Mediation Effect of Self-Efficacy Between Health Beliefs and Glycated Haemoglobin Levels in Elderly Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Anqi Zhang,1,2,&ast; Jinsong Wang,1– 3,&ast; Xiaojuan Wan,2 Jing Zhang,3 Zihe Guo,3 Yamin Miao,2 Shuhan Zhao,2 Shuo Bai,2 Ziyi Zhang,2 Weiwei Yang4 1The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, 225003, People’s Republic of China; 2School of Nursing and Public Health, Yangzhou University, Yangzhou, Jiangsu, 225009, People’s Republic of China; 3Yangzhou Commission of Health, Yangzhou, Jiangsu, 225009, People’s Republic of China; 4Community Health Service Center, Yangzhou, Jiangsu, 225003, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinsong Wang, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu, 225003, People’s Republic of China, Tel +86 15952771632, Email wangjs@yzu.edu.cnPurpose: To explore the mediating effect of self-efficacy in the relationship between glycated haemoglobin (HbA1c) levels and health beliefs in community elderly patients with type 2 diabetes.Patients and Methods: From January to March 2022, convenience sampling was adopted to investigate 200 elderly patients with type 2 diabetes in a community in Yangzhou, China. Data were collected using the Health Beliefs Questionnaire, Self-efficacy for Diabetes, and Medication Compliance Questionnaire. Laboratory parameters included HbA1c, fasting blood glucose, postprandial blood glucose, total cholesterol, triglyceride, high-density-lipoprotein cholesterol, and low-density-lipoprotein cholesterol levels. Correlation, linear regression, and mediation analyses were performed using SPSS 27.0.Results: HbA1c levels were higher in men (women vs men: 6.80% [6.08%, 7.73%] vs.7.30% [6.30%, 9.18%]) and employed (employed vs not employed vs retired: 7.60% [6.90%, 10.45%] vs 5.85% [5.40%, 6.95%] vs 7.10% [6.20%, 8.20%]) and low self-efficacy (low vs high: 13.1% [6.55%, 13.85%] vs 6.8% [6.10%, 7.70%]). HbA1c levels were negatively associated with health beliefs (r = − 0.246) and self-efficacy (r = − 0.240; p< 0.01). Linear regression showed that perceived susceptibility, severity, benefit, and barriers, cues to action, and self-efficacy explained 50% of the variance in HbA1c levels after adjusting for sex and current work status. The mediation effect of self-efficacy was partial between health beliefs and HbA1c levels and accounted for 24.65% of the total effect (p < 0.001).Conclusion: Health beliefs influenced the improvement of self-efficacy in older patients with type 2 diabetes mellitus, which in turn could improve HbA1c control. Self-efficacy plays a partial mediating role between health beliefs and Hba1c levels in elderly patients with type 2 diabetes.Keywords: health belief model, self-efficacy, glycated haemoglobin, mediation analysis, elderly, type 2 diabetes mellitus