Resilience, self-efficacy and diabetes distress on self-management behaviours in patients newly diagnosed with type 2 diabetes: A moderated mediation analysis

Abstract

Aim: To examine (1) the mediating role of self-efficacy between resilience and self-management behaviours and (2) the moderating role of diabetes distress on the relationship between self-efficacy and self-management behaviours in patients newly diagnosed with type 2 diabetes.

Design: Cross-sectional design.

Methods: Totally, 195 patients newly diagnosed with type 2 diabetes for more than 5 months but less than 18 months were recruited from three endocrine clinics in Taiwan through convenience sampling. Self-reported questionnaires including demographic and disease characteristics, resilience, self-efficacy and self-management behaviours were used to collect data from October 2020 to May 2021. Moderated mediation analysis was performed by Hayes's PROCESS macro.

Result: According to bootstrapping results, the indirect effect of resilience on self-management was significant, although the direct effect of resilience on self-management was not. Participants were categorized into with and without diabetes distress groups. The results of moderated mediation analysis indicated self-efficacy significantly correlated with self-management behaviours in participants without diabetes distress, although self-efficacy did not significantly correlate with self-management in participants with diabetes distress.

Conclusion: The association of resilience with self-management behaviours was fully mediated through self-efficacy with diabetes distress moderating the relationship between self-efficacy and self-management behaviours in patients newly diagnosed with type 2 diabetes.

Impact: Improving resilience could enhance self-efficacy leading to possible improvement in self-management behaviour, although improving self-efficacy might not benefit self-management behaviours for those with high levels of diabetes distress. Healthcare providers need to first assess and address the diabetes distress before intervening to improve self-efficacy to enhance self-management behaviours in patients newly diagnosed with type 2 diabetes.

Patient or public contribution: When designing this study, two patients newly diagnosed with diabetes were consulted about the importance of self-management behaviours for them personally.

Keywords: diabetes distress; mediator; moderator; newly diagnosed; nursing; psychological characteristics; resilience; self-care; self-efficacy; self-management; type 2 diabetes.