Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus.
OBJECTIVE
To validate a hypothesized model exploring the influencing pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycosylated hemoglobin (HbA1c) levels in patients with type 2 diabetes (T2DM).


METHODS
Overall, 295 patients with T2DM were recruited from five endocrine clinics in Taiwan through convenience sampling. Data regarding personal characteristics, empowerment perceptions, health literacy, self-efficacy, self-care behaviors, and HbA1c levels were collected. A structural equation modeling was used to validate the hypothesized model.


RESULTS
Significant direct pathways were determined from empowerment perceptions to health literacy, from health literacy to self-efficacy, from self-efficacy to self-care behaviors, and from self-care behaviors to HbA1c levels.


CONCLUSIONS
The empowerment perceptions and health literacy relatively influenced self-efficacy and self-care behaviors. Self-efficacy and self-care behaviors relatively influenced glycemic control in patients with T2DM.


CONCLUSIONS
Modifying self-care behaviors have been demonstrated to be the most essential for improving glycemic control. To improve self-care behaviors, healthcare providers should target improving self-efficacy, and enhancing health literacy can be considered to be a potential strategy for improving self-efficacy. To enhance health literacy, healthcare providers could use an empowerment approach rather than an authoritative approach that emphasizes patient compliance in managing patients with T2DM.
Lee's Endocrinology Clinic, Pingtung, Taiwan. Electronic address: t3275@ms25.hinet.net.
Yau-Jiunn
YJ
Lee
Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: sjshin@kmu.edu.tw.
Shyi-Jang
SJ
Shin
College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: wrhsia@kmu.edu.tw.
Ruey-Hsia
RH
Wang
Division of Endocrinology and Metabolism, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. Electronic address: 890073@ms.kmuh.ors.tw.
Kun-Der
KD
Lin
Division of Endocrinology and Metabolism, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan. Electronic address: jangirl1112@yahoo.com.tw.
Yu-Li
YL
Lee
Research Center for Nonlinear Analysis and Optimization, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: feynmanw@gmail.com.
Yi-Hsien
YH
Wang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D006442:Glycated Hemoglobin / Q000032:analysis*; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D010465:Perception; D011209:Power, Psychological; D015203:Reproducibility of Results; D012648:Self Care / Q000523:psychology*; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
D001786:Blood Glucose; D006442:Glycated Hemoglobin
Empowerment perceptions; Glycemic control; Health literacy; Model; Self-care behaviors; Self-efficacy; Type 2 diabetes