Illness Perception and Health-Related Quality of Life Among Patients With Type 2 Diabetes: The Mediating Role of Self-Care Behaviors
Keywords:
Illness perception, health-related quality of life, self-care behaviors, type 2 diabetes, mediation, structural equation modelingAbstract
Objective: This study aimed to examine the relationship between illness perception and health-related quality of life among patients with type 2 diabetes and to determine the mediating role of self-care behaviors in this relationship.
Methods and Materials: This descriptive-correlational cross-sectional study was conducted among 412 patients with type 2 diabetes receiving outpatient diabetes care in Canada. Participants were selected through convenience sampling based on inclusion and exclusion criteria. Data were collected using a demographic and clinical information form, the Brief Illness Perception Questionnaire, the Summary of Diabetes Self-Care Activities measure, and the Diabetes Quality of Life Brief Clinical Inventory. Data analysis was performed using SPSS and AMOS. Pearson correlation coefficients were used to examine associations among the main variables, and structural equation modeling was applied to test the proposed mediation model. The indirect effect was examined using the bootstrapping method with 5,000 resamples and 95% confidence intervals.
Findings: The results showed that illness perception was significantly and negatively correlated with self-care behaviors and health-related quality of life. Self-care behaviors were significantly and positively correlated with health-related quality of life. The structural model showed acceptable fit indices, including χ²/df = 1.79, CFI = 0.982, TLI = 0.973, GFI = 0.976, RMSEA = 0.044, and SRMR = 0.036. Illness perception had a significant negative direct effect on self-care behaviors and health-related quality of life, while self-care behaviors had a significant positive direct effect on health-related quality of life. The indirect effect of illness perception on health-related quality of life through self-care behaviors was also significant, confirming partial mediation.
Conclusion: The findings indicate that negative illness perception is associated with poorer health-related quality of life both directly and indirectly through reduced self-care behaviors. Interventions that improve illness perception and strengthen diabetes self-care may enhance quality of life among patients with type 2 diabetes.
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