Study On The Self-management Behaviors And Its Influencing Factors Of Diabetic Foot Patients Based On The Health Ecological Model

Objective This study aimed to investigate the current situation of diabetic foot patients' selfmanagement behaviors through cross-sectional survey.Based on the health ecological model,the influencing factors of diabetic foot patients' self-management behaviors were analyzed from five aspects,which included personal characteristics,behavioral characteristics,interpersonal networks,working and living conditions,and policy environment.A structural equation model of influencing factors of self-management behaviors in diabetic foot patients was established,through which the mechanisms of these factors were explored,and thus this provides scientific basis for clinical staff to formulate individualized intervention measures.Methods A questionnaire survey was conducted on 240 inpatients who met the inclusion criteria,from January 2018 to August 2019.The content included general information questionnaire,diabetic foot patient self-management behavior scale,social support rating scale,problem areas in diabetes scale,diabetic self-efficacy scale,and diabetic foot knowledge questionnaire.SPSS 23.0 software was used for statistical description,Pearson and Spearman correlation analysis,independent sample t test,one-way analysis of variance and hierarchical regression analysis.AMOS 24.0 software was used to construct the structural equation model.Results 1.The total score of self-management behaviors of diabetic foot patients was(45.49 ± 9.87),and the scores for each dimention were as follows: daily life management(19.19 ± 4.01),condition detection and control management(16.06 ± 4.25),and foot care management(10.23 ± 2.96).2.Hierarchical regression analysis showed that factors affecting self-management behaviors of diabetic foot patients were gender,Wagner classification,glycated hemoglobin, smoking status,problem areas in diabetes,diabetes self-efficacy,diabetic foot knowledge,number of children,social support and work status.The five levels of the health ecological model jointly explained 52.2% of the total variation in self-management behaviors of diabetic foot patients.3.Correlation analysis showed that self-management behaviors were positively correlated with self-efficacy(r = 0.380,P < 0.01),social support(r = 0.361,P < 0.01),and knowledge of diabetic foot(r = 0.346,P < 0.01),and negatively correlated with problem areas in diabetes(r =-0.326,P < 0.01).Social support was positively related to self-efficacy(r = 0.244,P < 0.01)and negatively related to problem areas in diabetes(r =-0.159,P < 0.05).Self-efficacy was positively correlated with diabetic foot knowledge(r = 0.168,P < 0.05).4.Structural equation model showed that there were three paths of social support to self-management behaviors: social support to self-management behaviors,social support to self-efficacy to self-management behaviors,social support to problem areas in diabetes to self-management behaviors.There were two paths for diabetic foot knowledge to selfmanagement behaviors: from diabetic foot knowledge to self-management behaviors,from diabetic foot knowledge to self-efficacy to self-management behaviors.Social support(? = 0.261,P < 0.001),self-efficacy(? = 0.270,P < 0.001),diabetic foot knowledge(? = 0.271,P < 0.001)had a direct positive effect on self-management behaviors,and problem areas in diabetes(? =-0.244,P < 0.001)had a direct negative effect on self-management behaviors.Social support(? = 0.227,P < 0.001)had a direct positive effect on self-efficacy,and social support(? =-0.159,P = 0.015)had a direct negative effect on problem areas in diabetes.Diabetic foot knowledge(? = 0.141,P = 0.027)had a direct positive effect on self-efficacy.The mediating effect of problem areas in diabetes in social support and self-management behaviors path was 0.039.The mediating effect of self-efficacy in social support and selfmanagement behaviors path was 0.061,and that in diabetic foot knowledge and selfmanagement behaviors path was 0.038.Conclusions 1.The status of self-management behaviors of diabetic foot patients was at a medium level and needed to be improved.2.The influential factors of self-management behaviors in diabetic foot patients were gender,Wagner classification,glycated hemoglobin,smoking status,problem areas in diabetes,diabetes self-efficacy,diabetic foot knowledge,number of children,social support, and work status under the five levels of the health ecological model.3.The higher scores of social support,diabetic foot knowledge and self-efficacy,the better self-management behaviors of diabetic foot patients.The higher scores of problem areas in diabetes,the worse the self-management behaviors of diabetic foot patients.4.Social support can directly affect self-management behaviors,or it can indirectly affect self-management behaviors through the intermediary role of self-efficacy or problem areas in diabetes.Diabetic foot knowledge can directly affect self-management behaviors,and can also indirectly affect self-management behaviors through the intermediary role of self-efficacy.The overall effect analysis showed that social support had the greatest impact on the self-management behaviors of diabetic foot patients.This showed that fully mobilizing and giving full play to the potential of social support was an important way to help diabetic foot patients improve their self-management behaviors.