Exploring the relationship between self-care agency and quality of life in adults with diabetes: A cross-sectional study

Kei Takahashi; Chizuko Takeishi; Chiyo Tsutsumi; Tomomi Nakao; Yuichi Sato; Yuji Uchizono; Kiyohide Nunoi; Yasunori Tabira; Yasuko Shimizu

doi:10.1371/journal.pone.0326783

Abstract

Self-care agency is the ability to perform self-care. Clarifying the factors of self-care agency that are related to quality of life can help determine the most effective nursing support. This cross-sectional study of patients with type 1 or type 2 diabetes aimed to explore the relationship between self-care agency and quality of life in adults with diabetes. Using a selective sampling method, we conducted a questionnaire survey using the Instrument of Diabetes Self-Care Agency and the SF-12 Health Survey. After identifying items related to quality of life from single regression and correlation analyses, multiple regression analyses were performed. There were 139 respondents, with an average age of 62.8 ± 11.7 years, of whom 71 were men (51.0%) and 117 had type 2 diabetes (84.1%). The average self-care agency score was 153.6 ± 22.5 points. Based on the results of the single regression analysis, age, sex, HbA1c, and BMI were selected as adjustment factors. Multiple regression analyses showed that the “ability to cope with stress” was related to the role/social component summary of health-related quality of life (β = 0.40, p < 0.01). The association between self-care agency and the mental component summary differed by age and sex, while “ability to cope with stress” was commonly related to this component across all groups (β = 0.39–0.70, p < 0.05). The “ability to make the most of the support available” (β = 0.37–0.52, p < 0.05) and the “ability to self-manage” (β = 0.51–0.56, p < 0.01) were also related to this component in the 65-and-over group. No factors of self-care agency were related to the physical component summary of health-related quality of life. The results suggest that nurses can clarify the type of support that will lead to improved quality of life by evaluating patients’ self-care agency.

Citation: Takahashi K, Takeishi C, Tsutsumi C, Nakao T, Sato Y, Uchizono Y, et al. (2025) Exploring the relationship between self-care agency and quality of life in adults with diabetes: A cross-sectional study. PLoS One 20(7): e0326783. https://doi.org/10.1371/journal.pone.0326783

Editor: Adobea Yaa Owusu, University of Ghana College of Humanities, GHANA

Received: April 19, 2024; Accepted: June 4, 2025; Published: July 1, 2025

Copyright: © 2025 Takahashi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: We have not obtained permission from the Ethics Review Committee for the publication of the data prior to statistical processing. Therefore, we have had to place restrictions on the publication of data from this study. Data are available from the Research Ethics Review Committee of Yuki no Seibo-kai (contact via kenkyusyo@st-mary-med.or.jp) for researchers who meet the criteria for access to confidential data. Part of the analysis process for this study is shown in the Supporting Information.

Funding: This work was supported by Japan Society for the Promotion of Science KAKENHI Grant Number JP16H05575. The funders had no role in study design, data collection and analysis, decision to publish to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

The prevalence of patients with diabetes continues to increase worldwide. In Japan, the diabetes prevalence rate is 19.7% in men and 10.8% in women [1]. The goal of treatment for people with diabetes is to prevent the development and progression of diabetic complications and maintain quality of life (QOL) [2]. As such, people with diabetes need to engage in ongoing self-care in their daily lives. Behavioral changes in patients, such as adjustments to their lifestyles they had before diagnosis and their engagement in self-care, are essential and are indicated as an outcome of diabetes self-management education and support [3].

Nurses who care for patients with diabetes are required to guide behavioral changes in these patients to improve their QOL. Previous studies have shown that self-care behaviors positively affect better glycemic control and QOL [4–6]. However, it has been reported that patients engaging in self-care behaviors may experience distress as these behaviors can lead to life limitations [7]. Furthermore, patients’ feelings of burden regarding diabetes have been shown to be related to QOL [8]. These findings suggest that nurses should not only focus on patients’ implementation of self-care, such as diet and exercise, but also consider how to provide self-care support in order to enhance patients’ QOL.

In this study, we focused on “self-care agency,” which has been defined as the ability to engage in self-care [9]. It refers to the ability to perform purposeful actions in the adjustment and development of human functioning and is related to the level of self-care behavior execution [9]. An increase in self-care agency may promote better involvement in diabetes management [10] as higher levels of self-care agency and self-efficacy are related to higher self-management [11]. A previous study also revealed the effectiveness of diabetes education that is based on theories such as Orem’s concept of self-care agency [12]. Consequently, it is significant to examine the concept of self-care agency in diabetes nursing.

In Japan, support using self-care agency is being considered based on studies such as the examination of factors related to self-care agency in patients with type 1 or type 2 diabetes [13,14] and the relationship between difficulties and self-care agency in patients with type 1 diabetes [15]. Furthermore, Gaffari-Fam et al. [16] found that more than two-thirds of QOL can be explained by health literacy and self-care behavior. Since self-care agency comprises patients’ involvement in self-care, it is thought that it also pertains to their involvement in their own QOL. Several studies have examined the effects of self-care behaviors and self-management on QOL. The self-care behaviors examined included, for example, higher exercise frequency [17,18], higher medication adherence [19], blood pressure monitoring frequency [20], and dietary self-care [21], which were all shown to be associated with a higher QOL. However, the studies clarifying the relationship between self-care agency and QOL have been limited to samples of adolescents with type 1 diabetes [22]. As such, it is essential to confirm the relationship between self-care agency and QOL in a population that includes adult and older adult patients. This issue is of particular importance as the number of people with diabetes is expected to rise in the future. This study, thus, aimed to explore the relationship between self-care agency and QOL in adults with diabetes. By clarifying these relationships, we sought to verify which type of self-care agency is most effective in improving the QOL of these patients and determine the directions of nursing support using self-care agency.

Definition of terms

Self-care: It is not limited to self-care for diabetes management in general but refers to activities that are based on decisions reflecting individual values and beliefs, mediated by social relationships including patient-provider relationships, the trial and error in the process, and the contribution to well-being [23].

Self-care agency: Self-care agency is the ability of individuals to carry out intentional actions to adjust themselves and their environment to inculcate self-care. In this study, self-care agency was defined with reference to Nakanishi et al. [23].

Methods

Research design, setting, and participants

This study clarified the relationship between self-care agency and QOL in adults with diabetes. A cross-sectional design, which is used to collect data at a specific point in time and is suitable for depicting the relationships among phenomena, was employed [24].

The study was conducted at a single institution in Kyushu, Japan. This hospital regularly conducts complication and self-care assessments of people with diabetes using questionnaires. This study undertook a secondary analysis of some of these data. The data were accessed for this research purposes on 8th January, 2021. The participants were individuals with type 1 or type 2 diabetes aged 18 years or older who were either outpatients or inpatients. Despite the age of adulthood in Japan at the time of data collection (2021) being 20 years or older, the participants in this study were aged 18 years or older. It was because the medical subsidy system in Japan defined individuals with certain chronic diseases of children as being under 18 years old [25], and to distinguish them from children, the subjects of this study were 18 years or older. However, as of 2024, the general age of adulthood in Japan has been revised to 18 years or older. Patients with severe complications, such as diabetic nephropathy, being in need of dialysis, or blindness due to diabetic retinopathy, and those with difficulty in verbal communication and cognitive impairment were excluded from the study. Individuals with diabetes who took part in the self-care assessments were informed by their physicians or nurses that the data would be used in this study. Data from those patients who gave consent were used for analysis. Consent was received verbally from the patients and the obtaining of consent was noted in the electronic medical record. This process was approved by the review committee. We used the time before and after outpatient consultations or outpatient nursing hours to collect patients’ responses to the assessment questionnaire in interviews. By inviting the participants to take part in this study through their physicians and nurses, we attempted to ensure that their participation in this study was voluntary, although they may have had difficulty avoiding it.

The sample size was calculated using G*Power [26]. In a multiple regression model with nine items as independent variables (eight items related to patients’ backgrounds and each factor of self-care agency), with an effect size (f2) of 0.15, the required sample size was 114 cases. This calculation was based on a significance level of 5% and a power of 80%. During the survey period, from June 2017 to April 2018, 180 people with diabetes were asked to complete the questionnaire.

Measurements

Participant’s basic attributes.

We collected details regarding participants’ age, sex, body mass index (BMI), HbA1c, type of diabetes, duration of living with diabetes, treatment, and employment status. Information about treatment, drugs used, and HbA1c levels was obtained from the participants’ electronic medical records with their permission during the survey period.

Self-care agency.

We measured self-care agency with the Instrument of Diabetes Self-Care Agency (IDSCA) and comprises seven factors with 35 items. The reliability and validity of the Japanese version have been confirmed [27]. The seven factors include the ability to acquire knowledge, the ability to cope with stress, the ability to make the most of the support available, monitoring ability, application or adjustment ability, motivation to self-manage, ability to self-manage. Using this tool, patients can reflect on their self-care agency with the nurse who supports them and identify their strengths, under-utilized abilities, and future abilities. Respondents rate each item on a six-point Likert scale ranging from 0 to 5. The higher the total score, the better the respondent’s self-care agency. In this study, total IDSCA scores were positively correlated with all seven subfactors (r = 0.39~0.82, p < 0.01). The Cronbach’s alpha of the IDSCA was 0.87 in this study; the Cronbach’s alphas for the subfactors ranged from 0.29 to 0.78.

Health-related QOL.

We used the 12-Item Short-Form Health Survey (SF-12) to measure health-related QOL [28]. This 12-item scale is an abbreviated version of a comprehensive QOL measurement, the SF-36, which has been shown to be reliable and valid [28]. It includes eight subscales: physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, energy/fatigue, social functioning, role limitations due to emotional problems, and emotional well-being. From the responses to each item, scores for these eight subscales can be calculated using norm-based scoring. In addition, these scores can be weighted to calculate three component summary scores: a physical component score (PCS), a mental component score (MCS), and a role/social component score (RCS). In Japan, the factor structure has been shown to be different from that in Europe and the United States, and the use of RCS in addition to PCS and MCS is recommended [29,30]. In this study, these three component scores were used to evaluate patients’ QOL. With permission from the developer, a Japanese version of the questionnaire was used in this study. The Cronbach’s alpha for the SF-12 was 0.85 in this study.

Ethical considerations

This secondary analysis was approved by the Research Ethics Review Committee of Yuki no Seibo-kai (Research approval number: Ken18–0701). Existing data were obtained to ascertain the complications and self-care status of patients attending the facility and were linked to the patient’s name and medical record ID. However, for the secondary use of these data in this study, patients’ personal information was removed and anonymized before analysis. Approval was obtained for this. The participants received a verbal and written explanation of the study, and their consent for the research use of the data and access to their medical records was obtained in advance. We explained to the participants that the data obtained would be strictly managed to protect their personal information and prevent data leakage or loss. At the beginning of the study, information about the study was presented on the research facility’s website, and opt-outs were provided.

Statistical analyses

Data without missing values were included in the analysis. We calculated the basic statistics for the participants’ attributes and their IDSCA and SF-12 scores. For the IDSCA, the total score and the scores of each of the seven factors were used. For the SF-12, we used the total scores of the three summary scores of the PCS, MCS, and RCS. Since the data did not follow a normal distribution, the following analysis was performed after log transformation.

To examine the self-care agency of adults with diabetes in relation to health-related QOL, we first performed a spearman’s rank correlation analysis (S1 Table) among age, BMI, HbA1c, and each factor of the IDSCA. Subsequently, a single regression analysis (S2 Table) was conducted with basic participant attributes and each factor of the IDSCA as independent variables and the summary score of health-related QOL as the dependent variable to identify variables related to health-related QOL. The results of the single regression analysis showed that age, sex, HbA1c, and BMI were associated with health-related QOL. In addition, we considered it necessary to adjust for age and sex based on demographics, as well as BMI and HbA1c as influences of glycemic control in patients with diabetes, and adopted these as adjustment factors. Other personal background factors were excluded in this study because we did not find any significant influence with self-care agency or QOL. Thus, multiple regression analyses were then performed with age, sex, HbA1c level, BMI, and each factor of the IDSCA as independent variables and the summary score of health-related QOL as the dependent variable. For each variable, the distribution was confirmed from histograms. We also examined the interaction term between age and sex; since the interaction term was significantly associated with the MCS of QOL, we conducted multiple regression analysis with HbA1c level, BMI, and each factor of the IDSCA as dependent variables in four groups by age and sex (men and women under 65 years old, men and women 65 years old and above). To examine multicollinearity, Spearman’s rank correlation coefficient and variance inflation factors (VIFs) between independent variables were calculated. For residuals, normal quantile plots were checked. JMP Pro 15.2.0 was used for statistical analyses, and the level of significance was set at p < 0.05.

Results

We asked 180 people with diabetes to complete the questionnaire and received responses from all of them (collection rate: 100%). Subsequently, responses from 139 participants with no missing values were included in the analyses (valid response rate: 77.2%).

Participants’ characteristics

Table 1 presents the participants’ characteristics. Their average age was 62.8 ± 11.7 years, and 71 (51.0%) were men. In total, 117 of the participants (84.1%) had type 2 diabetes, and their average duration of living with diabetes was 16.1 ± 10.4 years. The average BMI was 25.6 ± 4.9 kg/m², and the average HbA1c level was 8.0 ± 1.1%. Among the participants, 84 (60.4%) used injections as their current treatment. The average overall IDSCA score was 132.9 ± 20.1 points.

Download:

Table 1. Participants’ characteristics.

https://doi.org/10.1371/journal.pone.0326783.t001

Relationship between self-care agency factors and health-related QOL

A single regression analysis was performed with participants’ basic attributes and each factor of the IDSCA as independent variables and the three summary scores of the PCS, MCS, and RCS of health-related QOL as dependent variables (Table 2). The results showed that age and employment were significantly related to the PCS. Age, BMI, and the self-care agencies of “ability to cope with stress,” “ability to make the most of the support available,” “application or adjustment ability,” and “ability to self-manage” were significantly related with the MCS. “Ability to cope with stress” was significantly related to the RCS. The “ability to acquire knowledge,” “monitoring ability,” and “motivation to self-manage” were not related to any of the health-related QOL domains.

Download:

Table 2. Relationship between personal background factors, self-care agency, and QOL.

https://doi.org/10.1371/journal.pone.0326783.t002

To examine the association between self-care agency in adults with diabetes and health-related QOL, multiple regression analyses were performed based on the results of a single regression analysis, with age, sex, HbA1c, BMI, and diabetes self-care agency as independent variables and the three summary scores of the PCS, MCS, and RCS of health-related QOL as dependent variables. The shape of the distribution was confirmed by histograms. The distribution was slightly skewed toward higher scores for “ability to acquire knowledge;” however, no other variables deviated significantly from the normal distribution. Regarding the correlation coefficients between independent variables, weak correlations were found between age and BMI (r = −0.35, p < 0.01), age and HbA1c (r = −0.35, p = 0.04), and HbA1c and BMI (r = 0.21, p = 0.01). However, since both age and BMI are important background factors for patients with diabetes, we adopted them as adjustment factors. Weak to moderate correlations were also found between the basic attributes and the seven self-care agencies for several factors (r = −0.24~0.37, p < 0.05), but there were no variables that resulted in |r| > 0.8. Table 2 shows the results of the overall multiple regression analysis of the relationship between self-care agency and health-related QOL. The multiple regression analysis revealed that the “ability to cope with stress” was significantly related to the RCS (β = 0.40p < 0.01). The VIFs were all less than 2, and there was no multicollinearity. As for the residuals, no major deviations from the normal quantile plots were observed. No self-care agencies had any association with the PCS.

Regarding the MCS, a significant difference was found in the age × sex interaction term for some factors of self-care agency. Therefore, another multiple regression analysis was performed, this time dividing the results into four groups based on age (<65 and ≥65 years) and sex. No correlations were observed in any group between each independent variable that would result in |r| > 0.8. Consequently, the analysis indicated that the factors of self-care agency related to the MCS differed according to age and sex (Table 3). The self-care agency factors related to the MCS were “ability to cope with stress” (β = 0.40, p < 0.05) in the under-65 male group; “ability to cope with stress,” “ability to make the most of the support available,” and “ability to self-manage” (β = 0.30 ～ 0.39, p < 0.05) in the under-65 female group; “ability to cope with stress,” “ability to make the most of the support available,” and “ability to self-manage” (β = 0.37 ～ 0.70, p < 0.05) in the over-65 male and female groups; and “motivation to self-manage” (β = 0.42, p < 0.05) in the over-65 female group. The VIFs were all less than 2, and no multicollinearity was detected. Regarding residuals, in the four groups, the points were generally on a straight line in the normal quantile plots.

Download:

Table 3. Relationship between self-care agency factors and SF-12 mental component summary in four groups.

https://doi.org/10.1371/journal.pone.0326783.t003

Discussion

This study aimed to explore the relationship between self-care agency and QOL in adults and older adults with diabetes. The analysis revealed that the RCS was related to the “ability to cope with stress” factor of the IDSCA. Additionally, it was found that the MCS of self-care agency differed depending on the participants’ age and sex, with “ability to cope with stress” being commonly related. The “ability to make most of the support available” and the “ability to self-manage” also displayed associations to the MCS in both male and female participants over 65 years. There was no relationship between the factors of self-care agency and the PCS of QOL.

Further, the analysis demonstrated that the self-care agency factor related to the RCS domain of health-related QOL in participants with diabetes was the “ability to cope with stress.” The average age of participants in this study was 62.8 ± 11.7 years, and about half of them were employed. The presence of diabetes has been shown to cause patients to gain limited employment or to be fired from their jobs [31], as well as to experience limitations in their daily lives, such as in friendships and family relationships [32]. In response to this situation, patients may conceal the fact that they have diabetes for reasons such as anxiety about discrimination in the workplace, hindrance to employment or promotion, or not wanting to receive special consideration [33]. Moreover, in order to lead a trouble-free social life, patients may manage the reactions of those around them while receiving treatment, either by narrowing their social circle to the extent that they can hide their diabetes or gradually announcing their diabetes to the people around them as the disease progresses [34]. Though these patient behaviors could be viewed as narrowing their lives, they could also be seen as attempts to cope with the stress and difficulties caused by their relationships with the people around them, indicating that an “ability to cope with stress” may be behind such behavior. This could explain why the “ability to cope with stress” was related to the RCS in our results.

Among men under the age of 65, only the “ability to cope with stress” was related to the MCS. Meanwhile, for women under the age of 65, “application or adjustment ability” and “motivation to self-manage” were related to the MCS in addition to the “ability to cope with stress.” It has been shown that adults who engage in self-care may experience distress in adjusting to their personal and work lives [35]. In Japan, about half of the people in their 30s to 50s live with stress, and the top reason is related to work [36]. Factors related to social life are, thus, thought to have a significant impact on the QOL of patients in this age group, and the association between the abilities to cope with stress and to coordinate self-care may be related to the mental component of health-related QOL. Support provided to help this group enhance their ability to cope with stress and adjust their self-care to their own situations may lead to an improvement in their mental health-related QOL.

Several self-care agency factors were associated with the MCS among men and women aged 65 years and older. For men and women aged 65 and older, the “ability to cope with stress,” “ability to make the most of the support available,” and “ability to self-manage” were commonly related to the MCS of QOL. In addition to these factors, “motivation to self-manage” was also related to the MCS in women aged 65 and older. It has been shown that old age is a factor that reduces health-related QOL [37] and that older people with diabetes have a lower QOL than those without diabetes [38]. However, the results of the present study suggest that improving self-care agency may lead to improved QOL. In these groups, the “ability to cope with stress,” “ability to make the most of the support available,” and “ability to self-manage” were related to the MCS. It is considered necessary to support older adults with diabetes based on their relationship with their surroundings, that is, their social lives and the people around them who could assist with diabetes management. Additionally, the “ability to self-manage” showed the second strongest association after the “ability to cope with stress” for both men and women. Older adult patients want to age healthily despite being diagnosed with diabetes [39], and social activities tend to be associated with a higher QOL [40]. Older adults have the additional challenge of adjusting to aging, and diabetes management in this context is expected to be difficult. We suggest that a patient’s ability to self-manage in their own way while taking their values and future life into consideration may lead to an improvement in the mental component of health-related QOL.

The results of the multiple regression analysis indicated that the self-care agency factors were not related to the PCS domain of health-related QOL in adults with diabetes. It has been reported that age is inversely correlated with physical aspects of QOL [41] and that patients who have had diabetes for more than 10 years have a lower QOL in terms of physical aspects [42]. Although the participants in this study had lived with diabetes for a long time, with an average of 16.1 years, their PCS was somewhat higher than in previous studies [43,44]. Patients with diabetes often lack subjective symptoms during uncomplicated periods. Furthermore, the SF-12 is not a diabetes-specific questionnaire, making it difficult to assess physical aspects related to diabetes with this scale. Thus, it is possible that the SF-12 did not show an association with self-care agency.

Implications for practice

The findings of this study revealed the elements of diabetes self-care agency related to each aspect of health-related QOL. Providing support to enhance self-care agency is expected to improve patients’ QOL. To improve QOL, nurses may find it useful to be aware of and support patients in enhancing their self-care agency. When self-care agency related to QOL is low, nurses can contribute to the improvement of patients’ QOL by discussing patients’ circumstances with them and considering how to deal with situations that hinder the improvement of self-care agency. This study showed that among the factors of self-care agency, improving the “ability to cope with stress” may lead to improvements in the MSC and RCS aspects of QOL. Therefore, it is important to develop patients’ ability to cope with the stresses of diabetes management to improve the mental component of their health-related QOL. It was also found that the elements of self-care agency related to the mental component of QOL differed between women under 65 years of age and men and women over 65 years of age. Based on this study’s results, we suggest that strategies for assessing self-care agency that consider the patient’s age and sex and working to enhance self-care agency related to QOL can be useful for improving the mental component of the patient’s health-related QOL.

Strengths and limitations

This study has several limitations. First, the study was conducted with adults with diabetes who had no severe complications, were able to communicate in conversations, and had no cognitive impairment. Studies with patients who need treatment for severe complications or extensive assistance with their daily lives and diabetes management may yield different results. Second, although this study examined the relationship between self-care agency and QOL among adults with diabetes as a whole, its multiple regression analysis cannot demonstrate a causal relationship. Thus, it is necessary to confirm the association between self-care agency and QOL using prospective methods in future research. It is necessary to verify whether nursing interventions lead to improvement in health-related QOL; therefore, future work will include examining specific types of support to enhance self-care agency related to QOL and conducting intervention studies with patients.

Conclusion

This study identified the self-care agency related to QOL in adults with diabetes. The results revealed that the “ability to cope with stress” was related to the RCS domain of health-related QOL. In addition, the MCS showed different relations to self-care agency factors according to participants’ age and sex. Further, the “ability to cope with stress” was commonly associated with the MCS across the participant groups, and the “ability to make the most of the support available” and “ability to self-manage” were also associated with the MCS in both men and women aged 65 and over. The results suggest that engaging these agencies may improve the QOL of patients with diabetes. Nurses can clarify the type of support that will lead to improved QOL by evaluating patients’ self-care agency and understanding the status of their QOL-related agency.

Supporting information

S1 Table. Spearman’s rank correlation coefficient between independent variables.

https://doi.org/10.1371/journal.pone.0326783.s001

(XLSX)

S2 Table. Simple regression analysis between participant’s basic attributes, self-care agency, and health-related QOL.

https://doi.org/10.1371/journal.pone.0326783.s002

(XLSX)

S3 Table. Multiple regression analysis between self-care agency factors and SF-12 summary scores.

https://doi.org/10.1371/journal.pone.0326783.s003

(XLSX)

S4 Table. Multiple regression analysis between self-care agency factors and SF-12 mental component summary in four groups.

https://doi.org/10.1371/journal.pone.0326783.s004

(XLSX)

Acknowledgments

We would like to express our gratitude to the doctors, nurses, and participants of the medical institution who participated in this study.

References

1. Ministry of Health, Labour, and Welfare. The national health and nutrition survey in Japan. 2019. https://www.mhlw.go.jp/content/001066903.pdf
- View Article
- Google Scholar
2. Japan Diabetes Society. Diabetes treatment guide 2020-2021. Tokyo: Bunkodo; 2020.
3. Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, et al. 2017 national standards for diabetes self-management education and support. Diabetes Educ. 2017;43(5):449–64. pmid:28753378
- View Article
- PubMed/NCBI
- Google Scholar
4. Al-Khaledi M, Al-Dousari H, Al-Dhufairi S, Al-Mousawi T, Al-Azemi R, Al-Azimi F, et al. Diabetes self-management: a key to better health-related quality of life in patients with diabetes. Med Princ Pract. 2018;27(4):323–31. pmid:29669330
- View Article
- PubMed/NCBI
- Google Scholar
5. Hsu H-C, Lee Y-J, Wang R-H. Influencing pathways to quality of life and HbA1c in patients with diabetes: a longitudinal study that inform evidence-based practice. Worldviews Evid Based Nurs. 2018;15(2):104–12. pmid:29443437
- View Article
- PubMed/NCBI
- Google Scholar
6. Ausili D, Bulgheroni M, Ballatore P, Specchia C, Ajdini A, Bezze S, et al. Self-care, quality of life and clinical outcomes of type 2 diabetes patients: an observational cross-sectional study. Acta Diabetol. 2017;54(11):1001–8. pmid:28852863
- View Article
- PubMed/NCBI
- Google Scholar
7. Nicolucci A, Kovacs Burns K, Holt RIG, Comaschi M, Hermanns N, Ishii H, et al. Diabetes attitudes, wishes and needs second study (DAWN2™): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med. 2013;30(7):767–77. pmid:23711019
- View Article
- PubMed/NCBI
- Google Scholar
8. Moghaddam HR, Sobhi E, Soola AH. Determinants of quality of life among elderly patients with type 2 diabetes in northwest of iran: based on problem areas in diabetes. Front Endocrinol (Lausanne). 2022;13:924451. pmid:35937833
- View Article
- PubMed/NCBI
- Google Scholar
9. Orem DE. Nursing: concepts of practice. 6th ed. T. Onodera, trans. 4th ed. Tokyo: Igaku-shoin; 2001.
10. Sousa VD, Zauszniewski JA, Musil CM, McDonald PE, Milligan SE. Testing a conceptual framework for diabetes self-care management. Res Theory Nurs Pract. 2004;18(4):293–316. pmid:15776752
- View Article
- PubMed/NCBI
- Google Scholar
11. Sousa VD, Zauszniewski JA, Musil CM, Price Lea PJ, Davis SA. Relationships among self-care agency, self-efficacy, self-care, and glycemic control. Res Theory Nurs Pract. 2005;19(3):217–30. pmid:16144240
- View Article
- PubMed/NCBI
- Google Scholar
12. Surucu HA, Kizilci S, Ergor G. The impacts of diabetes education on self-care agency, self-care activities, and HbA1c levels of patients with type 2 diabetes: a randomized controlled study. Int J Caring Sci. 2017;10:479–89.
- View Article
- Google Scholar
13. Masuda C. Self-care agency and its related factor in menopausal patients with diabetes. J Japan Acad Diabet Educ Nurs. 2014;18:171–8.
- View Article
- Google Scholar
14. Nakajima K, Ando Y. Psychosocial and social factors related to self-care agency in patients with adult-onset type 1 diabetes. J Japan Acad Diabet Educ Nurs. 2021;25:83–92.
- View Article
- Google Scholar
15. Umeda E, Shimizu Y, Kawai N. Difficulties in daily life and the association with self-care ability in adults with type 1 diabetes mellitus in Japan: a cross-sectional study. Nurs Open. 2020;7(4):943–50. pmid:32587712
- View Article
- PubMed/NCBI
- Google Scholar
16. Gaffari-Fam S, Lotfi Y, Daemi A, Babazadeh T, Sarbazi E, Dargahi-Abbasabad G, et al. Impact of health literacy and self-care behaviors on health-related quality of life in Iranians with type 2 diabetes: a cross-sectional study. Health Qual Life Outcomes. 2020;18(1):357. pmid:33148266
- View Article
- PubMed/NCBI
- Google Scholar
17. Wonde TE, Ayene TR, Moges NA, Bazezew Y. Health-related quality of life and associated factors among type 2 diabetic adult patients in Debre Markos Referral Hospital, Northwest Ethiopia. Heliyon. 2022;8(8):e10182. pmid:36033286
- View Article
- PubMed/NCBI
- Google Scholar
18. Tran Kien N, Phuong Hoa N, Minh Duc D, Wens J. Health-related quality of life and associated factors among patients with type II diabetes mellitus: a study in the family medicine center (FMC) of Agricultural General Hospital in Hanoi, Vietnam. Health Psychol Open. 2021;8(1):2055102921996172. pmid:33747536
- View Article
- PubMed/NCBI
- Google Scholar
19. Chantzaras A, Yfantopoulos J. Association between medication adherence and health-related quality of life of patients with diabetes. Hormones (Athens). 2022;21(4):691–705. pmid:36219341
- View Article
- PubMed/NCBI
- Google Scholar
20. Nguyen HTT, Moir MP, Nguyen TX, Vu AP, Luong LH, Nguyen TN, et al. Health-related quality of life in elderly diabetic outpatients in Vietnam. Patient Prefer Adherence. 2018;12:1347–54. pmid:30100711
- View Article
- PubMed/NCBI
- Google Scholar
21. Babazadeh T, Dianatinasab M, Daemi A, Nikbakht HA, Moradi F, Ghaffari-Fam S. Association of self-care behaviors and quality of life among patients with type 2 diabetes mellitus: Chaldoran County, Iran. Diabetes Metab J. 2017;41(6):449–56. pmid:29272083
- View Article
- PubMed/NCBI
- Google Scholar
22. Rahmani F, Valizadeh S, Ghogazadeh M, Bagheriyeh F. Self-care agency and quality of life among Iranian adolescents with diabetes mellitus type 1. Nurs Pract Today. 2018;5:256–63.
- View Article
- Google Scholar
23. Nakanishi M, Kanematsu Y, Ono T, Amemiya E, Ibe T, Hirano K. A study of self-care behaviors of patients with chronic illness and the role of nursing. 53304057. Tokyo: Grant-in-aid for Scientific Research, Ministry of Education, Culture, Sports, Science, and Technology, Japan; 1990.
24. Polit DF, Beck CT. Nursing research: principles and methods. 7th ed. Tokyo: Igaku-shoin; 2004.
25. Ministry of Health, Labour, and Welfare. Overview of Measures for Chronic Childhood Diseases. Accessed 2024 July 4. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000078973.html
- View Article
- Google Scholar
26. Buchner A, Erdfelder E, Faul F, Lang AG. G*Power. HHU. 2020. https://www.psychologie.hhu.de/arbeitsgruppen/allgemeine-psychologie-und-arbeitspsychologie/gpower
- View Article
- Google Scholar
27. Miyawaki Y, Shimizu Y, Uchiumi K, Asou K, Murakado N, Kuroda K, et al. Reliability and validity of a shortened version of an instrument for diabetes self-care agency. J Nurs Meas. 2015;23(2):326–35. pmid:26284844
- View Article
- PubMed/NCBI
- Google Scholar
28. Ware J Jr, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33. pmid:8628042
- View Article
- PubMed/NCBI
- Google Scholar
29. Suzukamo Y, Fukuhara S, Green J, Kosinski M, Gandek B, Ware JE. Validation testing of a three-component model of Short Form-36 scores. J Clin Epidemiol. 2011;64(3):301–8. pmid:20800993
- View Article
- PubMed/NCBI
- Google Scholar
30. Qualitest Inc. SF-12. 2015 [Accessed 2022 February 1. ]. https://www.qualitest.jp/qol/sf12.html
- View Article
- Google Scholar
31. Cleal B, Willaing I, Stuckey H, Peyrot M. Work matters: diabetes and worklife in the second diabetes attitudes, wishes and needs (DAWN2) study. Diabetes Res Clin Pract. 2019;150:90–8. pmid:30825559
- View Article
- PubMed/NCBI
- Google Scholar
32. Browne JL, Ventura A, Mosely K, Speight J. “I call it the blame and shame disease”: a qualitative study about perceptions of social stigma surrounding type 2 diabetes. BMJ Open. 2013;3(11):e003384. pmid:24247325
- View Article
- PubMed/NCBI
- Google Scholar
33. Hakkarainen P, Munir F, Moilanen L, Räsänen K, Hänninen V. Concealment of type 1 diabetes at work in Finland: a mixed-method study. BMJ Open. 2018;8(1):e019764. pmid:29331976
- View Article
- PubMed/NCBI
- Google Scholar
34. Nakao T, Takataru Y, Yokota K, Masai S, Kataoka C, Nakamura N. Coping with stigma among working patients with type 2 diabetes. J Japan Acad Diabet Educ Nurs. 2015;19:121–30.
- View Article
- Google Scholar
35. Sugunari Y, Itagaki M, Watanabe H. Difficulties in a life of outpatients with type 2 diabetes. Bull Coll Nurs Ibaraki Christian University. 2010;2:37–44.
- View Article
- Google Scholar
36. Ministry of Health, Labour, and Welfare. 2019 overview of the national survey on living standards in Japan. 2019. https://www.mhlw.go.jp/toukei/saikin/hw/k-tyosa/k-tyosa19/index.html
- View Article
- Google Scholar
37. Jankowska A, Golicki D. EQ-5D-5L-based quality of life normative data for patients with self-reported diabetes in Poland. PLoS One. 2021;16(9):e0257998. pmid:34587218
- View Article
- PubMed/NCBI
- Google Scholar
38. Shamshirgaran SM, Stephens C, Alpass F, Aminisani N. Longitudinal assessment of the health-related quality of life among older people with diabetes: results of a nationwide study in New Zealand. BMC Endocr Disord. 2020;20(1):32. pmid:32138698
- View Article
- PubMed/NCBI
- Google Scholar
39. Koshino E, Inagaki M, Tasaki K. Self-care learning in type 2 diabetes patients aged 65 years or older at the time of diagnosis. J Japan Acad Diabet Educ Nurs. 2015:111–20.
- View Article
- Google Scholar
40. Kim H, Kim K. Health-Related Quality-of-Life and Diabetes Self-Care Activity in Elderly Patients with Diabetes in Korea. J Community Health. 2017;42(5):998–1007. pmid:28432547
- View Article
- PubMed/NCBI
- Google Scholar
41. Gálvez Galán I, Cáceres León MC, Guerrero-Martín J, López Jurado CF, Durán-Gómez N. Health-related quality of life in diabetes mellitus patients in primary health care. Enferm Clin (Engl Ed). 2021;31(5):313–22. pmid:34376354
- View Article
- PubMed/NCBI
- Google Scholar
42. Alshahrani JA, Alshahrani AS, Alshahrani AM, Alshalaan AM, Alhumam MN, Alshahrani NZ 4th. The impact of diabetes mellitus duration and complications on health-related quality of life among type 2 diabetic patients in Khamis Mushit City, Saudi Arabia. Cureus. 2023;15(8):e44216. pmid:37772253
- View Article
- PubMed/NCBI
- Google Scholar
43. Panahi N, Ahmadi M, Hosseinpour M, Sedokani A, Sanjari M, Khalagi K, et al. The association between quality of life and diabetes: the Bushehr Elderly Health Program. BMC Geriatr. 2024;24(1):267. pmid:38500039
- View Article
- PubMed/NCBI
- Google Scholar
44. Jankowska A, Golicki D. Self-reported diabetes and quality of life: findings from a general population survey with the Short Form-12 (SF-12) Health Survey. Arch Med Sci. 2021;18(5):1157–68. pmid:36160338
- View Article
- PubMed/NCBI
- Google Scholar

[ref1] 1. Ministry of Health, Labour, and Welfare. The national health and nutrition survey in Japan. 2019. https://www.mhlw.go.jp/content/001066903.pdf
View Article
Google Scholar

[2] View Article

[3] Google Scholar

[ref2] 2. Japan Diabetes Society. Diabetes treatment guide 2020-2021. Tokyo: Bunkodo; 2020.

[ref3] 3. Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, et al. 2017 national standards for diabetes self-management education and support. Diabetes Educ. 2017;43(5):449–64. pmid:28753378
View Article
PubMed/NCBI
Google Scholar

[6] View Article

[7] PubMed/NCBI

[8] Google Scholar

[ref4] 4. Al-Khaledi M, Al-Dousari H, Al-Dhufairi S, Al-Mousawi T, Al-Azemi R, Al-Azimi F, et al. Diabetes self-management: a key to better health-related quality of life in patients with diabetes. Med Princ Pract. 2018;27(4):323–31. pmid:29669330
View Article
PubMed/NCBI
Google Scholar

[10] View Article

[11] PubMed/NCBI

[12] Google Scholar

[ref5] 5. Hsu H-C, Lee Y-J, Wang R-H. Influencing pathways to quality of life and HbA1c in patients with diabetes: a longitudinal study that inform evidence-based practice. Worldviews Evid Based Nurs. 2018;15(2):104–12. pmid:29443437
View Article
PubMed/NCBI
Google Scholar

[14] View Article

[15] PubMed/NCBI

[16] Google Scholar

[ref6] 6. Ausili D, Bulgheroni M, Ballatore P, Specchia C, Ajdini A, Bezze S, et al. Self-care, quality of life and clinical outcomes of type 2 diabetes patients: an observational cross-sectional study. Acta Diabetol. 2017;54(11):1001–8. pmid:28852863
View Article
PubMed/NCBI
Google Scholar

[18] View Article

[19] PubMed/NCBI

[20] Google Scholar

[ref7] 7. Nicolucci A, Kovacs Burns K, Holt RIG, Comaschi M, Hermanns N, Ishii H, et al. Diabetes attitudes, wishes and needs second study (DAWN2™): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med. 2013;30(7):767–77. pmid:23711019
View Article
PubMed/NCBI
Google Scholar

[22] View Article

[23] PubMed/NCBI

[24] Google Scholar

[ref8] 8. Moghaddam HR, Sobhi E, Soola AH. Determinants of quality of life among elderly patients with type 2 diabetes in northwest of iran: based on problem areas in diabetes. Front Endocrinol (Lausanne). 2022;13:924451. pmid:35937833
View Article
PubMed/NCBI
Google Scholar

[26] View Article

[27] PubMed/NCBI

[28] Google Scholar

[ref9] 9. Orem DE. Nursing: concepts of practice. 6th ed. T. Onodera, trans. 4th ed. Tokyo: Igaku-shoin; 2001.

[ref10] 10. Sousa VD, Zauszniewski JA, Musil CM, McDonald PE, Milligan SE. Testing a conceptual framework for diabetes self-care management. Res Theory Nurs Pract. 2004;18(4):293–316. pmid:15776752
View Article
PubMed/NCBI
Google Scholar

[31] View Article

[32] PubMed/NCBI

[33] Google Scholar

[ref11] 11. Sousa VD, Zauszniewski JA, Musil CM, Price Lea PJ, Davis SA. Relationships among self-care agency, self-efficacy, self-care, and glycemic control. Res Theory Nurs Pract. 2005;19(3):217–30. pmid:16144240
View Article
PubMed/NCBI
Google Scholar

[35] View Article

[36] PubMed/NCBI

[37] Google Scholar

[ref12] 12. Surucu HA, Kizilci S, Ergor G. The impacts of diabetes education on self-care agency, self-care activities, and HbA1c levels of patients with type 2 diabetes: a randomized controlled study. Int J Caring Sci. 2017;10:479–89.
View Article
Google Scholar

[39] View Article

[40] Google Scholar

[ref13] 13. Masuda C. Self-care agency and its related factor in menopausal patients with diabetes. J Japan Acad Diabet Educ Nurs. 2014;18:171–8.
View Article
Google Scholar

[42] View Article

[43] Google Scholar

[ref14] 14. Nakajima K, Ando Y. Psychosocial and social factors related to self-care agency in patients with adult-onset type 1 diabetes. J Japan Acad Diabet Educ Nurs. 2021;25:83–92.
View Article
Google Scholar

[45] View Article

[46] Google Scholar

[ref15] 15. Umeda E, Shimizu Y, Kawai N. Difficulties in daily life and the association with self-care ability in adults with type 1 diabetes mellitus in Japan: a cross-sectional study. Nurs Open. 2020;7(4):943–50. pmid:32587712
View Article
PubMed/NCBI
Google Scholar

[48] View Article

[49] PubMed/NCBI

[50] Google Scholar

[ref16] 16. Gaffari-Fam S, Lotfi Y, Daemi A, Babazadeh T, Sarbazi E, Dargahi-Abbasabad G, et al. Impact of health literacy and self-care behaviors on health-related quality of life in Iranians with type 2 diabetes: a cross-sectional study. Health Qual Life Outcomes. 2020;18(1):357. pmid:33148266
View Article
PubMed/NCBI
Google Scholar

[52] View Article

[53] PubMed/NCBI

[54] Google Scholar

[ref17] 17. Wonde TE, Ayene TR, Moges NA, Bazezew Y. Health-related quality of life and associated factors among type 2 diabetic adult patients in Debre Markos Referral Hospital, Northwest Ethiopia. Heliyon. 2022;8(8):e10182. pmid:36033286
View Article
PubMed/NCBI
Google Scholar

[56] View Article

[57] PubMed/NCBI

[58] Google Scholar

[ref18] 18. Tran Kien N, Phuong Hoa N, Minh Duc D, Wens J. Health-related quality of life and associated factors among patients with type II diabetes mellitus: a study in the family medicine center (FMC) of Agricultural General Hospital in Hanoi, Vietnam. Health Psychol Open. 2021;8(1):2055102921996172. pmid:33747536
View Article
PubMed/NCBI
Google Scholar

[60] View Article

[61] PubMed/NCBI

[62] Google Scholar

[ref19] 19. Chantzaras A, Yfantopoulos J. Association between medication adherence and health-related quality of life of patients with diabetes. Hormones (Athens). 2022;21(4):691–705. pmid:36219341
View Article
PubMed/NCBI
Google Scholar

[64] View Article

[65] PubMed/NCBI

[66] Google Scholar

[ref20] 20. Nguyen HTT, Moir MP, Nguyen TX, Vu AP, Luong LH, Nguyen TN, et al. Health-related quality of life in elderly diabetic outpatients in Vietnam. Patient Prefer Adherence. 2018;12:1347–54. pmid:30100711
View Article
PubMed/NCBI
Google Scholar

[68] View Article

[69] PubMed/NCBI

[70] Google Scholar

[ref21] 21. Babazadeh T, Dianatinasab M, Daemi A, Nikbakht HA, Moradi F, Ghaffari-Fam S. Association of self-care behaviors and quality of life among patients with type 2 diabetes mellitus: Chaldoran County, Iran. Diabetes Metab J. 2017;41(6):449–56. pmid:29272083
View Article
PubMed/NCBI
Google Scholar

[72] View Article

[73] PubMed/NCBI

[74] Google Scholar

[ref22] 22. Rahmani F, Valizadeh S, Ghogazadeh M, Bagheriyeh F. Self-care agency and quality of life among Iranian adolescents with diabetes mellitus type 1. Nurs Pract Today. 2018;5:256–63.
View Article
Google Scholar

[76] View Article

[77] Google Scholar

[ref23] 23. Nakanishi M, Kanematsu Y, Ono T, Amemiya E, Ibe T, Hirano K. A study of self-care behaviors of patients with chronic illness and the role of nursing. 53304057. Tokyo: Grant-in-aid for Scientific Research, Ministry of Education, Culture, Sports, Science, and Technology, Japan; 1990.

[ref24] 24. Polit DF, Beck CT. Nursing research: principles and methods. 7th ed. Tokyo: Igaku-shoin; 2004.

[ref25] 25. Ministry of Health, Labour, and Welfare. Overview of Measures for Chronic Childhood Diseases. Accessed 2024 July 4. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000078973.html
View Article
Google Scholar

[81] View Article

[82] Google Scholar

[ref26] 26. Buchner A, Erdfelder E, Faul F, Lang AG. G*Power. HHU. 2020. https://www.psychologie.hhu.de/arbeitsgruppen/allgemeine-psychologie-und-arbeitspsychologie/gpower
View Article
Google Scholar

[84] View Article

[85] Google Scholar

[ref27] 27. Miyawaki Y, Shimizu Y, Uchiumi K, Asou K, Murakado N, Kuroda K, et al. Reliability and validity of a shortened version of an instrument for diabetes self-care agency. J Nurs Meas. 2015;23(2):326–35. pmid:26284844
View Article
PubMed/NCBI
Google Scholar

[87] View Article

[88] PubMed/NCBI

[89] Google Scholar

[ref28] 28. Ware J Jr, Kosinski M, Keller SD. A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–33. pmid:8628042
View Article
PubMed/NCBI
Google Scholar

[91] View Article

[92] PubMed/NCBI

[93] Google Scholar

[ref29] 29. Suzukamo Y, Fukuhara S, Green J, Kosinski M, Gandek B, Ware JE. Validation testing of a three-component model of Short Form-36 scores. J Clin Epidemiol. 2011;64(3):301–8. pmid:20800993
View Article
PubMed/NCBI
Google Scholar

[95] View Article

[96] PubMed/NCBI

[97] Google Scholar

[ref30] 30. Qualitest Inc. SF-12. 2015 [Accessed 2022 February 1. ]. https://www.qualitest.jp/qol/sf12.html
View Article
Google Scholar

[99] View Article

[100] Google Scholar

[ref31] 31. Cleal B, Willaing I, Stuckey H, Peyrot M. Work matters: diabetes and worklife in the second diabetes attitudes, wishes and needs (DAWN2) study. Diabetes Res Clin Pract. 2019;150:90–8. pmid:30825559
View Article
PubMed/NCBI
Google Scholar

[102] View Article

[103] PubMed/NCBI

[104] Google Scholar

[ref32] 32. Browne JL, Ventura A, Mosely K, Speight J. “I call it the blame and shame disease”: a qualitative study about perceptions of social stigma surrounding type 2 diabetes. BMJ Open. 2013;3(11):e003384. pmid:24247325
View Article
PubMed/NCBI
Google Scholar

[106] View Article

[107] PubMed/NCBI

[108] Google Scholar

[ref33] 33. Hakkarainen P, Munir F, Moilanen L, Räsänen K, Hänninen V. Concealment of type 1 diabetes at work in Finland: a mixed-method study. BMJ Open. 2018;8(1):e019764. pmid:29331976
View Article
PubMed/NCBI
Google Scholar

[110] View Article

[111] PubMed/NCBI

[112] Google Scholar

[ref34] 34. Nakao T, Takataru Y, Yokota K, Masai S, Kataoka C, Nakamura N. Coping with stigma among working patients with type 2 diabetes. J Japan Acad Diabet Educ Nurs. 2015;19:121–30.
View Article
Google Scholar

[114] View Article

[115] Google Scholar

[ref35] 35. Sugunari Y, Itagaki M, Watanabe H. Difficulties in a life of outpatients with type 2 diabetes. Bull Coll Nurs Ibaraki Christian University. 2010;2:37–44.
View Article
Google Scholar

[117] View Article

[118] Google Scholar

[ref36] 36. Ministry of Health, Labour, and Welfare. 2019 overview of the national survey on living standards in Japan. 2019. https://www.mhlw.go.jp/toukei/saikin/hw/k-tyosa/k-tyosa19/index.html
View Article
Google Scholar

[120] View Article

[121] Google Scholar

[ref37] 37. Jankowska A, Golicki D. EQ-5D-5L-based quality of life normative data for patients with self-reported diabetes in Poland. PLoS One. 2021;16(9):e0257998. pmid:34587218
View Article
PubMed/NCBI
Google Scholar

[123] View Article

[124] PubMed/NCBI

[125] Google Scholar

[ref38] 38. Shamshirgaran SM, Stephens C, Alpass F, Aminisani N. Longitudinal assessment of the health-related quality of life among older people with diabetes: results of a nationwide study in New Zealand. BMC Endocr Disord. 2020;20(1):32. pmid:32138698
View Article
PubMed/NCBI
Google Scholar

[127] View Article

[128] PubMed/NCBI

[129] Google Scholar

[ref39] 39. Koshino E, Inagaki M, Tasaki K. Self-care learning in type 2 diabetes patients aged 65 years or older at the time of diagnosis. J Japan Acad Diabet Educ Nurs. 2015:111–20.
View Article
Google Scholar

[131] View Article

[132] Google Scholar

[ref40] 40. Kim H, Kim K. Health-Related Quality-of-Life and Diabetes Self-Care Activity in Elderly Patients with Diabetes in Korea. J Community Health. 2017;42(5):998–1007. pmid:28432547
View Article
PubMed/NCBI
Google Scholar

[134] View Article

[135] PubMed/NCBI

[136] Google Scholar

[ref41] 41. Gálvez Galán I, Cáceres León MC, Guerrero-Martín J, López Jurado CF, Durán-Gómez N. Health-related quality of life in diabetes mellitus patients in primary health care. Enferm Clin (Engl Ed). 2021;31(5):313–22. pmid:34376354
View Article
PubMed/NCBI
Google Scholar

[138] View Article

[139] PubMed/NCBI

[140] Google Scholar

[ref42] 42. Alshahrani JA, Alshahrani AS, Alshahrani AM, Alshalaan AM, Alhumam MN, Alshahrani NZ 4th. The impact of diabetes mellitus duration and complications on health-related quality of life among type 2 diabetic patients in Khamis Mushit City, Saudi Arabia. Cureus. 2023;15(8):e44216. pmid:37772253
View Article
PubMed/NCBI
Google Scholar

[142] View Article

[143] PubMed/NCBI

[144] Google Scholar

[ref43] 43. Panahi N, Ahmadi M, Hosseinpour M, Sedokani A, Sanjari M, Khalagi K, et al. The association between quality of life and diabetes: the Bushehr Elderly Health Program. BMC Geriatr. 2024;24(1):267. pmid:38500039
View Article
PubMed/NCBI
Google Scholar

[146] View Article

[147] PubMed/NCBI

[148] Google Scholar

[ref44] 44. Jankowska A, Golicki D. Self-reported diabetes and quality of life: findings from a general population survey with the Short Form-12 (SF-12) Health Survey. Arch Med Sci. 2021;18(5):1157–68. pmid:36160338
View Article
PubMed/NCBI
Google Scholar

[150] View Article

[151] PubMed/NCBI

[152] Google Scholar

Figures

Abstract

Introduction

Definition of terms

Methods

Research design, setting, and participants

Measurements

Participant’s basic attributes.

Self-care agency.

Health-related QOL.

Ethical considerations

Statistical analyses

Results

Participants’ characteristics

Relationship between self-care agency factors and health-related QOL

Discussion

Implications for practice

Strengths and limitations

Conclusion

Supporting information

S1 Table. Spearman’s rank correlation coefficient between independent variables.

S2 Table. Simple regression analysis between participant’s basic attributes, self-care agency, and health-related QOL.

S3 Table. Multiple regression analysis between self-care agency factors and SF-12 summary scores.

S4 Table. Multiple regression analysis between self-care agency factors and SF-12 mental component summary in four groups.

Acknowledgments

References