title: The Association Between Self-Management Barriers and Self-Efficacy in Chinese Patients with Type 2 Diabetes: The Mediating Role of Appraisal.
abstract: BACKGROUND
  Patients with higher levels of self-management barriers are more likely to exhibit a lower level of self-efficacy. However, the theoretically meaningful mechanisms underlying the association between the two variables have not yet been established.
  
  
  OBJECTIVE
  Informed by the Transactional Model of Stress and Coping, this study aimed to examine the potential role of diabetes appraisal on the association of self-management barriers and self-efficacy in patients with type 2 diabetes mellitus.
  
  
  METHODS
  This article presents the secondary data analyses of a multicenter, cross-sectional study. A sample of 346 adults with type 2 diabetes was interviewed, using the Personal Diabetes Questionnaire, the Appraisal of Diabetes scale, the Diabetes Empowerment Scale-Short Form, and the Summary of Diabetes Self-Care Activities. Structure equation modeling was performed with 10,000 bootstrap samples using Mplus 7.
  
  
  RESULTS
  The hypothesized model provided a good fit to the data (χ2= 22.975, df = 33; p = .1144; CFI = 0.989; SRMR = 0.036; RMSEA = 0.042). The mediating effect of diabetes appraisal on the association of self-management barriers and self-efficacy was significant (β = -0.521; 95% CI: -0.865, -0.283), explaining 44.82% of the total effect of barriers on self-efficacy. Significant associations were also detected between diet knowledge and diabetes appraisal (β = 0.148, p = .047).
  
  
  CONCLUSIONS
  Diabetes appraisal plays a mediating role in the association between self-management barriers and self-efficacy in patients with type 2 diabetes. Reflecting on patients' appraisal of diabetes can help to develop evidence-based and patient-centered interventions. Interventions that enhance individuals' positive appraisal of diabetes have the potential to buffer the negative effects of self-management barriers on self-efficacy.
authors.affiliation: Doctoral Student, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong. lilycheng@link.cuhk.edu.hk.
authors.forename: Li
authors.initials: L
authors.lastname: Cheng
authors.affiliation: Associate Professor, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Janet W H
authors.initials: JW
authors.lastname: Sit
authors.affiliation: Assistant Professor, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Doris Y P
authors.initials: DY
authors.lastname: Leung
authors.affiliation: Professor, The School of Nursing, Faculty of Medicine, The Xi'an Jiaotong University, Xi'an, China.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Li
mesh_terms: D002681:China; D003430:Cross-Sectional Studies; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy*; D005247:Feeding Behavior; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D010358:Patient Participation; D012648:Self Care / Q000592:standards*; D020377:Self Efficacy; D011795:Surveys and Questionnaires
keywords: appraisal; decision making; diabetes; knowledge; mediating effect; self-efficacy; self-management barriers