A Qualitative Study Exploring the Mechanisms Underlying Self-Management Behaviours Among Community-Dwelling Type 2...

Effective self-management is essential for improving the health outcomes of patients with type 2 diabetes mellitus (T2DM). However, many patients fail to achieve ideal self-management. This qualitative study, grounded in the theory of planned behaviour (TPB), aims to explore the mechanisms underlying self-management behaviours of patients with T2DM in the community, to provide insights for improve patients' self-management and reduce the disease burden.

Within the framework of the TPB, a semi-structured interview guide was developed based on a literature review and expert consensus. Qualitative data were obtained from in-depth interviews with 21 patients with T2DM from a community health service centre in Nanjing, Jiangsu Province. All interviews were conducted by the same interviewer to ensure consistency. Content analysis was used to identify the key factors influencing patients' self-management behaviours and the underlying mechanism.

This study systematically explained the underlying mechanisms of self-management behaviours among patients with T2DM based on Ajzen's TPB, including three key levels: (1) Attitudes towards self-management: shaped by both internal (e.g., self-perception, perceived importance and understanding of the disease) and external factors (e.g., perceived benefits and degree of acceptance). (2) Subjective norms: influenced by both intrinsic (e.g., personal motivations) and extrinsic pressures (e.g., surrounding individuals and social groups). (3) Perceived behavioural control: determined by both inner (e.g., personal characteristics, physical and mental experience, economic resources and time management) and outer factors (e.g., environmental suitability, policy support and technical availability).

This study provides a valuable theoretical basis and practical implications for designing effective interventions to improve self-management behaviours of patients with T2DM in the community. To optimize self-management behaviours of this population, a multifaceted approach is recommended, focusing on the following six key areas: improving T2DM knowledge, strengthening follow-up management system, empowering patients to take an active role in their care, fostering social support network, developing their own coping skills and expanding policy support for T2DM care.

Patients with T2DM were actively involved in this study, providing essential insights and feedback throughout. Their first-hand experiences contributed to the identification of sub-categories and categories. Participants also reviewed and confirmed the accuracy of the interview transcripts, ensuring the reliability of the data.