Effects of self-care, self-efficacy, social support on glycemic control in adults with type 2 diabetes

Background: A number of studies have examined the influence of self-efficacy, social support and patient-provider communication (PPC) on self-care and glycemic control. Relatively few studies have tested the pathways through which these constructs operate to improve glycemic control, however. We used structural equation modeling to examine a conceptual model that hypothesizes how self-efficacy, social support and patient-provider communication influence glycemic control through self-care behaviors in Chinese adults with type 2 diabetes. Methods: We conducted a cross-sectional study of 222 Chinese adults with type 2 diabetes in one primary care center. We collected information on demographics, self-efficacy, social support, patient-provider communication (PPC) and diabetes self-care. Hemoglobin A1c (HbA1c) values were also obtained. Measured variable path analyses were used to determine the predicted pathways linking self-efficacy, social support and PPC to diabetes self-care and glycemic control. Results: Diabetes self-care had a direct effect on glycemic control (beta = -0.21, p = .007), No direct effect was observed for self-efficacy, social support or PPC on glycemic control. There were significant positive direct paths from self-efficacy (beta = 0.32, p < .001), social support (beta = 0.17, p = .009) and PPC (beta = 0.14, p = .029) to diabetes self-care. All of them had an indirect effect on HbA1c (beta = -0.06, beta = -0.04, beta = -0.03 respectively). Additionally, PPC was positively associated with social support (gamma = 0.32, p < .001). Conclusions: Having better provider-patient communication, having social support, and having higher self-efficacy was associated with performing diabetes self-care behaviors; and these behaviors were directly linked to glycemic control. So longitudinal studies are needed to explore the effect of self-efficacy, social support and PPC on changes in diabetes self-care behaviors and glycemic control.