy was more than that of other ones (β = 0.17).
Conclusion: The study findings showed that the researchers who want to perform interventions based on cognitive-social theory should mainly focus on self-care and self-efficacy.


Main Subjects

1.Bharati DR, Pal R, Rekha R, Yamuna TV. Evaluation of the burden of type 2 diabetes mellitus in population of Puducherry, South India. Diabetes Metab Syndr. 2011;5(1):12-6. doi: 10.1016/j.dsx.2010.05.008. 
2.Sakthiswary R, Zakaria Z, Das S. Diabetes mellitus: Treatment challenges and the role of some herbal therapies. Middle East J Sci Res. 2014;20(7):786-98. doi: 10.5829/idosi. mejsr.2014.20.07.82226. 
3.Amini M, Khadivi R, Haghighi S. Costs of type 2 Diabetes in Isfahan–Iran in 1998. Iran J Endocrinol Metab. 2002;4(2):97- 104. 
4.Smith C, McNaughton DA, Meyer S. Client perceptions of group education in the management of type 2 diabetes mellitus in South Australia. Aust J Prim Health. 2016;22(4):360-7. doi: 10.1071/py15008. 
5.Gallagher KM, Updegraff JA. Health message framing effects on attitudes, intentions, and behavior: a meta-analytic review. Ann Behav Med. 2012;43(1):101-16. doi: 10.1007/s12160- 011-9308-7. 
6.Lin CC, Anderson RM, Chang CS, Hagerty BM, LovelandCherry CJ. Development and testing of the Diabetes Selfmanagement Instrument: a confirmatory analysis. Res Nurs Health. 2008;31(4):370-80. doi: 10.1002/nur.20258. 
7.Kulzer B, Hermanns N, Gorges D, Schwarz P, Haak T. Prevention of diabetes self-management program (PREDIAS): effects on weight, metabolic risk factors, and behavioral outcomes. Diabetes Care. 2009;32(7):1143-6. doi: 10.2337/ dc08-2141. 
8.Al Hayek AA, Robert AA, Al Dawish MA, Zamzami MM, Sam AE, Alzaid AA. Impact of an education program on patient anxiety, depression, glycemic control, and adherence to selfcare and medication in Type 2 diabetes. J Family Community Med. 2013;20(2):77-82. doi: 10.4103/2230-8229.114766. 
9.Hofer R, Choi H, Mase R, Fagerlin A, Spencer M, Heisler M. Mediators and Moderators of Improvements in Medication Adherence. Health Educ Behav. 2017;44(2):285-96. doi: 10.1177/1090198116656331. 
10.Wu SF, Young LS, Yeh FC, Jian YM, Cheng KC, Lee MC. Correlations among social support, depression, and anxiety in patients with type-2 diabetes. J Nurs Res. 2013;21(2):129-38. doi: 10.1097/jnr.0b013e3182921fe1. 
11.Rambod M, Ghodsbin F, Beheshtipour N, Raieyatpishe AA, Mohebi Noubandegani Z, Mohammadi-Nezhad A. The Relationship between Perceived Social Support and Quality of Sleep in Nursing Students. Iran Journal of Nursing. 2012;25(79):12-23. 
12.Yu Y, Yang JP, Shiu CS, Simoni JM, Xiao S, Chen WT, et al. Psychometric testing of the Chinese version of the Medical Outcomes Study Social Support Survey among people living with HIV/AIDS in China. Appl Nurs Res. 2015;28(4):328-33. doi: 10.1016/j.apnr.2015.03.006. 
13.Powers MA, Bardsley J, Cypress M, Duker P, Funnell MM, Fischl AH, et al. Diabetes Self-management Education and Support in Type 2 Diabetes:A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Educ. 2017;43(1):40-53. doi: 10.1177/0145721716689694. 
14.Butler JT. Principles of health education and health promotion.. Englewood, Colo: Morton Publishing Company; 1994.
15.Rogers LQ, Matevey C, Hopkins-Price P, Shah P, Dunnington G, Courneya KS. Exploring social cognitive theory constructs for promoting exercise among breast cancer patients. Cancer Nurs. 2004;27(6):462-73.
16.Rogers LQ, Fogleman A, Verhulst S, Bhugra M, Rao K, Malone J, et al. Refining Measurement of Social Cognitive Theory Factors Associated with Exercise Adherence in Head and Neck Cancer Patients. J Psychosoc Oncol. 2015;33(5):467-87. doi: 10.1080/07347332.2015.1067277. 
17.Gallant MP. The influence of social support on chronic illness self-management: a review and directions for research. Health Educ Behav. 2003;30(2):170-95. doi: 10.1177/1090198102251030. 
18.Polonsky WH, Fisher L, Earles J, Dudl RJ, Lees J, Mullan J, et al. Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes Care. 2005;28(3):626-31.
19.Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. Jama. 2002;288(19):2469-75. 
20.Bruwer B, Emsley R, Kidd M, Lochner C, Seedat S. Psychometric properties of the Multidimensional Scale of Perceived Social Support in youth. Compr Psychiatry. 2008;49(2):195-201. doi: 10.1016/j.comppsych.2007.09.002. 
21.Moghimehfar F, Nasr-Esfahani MH. Decisive factors in medical tourism destination choice: A case study of Isfahan, Iran and fertility treatments. Tour Manag. 2011;32(6):1431-4. doi: 10.1016/j.tourman.2011.01.005.
22.Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943-50. 
23.Lin CC, Wu CC, Wu LM, Chen HM, Chang SC. Psychometric evaluation of a new instrument to measure disease selfmanagement of the early stage chronic kidney disease patients. J Clin Nurs. 2013;22(7-8):1073-9. doi: 10.1111/j.1365- 2702.2011.04048.x. 
24.Nelson KM, McFarland L, Reiber G. Factors influencing disease self-management among veterans with diabetes and poor glycemic control. J Gen Intern Med. 2007;22(4):442-7. doi: 10.1007/s11606-006-0053-8. 
25.Liu MY, Tai YK, Hung WW, Hsieh MC, Wang RH. [Relationships between emotional distress, empowerment perception and self-care behavior and quality of life in patients with type 2 diabetes]. Hu Li Za Zhi. 2010;57(2):49-60. 
26.Schillinger D, Handley M, Wang F, Hammer H. Effects of selfmanagement support on structure, process, and outcomes among vulnerable patients with diabetes: a three-arm practical clinical trial. Diabetes Care. 2009;32(4):559-66. doi: 10.2337/dc08-0787. 
27.Aikens JE, Rosland AM, Piette JD. Improvements in illness self-management and psychological distress associated with telemonitoring support for adults with diabetes. Prim Care Diabetes. 2015;9(2):127-34. doi: 10.1016/j.pcd.2014.06.003. 
28.Kanbara S, Taniguchi H, Sakaue M, Wang DH, Takaki J, Yajima Y, et al. Social support, self-efficacy and psychological stress responses among outpatients with diabetes in Yogyakarta, Indonesia. Diabetes Res Clin Pract. 2008;80(1):56-62. doi: 10.1016/j.diabres.2007.12.015. 
29.Nugent LE, Wallston KA. Modified social learning theory reexamined: correlates of self-management behaviors of persons with Type 2 diabetes. J Behav Med. 2016;39(6):947-56. doi: 10.1007/s10865-016-9753-7. 
30.Morowati Sharifabad MA, Rouhani Tonekaboni N. Social support and self-care behaviors in diabetic patients referring to Yazd Diabetes Research Center. Zahedan Journal of Research in Medical Sciences. 2008;9(4):275-84. [Persian]. 
31.Sarkar U, Fisher L, Schillinger D. Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy? Diabetes Care. 2006;29(4):823-9.