Chen Meijun, Yun Qingping, Lin Haoxiang, Liu Shenglan, Liu Yihua, Shi Yuhui, Ji Ying, Chang Chun
School of Public Health, Peking University, Beijing, People's Republic of China.
Department of Social Development, Development Research Center of the State Council, Beijing, People's Republic of China.
Patient Prefer Adherence. 2022 Apr 6;16:925-936. doi: 10.2147/PPA.S335363. eCollection 2022.
Self-management behavior (SMB) plays a significant role in glycemic control. This study aimed to explore the factors related to SMB among patients with type 2 diabetes and how these factors interacted with each other.
Patients diagnosed with type 2 diabetes were recruited from 18 community healthcare stations (CHSs) from six community healthcare centers (CHCs) in Beijing, China from April to May in 2017. Motivation, competence, autonomy support, social support, self-management skills, adherence to self-monitoring of blood glucose (SMBG) and haemoglobin A1c (HbA1c) measurement were tested by questionnaire. Correlation analysis and path analysis were performed so as to identify the factors associated with patients' SMB.
A total of 532 participants completed this study. Participants who have good compliance to SMBG got higher scores in social support (F = 7.68, p = 0.01), competence (F = 10.47, p = 0.01), and skills (F = 12.34, p < 0.01). Higher competence (β = 0.03, P < 0.001), higher social support (β = 0.01, P < 0.001), better skills(β = 0.01, P < 0.001) directly led to better adherence to SMBG. Social support had a positive effect on autonomy support (β = 0.69, P < 0.001), motivation (β = 0.45, P < 0.001), competence (β = 0.28, P < 0.001), skills (β = 0.14, P < 0.001), which was also indirectly linked to better adherence to SMBG. Better self-management skills directly led to better adherence to HbA1c measurement (β = 0.03, P < 0.001). Social support had a positive effect on autonomy support (β = 0.69, P < 0.001), motivation (β = 0.45, P < 0.001), competence (β = 0.28, P < 0.001), skills (β = 0.14, P < 0.001), which was also indirectly linked to better adherence to HbA1c measurement.
Self-determination theory and social support theory were practical in explaining SMB in Chinese population. Competence, motivation and social support played an important role in diabetic self-management. Paying attention to the promotion of individual's intrinsic motivation and self-efficacy may be able to help patients maintain self-management behavior in the long-term routine.
自我管理行为（SMB）在血糖控制中起着重要作用。本研究旨在探讨2型糖尿病患者中与SMB相关的因素以及这些因素之间如何相互作用。
2017年4月至5月，从中国北京6个社区卫生服务中心（CHC）的18个社区卫生站（CHS）招募诊断为2型糖尿病的患者。通过问卷调查测试动机、能力、自主支持、社会支持、自我管理技能、血糖自我监测（SMBG）依从性和糖化血红蛋白（HbA1c）测量。进行相关分析和路径分析以确定与患者SMB相关的因素。
共有532名参与者完成了本研究。对SMBG依从性良好的参与者在社会支持（F = 7.68，p = 0.01）、能力（F = 10.47，p = 0.01）和技能（F = 12.34，p < 0.01）方面得分更高。更高的能力（β = 0.03，P < 0.001）、更高的社会支持（β = 0.01，P < 0.001）、更好的技能（β = 0.01，P < 0.001）直接导致对SMBG更好的依从性。社会支持对自主支持（β = 0.69，P < 0.001）、动机（β = 0.45，P < 0.001）、能力（β = 0.28，P < 0.001）、技能（β = 0.14，P < 0.001）有积极影响，这也与对SMBG更好的依从性间接相关。更好的自我管理技能直接导致对HbA1c测量更好的依从性（β = 0.03，P < 0.001）。社会支持对自主支持（β = 0.69，P < 0.001）、动机（β = 0.45，P < 0.001）、能力（β = 0.28，P < 0.001）、技能（β = 0.14，P < 0.001）有积极影响，这也与对HbA1c测量更好的依从性间接相关。
自我决定理论和社会支持理论在解释中国人群的SMB方面具有实用性。能力、动机和社会支持在糖尿病自我管理中起重要作用。关注促进个体的内在动机和自我效能可能有助于患者在长期日常中维持自我管理行为。
