Mediating Effects of Perceived Barriers on the Relationship between Depression and Diabetes Management Self-efficacy in Type 2 Diabetes Patients

Heakung Hur; Jihea Choi; Eunhee Choi; Jinhwa Koh; Hakhee Moon

doi:10.15384/kjhp.2015.15.4.235

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Hur, Choi, Choi, Koh, and Moon: Mediating Effects of Perceived Barriers on the Relationship between Depression and Diabetes Management Self-efficacy in Type 2 Diabetes Patients

Original Article

Korean J Health Promot 2015;15(4):235-243.

Published online: 19 December 2015

DOI: https://doi.org/10.15384/kjhp.2015.15.4.235

Mediating Effects of Perceived Barriers on the Relationship between Depression and Diabetes Management Self-efficacy in Type 2 Diabetes Patients

Heakung Hur¹, Jihea Choi¹, Eunhee Choi², Jinhwa Koh¹, Hakhee Moon³

¹Department of Nursing, Wonju College of Medicine, Yonsei University, Wonju, Korea

²Institute of Lifestyle Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea

³Department of Nursing, Yeoju Institute of Technology, Yeoju, Korea

￭ Corresponding author：Jihea Choi, PhD Department of Nursing, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 06273, Korea Tel: +82-33-741-0379, Fax: +82-33-743-9490 E-mail: jiheachoi@yonsei.ac.kr

Received 9 July 2015 Accepted 12 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Diabetes mellitus is a life threatening disease that one out of ten Korean adults aged over 30 has it. Depression of diabetes patients affects the perception on their health negatively and self-management inefficiently, and then leads to a failure in blood sugar control. Therefore, it is necessary to investigate the relationships among depression, perceived barriers and self-efficacy on diabetes management in depth.

Methods

This descriptive study was undertaken to identify the mediating effects of perceived barriers on the relationship between depression and self-efficacy on diabetes management among type 2 diabetes patients. 173 patients with type 2 diabetes were recruited from an out-patient clinic of Y university hospital. Data were collected from June 26 to July 18, 2014 using a structured self-report questionnaire, and analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, multiple regressions, and Sobel test.

Results

Among173 participants, 12.1% were classified as depressed group. Self-efficacy on diabetes management was found to be significantly associated with education level and the presence of complications. Depression and perceived barriers were positively related to each other, but both were negatively related to self-efficacy on diabetes management. In addition, perceived barriers were found to mediate the relationship between depression and diabetes management self-efficacy.

Conclusions

Strategic nursing interventions based on considerations of the relationship between perceived barriers and self-efficacy on diabetes management need to be provided for type 2 diabetes patients with depression.

Keywords: Type 2 Diabetes, Depression, Perceived barriers, Self-efficacy

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Figure 1.

Mediation model

Table 1.

Depression, perceived barriers, and self-efficacy on diabetes management (N＝173)

Variables	Total number of items	Scale	Possible range	Actual range	Mean±SD^a
Depression	9	0-3	0-27	0-21	0.48±0.47
Perceived barriers	8	1-5	8-40	8-27	1.79±0.59
Diabetes management self-	efficacy 20	1-5	20-100	30-99	3.18±0.53

^a Mean and SD were divided by total number of items to compare variables.

Table 2.

Depression, perceived barriers, and self-efficacy on diabetes management according to general characteristics (N＝ 173)

Characteristics		N (%) Mean±SD (range)	Depression		Perceived barriers		self-efficacy on diabetes management
Characteristics		N (%) Mean±SD (range)	Mean±SD (range)	t/F/r (P)	Mean±SD (range)	t/F/r (P)	Mean±SD (range)	t/F/r (P)
Age, y		59.42±10.1	-	-0.01	-	0.07	-	0.07
Age, y		(31-75)		(0.087)		(0.362)		(0.369)
Sex	Female	79(45.7)	0.47±0.51	-0.46	1.77±0.60	-0.68	3.18±0.56	0.07
Sex	Male	94(54.3)	0.57±0.44	(0.646)	1.82±0.57	(0.499)	3.17±0.49	(0.946)
Education	Not educated (A)	12(6.9)	0.82±0.31	2.26	2.02±0.55	1.28	2.78±0.73	4.65
	Elementary school (B)	21(12.1)	0.60±0.63	(0.066)	1.77±0.65	(0.280)	3.10±0.55	(0.001)
	Junior school (C)	45(26.0)	0.46±0.39		1.87±0.57		3.20±0.47	(A＜E)^a
	High school (D)	71(41.0)	0.42±0.49		1.77±0.57		3.14±0.47
	College or over (E)	24(13.9)	0.42±0.46		1.61±0.63		3.51±0.49
Income	Very low (A)	13(7.5)	0.74±0.47	3.60	1.84±0.61	0.29	3.02±0.85	1.29
	Low (B)	54(31.2)	0.52±0.45	(0.015)	1.83±0.54	(0.831)	3.10±0.48	(0.280)
	Moderate (C)	88(50.9)	0.47±0.51	(A＞D)^a	1.75±0.61		3.21±0.48
	High (D)	18(10.4)	0.20±0.23		1.86±0.65		3.31±0.60
BMI, kg/m²		24.53±3.40	-	0.06		0.06	-	0.01
BMI, kg/m²		(17.31-39.06)		(0.422)		(0.416)		(0.894)
Type of treatment	Diabetes pills (A)	113(65.3)	0.38±0.43	8.71	1.82±0.60	0.41	3.20±0.50	0.45
	Insulin (B)	29(16.8)	0.66±0.48	(＜0.001)	1.77±0.58	(0.667)	3.16±0.55	(0.638)
	Diabetes pills & Insulin (C)	31(17.9)	0.70±0.52	(A＜B, C)^a	1.72±0.58		3.10±0.61
Duration of diabetes, mo		138.7±108.47	-	0.08	-	-0.14	-	-0.08
Duration of diabetes, mo		(2-480)		(0.299)		(0.061)		(0.317)
Complications	Yes	52(30.1)	0.66±0.50	3.41	1.74±0.53	-0.77	3.04±0.59	-2.25
Complications	No	121(69.9)	0.40±0.45	(0.001)	1.82±0.61	(0.438)	3.23±0.49	(0.026)

Abbreviation: BMI, body mass index.

^a Post-hoc: Scheffe test.

Table 3.

Relationship among depression, perceived barriers, and self-efficacy on diabetes management (N＝173)

Variables	Perceived barriers	self-efficacy on diabetes management
Variables	r (P)	r (P)
Depression	0.16 (0.035)	-0.20 (0.010)
Perceived barriers		-0.31 (＜0.001)

Table 4.

Influencing of covariate variables and depression to perceived barriers (path a) (N＝ 173)

Variables		path a
Variables		β (P)
Education status	High school or over	1.00
	Junior school or below	-.10 (0.189)
Complications	Yes	1.00
	No	-.11 (0.184)
Depression		.17 (0.028)

Table 5.

Influence of covariate variables and perceived barriers on self-efficacy on diabetes management (path b) (N＝173)

Variables		path b
Variables		β (P)
Education status	High school or over	1.00
	Junior school or below	0.05 (0.469)
Complications	Yes	1.00
	No	-0.17 (0.018)
Perceived barriers		-0.31 (＜0.001)

Table 6.

Influence of covariate variables, depression, and perceived barriers on self-efficacy on diabetes management (path c, path c´) (N＝ 173)

Variables		path c	path c´
Variables		β (P)	β (P)
Education status	High school or over	1.00	1.00
	Junior school or below	0.08 (0.325)	0.05 (0.537)
Complications	Yes	1.00	1.00
	No	-0.12 (0.132)	-0.15 (0.049)
Depression		-0.16 (0.047)	-0.10 (0.168)
Perceived barriers			-0.30 (＜0.001)

Sobel test Z＝-1.98, P＝0.047

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