PSYCHOSOCIAL AND INTERPERSONAL FACTORS INFLUENCING DIABETES SELF-MANAGEMENT: THE ROLES OF SELF-EFFICACY, PSYCHOLOGICAL STRESS, FAMILY SUPPORT, AND HEALTHCARE COMMUNICATION
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Eliza Zihni Zatihulwani
https://orcid.org/0000-0002-1152-9458
Kusuma Wijaya Ridi Putra
https://orcid.org/0000-0003-2009-0392
Karisma Dwi Ana
Abstract
Background: Diabetes mellitus is a major global health challenge requiring lifelong self-management. Optimal diabetes self-management is influenced not only by clinical factors but also by psychosocial and interpersonal aspects, including self-efficacy, psychological stress, family support, and healthcare communication.
Objective: This study aimed to analyses the influence of psychosocial and interpersonal factors on diabetes self-management among patients with Type 2 Diabetes Mellitus (T2DM).
Methods: A cross-sectional analytical study was conducted among 50 T2DM patients at RSUD Jombang from January to March 2025. Data were collected using validated instruments, including the Summary of Diabetes Self-Care Activities (SDSCA), Diabetes Management Self-Efficacy Scale (DMSES), Perceived Stress Scale (PSS-10), Multidimensional Scale of Perceived Social Support (MSPSS), and a healthcare communication questionnaire. Data analysis included descriptive statistics, correlation tests, and multiple linear regression.
Results: Self-efficacy showed a significant positive correlation with diabetes self-management (r = 0.521; p = 0.001), while psychological stress showed a significant negative correlation (r = -0.463; p = 0.002). Family support (r = 0.487; p = 0.001) and healthcare communication (r = 0.455; p = 0.003) were positively associated with self-management. Multiple regression analysis revealed that all variables significantly influenced diabetes self-management, with self-efficacy as the strongest predictor (β = 0.41; p = 0.002). The model explained 50.7% of the variance. However, this study is limited by its cross-sectional design, small sample size, and reliance on self-reported data, which may affect generalizability and causal interpretation.
Conclusion: Psychosocial and interpersonal factors significantly influence diabetes self-management. Interventions should focus on improving self-efficacy, reducing stress, enhancing family support, and strengthening healthcare communication to improve patient outcomes.
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References
Abshire Saylor, M., DeGroot, L., Pavlovic, N., McIlvennan, C. K., Taylor, J., Gilotra, N. A., … Szanton, S. L. (2023). The Context of Caregiving in Heart Failure: A Dyadic, Mixed Methods Analysis. Journal of Cardiovascular Nursing, 38(4). Retrieved from https://journals.lww.com/jcnjournal/fulltext/2023/07000/the_context_of_caregiving_in_heart_failure__a.9.aspx
Alfatikhatu Khoirun Nisak, Suyanto Suyanto, & Indah Sri Wahyuningsih. (2025). Faktor-Faktor yang Berhubungan dengan Diabetes Self Care Management pada Pasien Diabetes Mellitus Tipe 2. Jurnal Ventilator, 3(1 SE-Articles), 236–246. https://doi.org/10.59680/ventilator.v3i1.1754
AlJohani, K., Kendall, G., & Snider, P. (2024). Predictors of diabetes self-management behaviour among patients with type 2 diabetes mellitus: A cross-sectional study. Diabetes, Metabolic Syndrome and Obesity.
Ataya, J., Soqia, J., Albani, N., Tahhan, N. K., Alfawal, M., Elmolla, O., … Kabalan, Y. (2024). The role of self-efficacy in managing type 2 diabetes and emotional well-being: a cross sectional study. BMC Public Health, 24(1), 3471. https://doi.org/10.1186/s12889-024-21050-2
Bandura, A. (1997). Self-Efficacy: The Exercise of Control. New York: W. H. Freeman.
Engel, G. L. (1977). The Need for a New Medical Model: A Challenge for Biomedicine. Science, 196(4286), 129–136. https://doi.org/10.1126/science.847460
Fisher, L., Hessler, D. M., Polonsky, W. H., & Mullan, J. (2020). When diabetes and self-management intersect: Current findings and future directions. Diabetes Spectrum, 33(2), 197–204.
Ha, J. F., & Longnecker, N. (2021). Doctor–patient communication: A review. Ochsner Journal, 21(3), 255–259. https://doi.org/https://doi.org/10.31486/toj.20.0104
Heo, S., Kang, J., Barbé, T., Kim, J., Slocumb, R. H., Haley, B., & Wright, N. (2025). Relationships of Psychosocial Factors to Diabetes Self-efficacy: A Cross-sectional, Correlational Study. Journal of Cardiovascular Nursing, 40(2). Retrieved from https://journals.lww.com/jcnjournal/fulltext/2025/03000/relationships_of_psychosocial_factors_to_diabetes.7.aspx
Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., … Haire-Joshu, D. (2020). Social Determinants of Health and Diabetes: A Scientific Review. Diabetes Care, 44(1), 258–279. https://doi.org/10.2337/dci20-0053
Innab, A., & Kerari, A. (2024). Validation of the Arabic version of the diabetes self-management questionnaire in patients with type 2 diabetes mellitus: a cross-sectional study. BMC Primary Care, 25(1), 274. https://doi.org/10.1186/s12875-024-02529-8
Ismail, K., Winkley, K., & Rabe-Hesketh, S. (2022). Systematic review and meta-analysis of psychological interventions in diabetes. The Lancet Diabetes & Endocrinology, 10(5), 356–367. https://doi.org/https://doi.org/10.1016/S2213-8587(22)00035-4
Köse, S., Geçkil, E., Sabetsarvestani, R., & Bolat, S. (2024). Examining the interplay of self-efficacy and emotional autonomy on diabetic control index. Journal of Pediatric Nursing: Nursing Care of Children and Families, 78, 60–65. https://doi.org/10.1016/j.pedn.2024.06.003
Maghalian, M., Jafarabadi, M. A., Abbasalizadeh, F., Mohammad-Alizadeh-Charandabi, S., Ghanbari-Homaie, S., & Mirghafourvand, M. (2025). Validation of the Persian version of the summary of diabetes self-care activities scale (SDSCA) in pregnant women with gestational diabetes mellitus using a COSMIN methodology. BMC Endocrine Disorders, 25(1), 103. https://doi.org/10.1186/s12902-025-01931-2
Mayberry, L. S., & Osborn, C. Y. (2021). Family involvement is helpful and harmful to patients’ self-care and glycemic control. Current Diabetes Reports, 21(3), 1–10. https://doi.org/https://doi.org/10.1007/s11892-021-01386-5
Mrayan, L., Abujilban, S., AbuKaraki, A., & Nashwan, A. J. (2024). Evaluate the effectiveness of using non-pharmacological intervention during childbirth: an improvement project in Jordanian maternity hospitals. BMC Women’s Health, 24(1), 605. https://doi.org/10.1186/s12905-024-03414-3
Obura, M., Beulens, J. W. J., Slieker, R., Koopman, A. D. M., Hoekstra, T., Nijpels, G., … Consortium, the I.-D. (2021). Clinical profiles of post-load glucose subgroups and their association with glycaemic traits over time: An IMI-DIRECT study. Diabetic Medicine, 38(2), e14428. https://doi.org/https://doi.org/10.1111/dme.14428
Pamungkas, R. A., Chamroonsawasdi, K., & Vatanasomboon, P. (2021). A systematic review of family support integrated interventions in diabetes self-management. International Journal of Nursing Sciences, 8(3), 289–296.
Powers, M. A., Bardsley, J. K., Cypress, M., Funnell, M. M., Harms, D., Hess-Fischl, A., … Uelmen, S. (2020). Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care, 43(7), 1636–1649. https://doi.org/10.2337/dci20-0023
Rosland, A. M., Heisler, M., & Piette, J. D. (2020). The impact of family behaviors on diabetes self-management. Current Diabetes Reports, 20(12), 1–9. https://doi.org/https://doi.org/10.1007/s11892-020-01377-7
Rosland, A. M., Kieffer, E., Israel, B., Cofield, M., Palmisano, G., Sinco, B., & Heisler, M. (2020). When is Social Support Important? The Association of Family Support and Professional Support with Specific Diabetes Self-Management Behaviors. Journal of General Internal Medicine, 33(1), 1–10.
Rozbroj, T., Lyons, A., & Lucke, J. (2019). Psychosocial and demographic characteristics relating to vaccine attitudes in Australia. Patient Education and Counseling, 102(1), 172–179. https://doi.org/https://doi.org/10.1016/j.pec.2018.08.027
Shen, Y., Wang, T., Gao, M., Wang, F., Zhu, X., Zhang, X., … Sun, X. (2020). Association of glucose control and stages of change for multiple self-management behaviors in patients with diabetes: A latent profile analysis. Patient Education and Counseling, 103(1), 214–219. https://doi.org/https://doi.org/10.1016/j.pec.2019.08.020
Sukma Wicaturatmashudi, Pradana Soewondo, Debie Dahlia, Sali Rahadi Asih, Dewi Gayatri, & Ratna Aryani. (2024). The Impact of Self-Management on the Quality of Life of Patient with Diabetes Mellitus: A Systematic Review. Jurnal Promkes: The Indonesian Journal of Health Promotion and Health Education, 12(1 SE-literature review), 120–128. https://doi.org/10.20473/jpk.V12.I1.2024.120-128
van Son, J., Nyklíček, I., Pop, V. J. M., & Pouwer, F. (2020). Mindfulness-based interventions for diabetes distress. Diabetes Care, 43(4), 812–818. https://doi.org/https://doi.org/10.2337/dc19-1320
Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., … Peng, Z. (2020). Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA, 323(11), 1061–1069. https://doi.org/10.1001/jama.2020.1585
Wang, L., Li, L., Qiu, Y., Li, S., & Wang, Z. (2024). Examining the Relationship Between Social Support, Self-Efficacy, Diabetes Self-Management, and Quality of Life Among Rural Individuals With Type 2 Diabetes in Eastern China: Path Analytical Approach. JMIR Public Health Surveill, 10, e54402. https://doi.org/10.2196/54402
Zaini, N., Idris, I. B., Ahmad, N., Hashim, S. M., Abdullah, N. N., & Shamsusah, N. A. (2025). Enhancing self-care management among women with type 2 diabetes mellitus. Scientific Reports, 15(1), 13093. https://doi.org/10.1038/s41598-025-96308-9