Application of the Social Cognitive Theory to Predict Self-Care Behavior among Type 2 Diabetes Patients with Limited Health Literacy

Document Type : Original Article


1 Department of Health Education and Health Promotion, Faculty of Health, Bushehr University of Medical Sciences, Bushehr, Iran

2 Department of Epidemiology and Bio-Statistics, Faculty of Health, Bushehr University of Medical Sciences, Bushehr, Iran

3 Bushehr University of Medical SciencesDepartment of Health Education and Health Promotion, Faculty of Health, Bushehr University of Medical Sciences, Bushehr, Iran


Background and Objective: Although compliance with self-care behaviors is necessary for the successful management of diabetes, patients with diabetes often refuse favorable self-care. This study was conducted to determine the factors influencing self-care behaviors among type-2 diabetic patients who had limited health literacy based on social cognitive theory (SCT).

Materials and Methods: A cross-sectional study was conducted among 293 diabetic patients with limited health literacy that was identified by S-TOFHLA. The data were collected using the summary of diabetes self-care activities, diabetes management self-efficacy scale, outcome expectancies questionnaire, and a researcher-made questionnaire for collecting data related to self-regulation and social support constructs. Data were analyzed by SPSS ver.22 using multiple linear regression to determine the predictors of self-care behaviors.

 Results: In the case of patient’s adherence to self-care tasks, they had the best adherence to medication regime and the worst adherence to physical activity. Employment status (p <0.032, β=3.57), supplementary insurance (p <0.018, β=1.74), and history of participating in diabetes education classes (p <0.044, β=1.63) were predictors of self-care behaviors in the studied patients. Among the SCT constructs, perceived self-efficacy (p <0.001, β=0.21) predicted self-care ability. The mean score of self-care increased around 0.21 by increasing one single unit of self-efficacy. Overall, these factors predicted 67% (R2 = 0.67) of self-care changes.

Conclusions: The results of this study showed that self-efficacy and demographic variables are significant predictors to improve self-care ability among diabetic patients with limited health literacy.  


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