Underlying mechanisms of diabetes knowledge influencing diabetes self-management behaviors among patients with type II diabetes in rural China: Based on health belief model

To investigate the association between diabetes knowledge and diabetes self-management (DSM) behaviors and to explore the influence mechanism between them among patients with type 2 diabetes mellitus (T2DM) based on health belief model in rural China. This cross-sectional study included 483 participants with T2DM from 8 villages of 3 townships in Jiangsu Province. All participants completed a structured questionnaire, including demographic information, diabetes knowledge, DSM behaviors, health beliefs, and cognitive function. Multiple linear regression and mediation analysis were performed to analyze the association between diabetes knowledge and DSM behaviors, furthermore the mechanism between them. Diabetes knowledge and self-efficacy positively influenced DSM behaviors. Health beliefs multiply mediated the association between diabetes knowledge and DSM behaviors. Perceived behavioral barriers mediated the relationship between diabetes knowledge and DSM behaviors, where a suppression effect existed. A chain-mediated effect was found: diabetes knowledge affected perceived benefits, followed by self-efficacy, and finally DSM behaviors. Diabetes knowledge acquisition played an important role in improving DSM behaviors, and health beliefs multiply mediated the relationship between them. When designing interventions, health systems and health providers should refocus on diabetes knowledge, emphasize the benefits of self-management, and consider the barriers that patients may encounter. •The more patients know about diabetes, the more benefits they feel of self-care.•The more benefits patients have of self-care, the more confident they are to do it.•The more confident patients are in self-care, the more likely they are to do it.•The more patients know about diabetes, the more barriers they have to self-care.•The more barriers patients feel of self-care, the less likely they are to do it.