Examining the Relationship Between Social Support, Self-Efficacy, Diabetes Self-Management, and Quality of Life Among RuralIndividuals With Type 2 Diabetes in Eastern China:Path Analytical Approach

Background: Patients with type 2 diabetes (T2D) in rural China frequently exhibit inadequate diabetes self-management (DSM)and a reduced quality of life (QoL). Social support and self-efficacy are known to influence DSM and QoL. However, the pathwaysthrough which social support and self-efficacy impact DSM and QoL among patients with T2D in rural China has yet to be fullyelucidated.<br /> Objective: This study offers a foundation for developing policies in rural chronic disease management, thereby, contributingto the improvement of T2D prevention and control in China and other transitional countries. Methods: This study used a cross-sectional design, collecting data from a survey conducted between May and July 2021 onDSM and QoL among rural patients diagnosed with T2D in 2 townships in East China. All patients with T2D were enrolledthrough cluster sampling from the township health center database, and a questionnaire survey was administered by investigators.Structural equation modeling and multiple regression analyses were used to explore the pathways through which social supportinfluences DSM and QoL, as well as the mediating role of self-efficacy.<br /> Results: It was found that the DSM score (mean 37.42, SD 7.70) was less than half of the maximum theoretical score. The QoLscore (mean 48.92, SD 8.88) accounted for 36% of the maximum theoretical score. Social support directly and positively affectedthe DSM and QoL of Chinese rural patients with T2D (P<.01); an increase of 1 unit in social support was associated with a directincrement of 0.339 units in DSM and 0.397 units in QoL. Self-efficacy played a positive mediating role (P<.01), further increasingDSM and QoL by 0.147 and 0.159 units, respectively. The mediating effect of self-efficacy accounted for 30.2% and 28.6% ofthe total effect of social support on DSM and QoL. Furthermore, the family and friend dimension of social support, along withthe symptom and disease management dimensions of self-efficacy, were significantly associated with DSM or QoL (P<.01).<br /> Conclusions: The study confirmed the direct and indirect influences of social support on DSM and QoL and elucidated themediating effect of self-efficacy among rural patients with T2D in eastern China. Interventions should be developed to enhanceboth social support and self-efficacy, creating a positive cycle of mutual reinforcement to improve DSM and QoL among thisgroup