Quality of Life Research

, Volume 26, Issue 2, pp 359–366 | Cite as

Self-management behavior among patients with diabetic retinopathy in the community: a structural equation model

  • Li Yang
  • Qunhong WuEmail author
  • Yanhua HaoEmail author
  • Yu Cui
  • Libo Liang
  • Lijun Gao
  • Mingli Jiao
  • Ning Ning
  • Hong Sun
  • Zheng Kang
  • Liyuan Han
  • Ye Li
  • Hui Yin



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.


Diabetic retinopathy Health beliefs Self-management Social support Structural equation modeling 



We would like to thank all study participants, and the doctors and nurses from the Jianhua community clinics in Qiqihar city for their considerable assistance.


This study was funded by the Ministry of Education of Heilongjiang province (Grant Number 12541377).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Li Yang
    • 1
    • 2
  • Qunhong Wu
    • 2
    Email author
  • Yanhua Hao
    • 2
    Email author
  • Yu Cui
    • 2
  • Libo Liang
    • 2
  • Lijun Gao
    • 2
  • Mingli Jiao
    • 2
  • Ning Ning
    • 2
  • Hong Sun
    • 2
  • Zheng Kang
    • 2
  • Liyuan Han
    • 3
  • Ye Li
    • 2
  • Hui Yin
    • 2
  1. 1.School of NursingHarbin Medical UniversityHarbinPeople’s Republic of China
  2. 2.Department of Social Medicine, School of Public HealthHarbin Medical UniversityHarbinPeople’s Republic of China
  3. 3.Department of Preventive Medicine MedicalSchool of Ningbo UniversityNingboPeople’s Republic of China

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