title: Self-management behavior among patients with diabetic retinopathy in the community: a structural equation model.
abstract: Diabetic retinopathy (DR) is an important, chronic complication of diabetes, requiring competent self-management that depends on adherence to behavioral regimens. This study attempted to identify factors influencing self-management behaviors and develop a model illustrating the interdependence of several factors associated with DR patients.
  
  
  
  In June-December 2012, 368 patients with DR completed questionnaires assessing self-management behavior, diabetes knowledge, health beliefs, social support, and treatment adherence. Structural equation modeling was used to test predicted pathways linking self-management behavior to diabetes knowledge, health beliefs, social support, and treatment adherence.
  
  
  
  The results indicated that health beliefs, treatment adherence, and duration of diabetes each had a direct impact on diabetes self-management (p < 0.05). Diabetes knowledge only indirectly influenced diabetes self-management, through health beliefs. Social support had a direct impact on diabetes self-management (β = 0.35, p < 0.01), and an indirect influence on diabetes self-management, through treatment adherence (β = 0.77, p < 0.01).
  
  
  
  Health beliefs, treatment adherence, and social support directly affect diabetes self-management, and diabetes knowledge indirectly affects diabetes self-management. This suggests that enhancing DR patients' health beliefs, treatment adherence, and social support would facilitate their diabetes self-management. Meanwhile, improved health education can strengthen diabetes knowledge, which in turn, can positively affect diabetes self-management.
authors: School of Nursing, Harbin Medical University, Harbin, 150086, Heilongjiang province, People's Republic of China.|Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang province, People's Republic of China.
authors: Li
authors: L
authors: Yang
authors: Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang province, People's Republic of China. wuqunhong@163.com.
authors: Qunhong
authors: Q
authors: Wu
authors: Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang province, People's Republic of China. hyhyjw@126.com.
authors: Yanhua
authors: Y
authors: Hao
authors: Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang province, People's Republic of China.
authors: Yu
authors: Y
authors: Cui
authors: Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang province, People's Republic of China.
authors: Libo
authors: L
authors: Liang
authors: Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang province, People's Republic of China.
authors: Lijun
authors: L
authors: Gao
authors: Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang province, People's Republic of China.
authors: Mingli
authors: M
authors: Jiao
authors: Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang province, People's Republic of China.
authors: Ning
authors: N
authors: Ning
authors: Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang province, People's Republic of China.
authors: Hong
authors: H
authors: Sun
authors: Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang province, People's Republic of China.
authors: Zheng
authors: Z
authors: Kang
authors: Department of Preventive Medicine Medical, School of Ningbo University, Ningbo, 315000, Zhejiang province, People's Republic of China.
authors: Liyuan
authors: L
authors: Han
authors: Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang province, People's Republic of China.
authors: Ye
authors: Y
authors: Li
authors: Department of Social Medicine, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, Heilongjiang province, People's Republic of China.
authors: Hui
authors: H
authors: Yin
mesh_terms: D000368:Aged; D003930:Diabetic Retinopathy / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D012648:Self Care; D018434:Sickness Impact Profile; D012944:Social Support; D011795:Surveys and Questionnaires
keywords: Diabetic retinopathy; Health beliefs; Self-management; Social support; Structural equation modeling