Relationship between diabetes health literacy, distress, burnout, social support, complications, self-care behaviors, and quality of life among patients with type 2 diabetes: a path analysis study

Abstract

Abstract Introduction Improving the quality of life (QOL) is the most important goal of early diagnosis and treatment in patients with type 2 diabetes (T2D). Numerous studies have indicated the positive effects of health literacy, social support and self-care behaviors and the negative effects of diabetes distress and burnout on the QOL of patients with T2D. Understanding these factors is crucial for people with diabetes. However, no study has investigated the simultaneous effects of these variables on QOL. In this study, our goals were to find out how these variables are related to each other, in addition, which variables play the role of mediating variables, and finally, what is the cumulative effect of these variables in predicting the QOL of patients with T2D. So, this study aimed to examine the relationship between diabetes health literacy (DHL), distress, burnout, social support, complications of diabetes, self-care behaviors, and QOL among patients with T2D by application Path analysis method. Methods In this study 929 participants were entered to study by cluster sampling method and finally, data were analyzed among 820 participants. Data were gathered by self-report and with seven tools of Demographic section, DHL Scale, Diabetes distress scale, Diabetes Burnout scale, Diabetes Self-Management Questionnaire (DSMQ), Perceived social support, Diabetes Quality of Life (DQOL) Questionnaire. The software’s of SPSS version 24 and AMOS version 24 were used for analysis. Results The variables of DHL, social support, diabetes distress, and complications of diabetes predicted 38% variance in diabetes burnout (R2 = 0.38). Greatest impact on diabetes burnout was related to diabetes distress (estimate total effect = 0.539). The variables of DHL, social support, diabetes distress, complications of diabetes, and diabetes burnout predicted 24% variance in self- care behaviors (R2 = 0.24). Greatest impact on self- care behaviors was related to DHL (estimate total effect = 0.354). The variables of DHL, social support, diabetes distress, diabetes burnout, complications of diabetes, and self- care behaviors predicted 49% variance in DQOL (R2 = 0.49). Greatest impact on DQOL was related to variables of diabetes distress (estimate total effect = -0.613), DHL (estimate total effect = 0.225), diabetes burnout (estimate total effect = -0.202), complications of diabetes (estimate total effect = − 0.173), social support (estimate total effect = 0.149), and self -care (estimate total effect = 0.149), respectively. Conclusion To improve QOL in patients with T2D, health care providers must develop interventions that increase DHL of diabetic. Because DHL can decrease distress and burnout, enhance self -care skills, create supportive networks, and ultimately improve QOL in patients with type 2 diabetes.