Gharaibeh, B., Gajewski, B. J., Al-smadi, A., & Boyle, D. K. (2016). The relationships among depression, self-care agency, self-efficacy and diabetes self-care management. Journal of Research in Nursing, 21(2), 110-122.?
The coexistence of diabetes and depression is associated with negative outcomes such as poor
diabetes self-care management (DSCM). Complex relationships exist among diabetes knowledge,
self-efficacy, self-care agency, depression and DSCM. No study has examined the relationships
among all these factors at the same time. We aimed to examine relationships among depression,
diabetes knowledge, self-care agency, self-efficacy and DSCM in insulin- treated people based on a
modification of the DSCM model. A cross-sectional, correlational model testing design was used.
Participants with type 1 (n?35) and type 2 (n?43) diabetes were recruited from both outpatient
and community sites. Participants mean age was 46.6 years (standard deviation 13.7) and the
majority were men (56.4%). Multiple regression analyses tested the hypothesised relationships.
Depression was found to have a direct negative relationship with self-care agency and self-efficacy.
The relationship between depression and DSCM was not direct. Self-care agency and self-efficacy
completely mediated the effect of depression on DSCM. Self-efficacy completely mediated the
effect of self-care agency on DSCM. We conclude that effective treatment programmes for
persons managed with insulin should probably include not only screening and treatment
of depression, but also skills training to enhance patient self-care agency and self-efficacy
alongside DSCM.