Exploring the relationships between self-efficacy, self-care, and glycaemic control in primary care diabetes management

Abstract

Objectives: Our study aimed to identify the complex interplay between self-efficacy, self-care practice, and glycaemic control among people with type 2 diabetes mellitus (PWDs) to inform the design of more targeted and effective behavioural interventions in primary care.

Methods: A cross-sectional descriptive study was performed with 294 PWDs managed in primary care. The Diabetes Management Self-Efficacy Scale (DMSES) and Summary of Diabetes Self-Care Activities (SDSCA) questionnaire measured patients' self-efficacy and self-care practice. Multivariate logistic regression models were developed to explore how SDSCA, DMSES, and their combined effect relate to glycaemic control, adjusting for patient characteristics. Network analysis in R software examined relationships between self-efficacy and self-care dimensions across glycaemic control subgroups using a Gaussian graphical model with the extended Bayesian information criterion.

Results: Half the PWDs (50.7%) had suboptimal glycaemic control. Better glycaemic control was consistently associated with higher self-efficacy (odds ratio (OR) = 0.76, 95% confidence (CI) (0.60, 0.97), p = 0.03), shorter duration of diabetes (OR = 1.89, 95% CI (1.08, 3.31), p = 0.03), normal waist circumference (OR = 1.76, 95% CI (1.02, 3.05), p = 0.04), absence of diabetes complications (OR = 2.09, 95% CI (1.10, 3.98), p = 0.02), and treatment with oral hypoglycaemic agents (OR = 3.05, 95% CI (1.53, 6.09), p < 0.01). Network analysis among people with well-controlled HbA1c revealed that diet adherence and self-efficacy had the most robust connection, with diet self-efficacy strongly associated with most self-efficacy dimensions. Self-efficacy in exercise, blood glucose monitoring, and foot care are the most central factors in the network structures for PWDs with suboptimal glycaemic control.

Conclusions: Our study highlights the critical role of self-efficacy in diabetes primary care. For people with optimal glycaemic control, prioritising self-efficacy in diet adherence is crucial for sustaining glycaemic outcomes and supporting other self-care behaviours. Among those with suboptimal glycaemic control, enhancing self-efficacy in exercise, blood glucose monitoring, and foot care is essential. Targeted education programs, personalised counselling, and E-health tools can further empower patients to manage their diabetes more effectively.

Keywords: Type 2 diabetes; glycaemic control; network analysis; primary care; self-care; self-efficacy.

Figure 1.

Structure, class categorisation, and functions of different levels in diabetes care within the Vietnamese public healthcare system. Note: The health facility is categorised into class I, II, III, or IV based on its infrastructure and equipment, human resources, health services offered, size, and function.

Figure 2.

Network structure (A) and centrality indices (B) of the total sample. SDSCA_D: diet adherence, SDSCA_E: Exercise adherence, SDSCA_M: medication adherence, SDSCA_B: blood glucose monitoring practice, SDSCA_F: foot care; SES_D: diet self-efficacy, SES_E: Exercise self-efficacy, SES_M: medication adherence self-efficacy, SES_B: blood glucose monitoring self-efficacy, SES_F: foot care self-efficacy.

Figure 3.

Network structures for optimal glycaemic control (A) and suboptimal glycaemic control (B). SDSCA_D: diet adherence, SDSCA_E: Exercise adherence, SDSCA_M: medication adherence, SDSCA_B: blood glucose monitoring practice, SDSCA_F: foot care; SES_D: diet self-efficacy, SES_E: Exercise self-efficacy, SES_M: medication adherence self-efficacy, SES_B: blood glucose monitoring self-efficacy, SES_F: foot care self-efficacy.

Figure 4.

Nodal strength centrality indices for glycaemic control. SDSCA_D: diet adherence, SDSCA_E: Exercise adherence, SDSCA_M: medication adherence, SDSCA_B: blood glucose monitoring practice, SDSCA_F: foot care; SES_D: diet self-efficacy, SES_E: Exercise self-efficacy, SES_M: medication adherence self-efficacy, SES_B: blood glucose monitoring self-efficacy, SES_F: foot care self-efficacy.