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Cognitive and Behavioral Transformation in Type 2 Diabetes Through a Self-Efficacy-Focused Structured Education
Xinjun Jiang1, Hua Jiang2, Rongsong Tang3
1School of Nursing, Hainan Medical University, Haikou, Hainan, People's Republic of China.
Patient Preference and Adherence
|February 25, 2026
Summary
Adults with type 2 diabetes transformed their self-management through reflective learning, developing enhanced self-efficacy and cognitive-behavioral changes. This led to sustained healthy habits and improved diabetes self-management.
Area of Science:
- Endocrinology
- Behavioral Science
- Health Education
Background:
- Type 2 diabetes requires lifelong self-management.
- Structured education programs aim to improve self-care behaviors.
- Sustaining self-management post-intervention remains a challenge.
Purpose of the Study:
- To explore adult perceptions of sustained self-management 12 months after a Self-Efficacy-Focused Structured Education Program (SSEP).
Main Methods:
- Descriptive qualitative design utilizing in-depth, semi-structured interviews.
- Seventeen participants from a multicenter randomized controlled trial in China were interviewed.
- Braun and Clarke's reflexive thematic analysis was employed for data analysis.
Main Results:
- Five themes emerged: restructuring diabetes cognition, enhancing self-efficacy, reshaping mindset, reconstructing behaviors, and identifying influencing factors.
- Participants demonstrated a cognitive-behavioral transformation driven by reflective learning.
- Sustained behavioral change was facilitated by this transformation.
Conclusions:
- A dual-process mechanism involving reflective learning (System 2) evolving into automatic habits (System 1) supports sustained self-management.
- Integrating contextual cues, visual prompts, and mobile nudges can enhance habit formation and adherence.
- Combining reflective training with family and community support can strengthen long-term diabetes self-management.
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