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Mediating Role of Diabetes Self-Efficacy in the Relationship Between Knowledge and Self-Management in Individuals
Seongkum Heo1, Tammy Barbé, Justus Randolph
1Seongkum Heo, PhD, RN, Professor, Georgia Baptist College of Nursing, Mercer University, Atlanta, Georgia. Tammy Barbé, PhD, RN, Dean, Georgia Baptist College of Nursing, Mercer University, Atlanta, Georgia. Justus Randolph, PhD, Professor, Georgia Baptist College of Nursing, Mercer University, Atlanta, Georgia. JinShil Kim, PhD, RN, Professor, College of Nursing, Gachon University, Yeonsu-gu, Incheon, South Korea. JungHee Kang, PhD, MPH, RN, Assistant Professor, College of Nursing, University of Kentucky, Lexington, Kentucky.
Background:
Poor diabetes self-management is prevalent in individuals with diabetes and can result in macro- and micro-cardiovascular diabetes complications. Diabetes knowledge may impact diabetes self-management directly and indirectly via the impact on diabetes self-efficacy. However, these relationships have rarely been examined among individuals with diabetes, controlling for potential psychosocial, demographic, and clinical covariates.
Objective:
To investigate whether diabetes knowledge was associated with diabetes self-management directly and indirectly via diabetes self-efficacy, controlling for depressive symptoms, diabetes distress, self-esteem, self-compassion, resilience, social support, body mass index, and age.
Methods:
Baseline data from 2 studies were used in this cross-sectional, correlational study. Data on all study and demographic variables were collected from 228 adults with diabetes (mean age: 56.5 years) in 2023 and 2025. PROCESS Macro for the Statistical Package for Social Sciences (Model 4; 5000 bootstraps; 95% confidence intervals [CIs]) was used to examine the suggested relationships.
Results:
The mean diabetes knowledge score was 10.7 out of 13 (standard deviation [SD] = 1.9); the mean diabetes self-efficacy score was 28.0 (SD = 6.1); and the mean diabetes self-management score was 18.0 (SD = 6.3). Stronger diabetes knowledge showed a direct relationship with better diabetes self-management (effect(B) = 0.779, 95% bootstrap CI = 0.401, 1.157) and an indirect relationship through higher levels of diabetes self-efficacy (effect(B) = 0.193, 95% bootstrap CI = 0.078, 0.333).
Conclusions:
Diabetes knowledge was associated with diabetes self-management directly and indirectly via diabetes self-efficacy. Clinicians and researchers may modify diabetes knowledge to improve diabetes self-efficacy, and, in turn, diabetes self-management.
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