{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T03:32:25Z","timestamp":1771471945275,"version":"3.50.1"},"reference-count":22,"publisher":"Belitung Raya Foundation","issue":"5","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"award":[""],"award-info":[{"award-number":[""]}]}],"content-domain":{"domain":["belitungraya.org"],"crossmark-restriction":true},"short-container-title":["Belitung Nurs J"],"abstract":"<jats:p>Background:\u00a0The relationship between self-care behaviors, physiological indicators, and quality of life (QoL) in Type 2 Diabetes Mellitus (T2DM) remains underexplored in Indonesian populations. Understanding these factors is crucial for designing culturally appropriate interventions.\nObjective:\u00a0 To examine the direct effects of four self-care domains on QoL and the potential mediating roles of HbA1c, blood pressure, and BMI among Indonesian patients with T2DM.\nMethods:\u00a0A cross-sectional exploratory study was conducted August to September 2022 among 128 purposively selected patients from community health centers. Self-care (SCODI) and QoL (DQOL) were measured using validated questionnaires, and HbA1c, blood pressure, and BMI were obtained from clinical records. Structural equation modeling (SEM) was conducted using IBM AMOS version 24.\nResults:\u00a0The SEM analysis yielded an overidentified model (df = 1578) with acceptable fit indices (CFI = 0.908, RMSEA = 0.082, CMIN\/df = 1.851). Self-maintenance significantly predicted QoL, HbA1c, and blood pressure. Self-monitoring reduced blood pressure and BMI but was negatively associated with QoL. Self-management improved HbA1c but increased blood pressure and BMI, with a borderline positive effect on QoL. Self-confidence was positively associated with BMI but not with QoL, HbA1c, or blood pressure. Among physiological indicators, only HbA1c significantly predicted QoL.\nConclusion:\u00a0The direct effects of self-care behaviors on quality of life were more significant than the indirect effects mediated by clinical indicators, emphasizing the importance of strengthening daily self-care skills as a core strategy to enhance well-being in patients with T2DM. Given the exploratory cross-sectional design, findings should be interpreted as associative rather than causal. Future longitudinal research should validate these pathways and develop culturally sensitive intervention models that empower patients to sustain effective self-care behaviors over time.<\/jats:p>","DOI":"10.33546\/bnj.3882","type":"journal-article","created":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T08:40:59Z","timestamp":1759653659000},"page":"612-618","update-policy":"https:\/\/doi.org\/10.33546\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The relationship among self-care, glycemic control, and quality of life in Indonesian patients with type 2 diabetes mellitus: An exploratory structural equation modeling study"],"prefix":"10.33546","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3224-5657","authenticated-orcid":false,"given":"Hema","family":"Malini","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0136-8081","authenticated-orcid":false,"given":"Intan Yullya","family":"Kardila","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7370-0062","authenticated-orcid":false,"given":"Aisha","family":"Alhofaian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"19163","published-online":{"date-parts":[[2025,10,5]]},"reference":[{"key":"130217","doi-asserted-by":"crossref","unstructured":"Ausili, D., Barbaranelli, C., Rossi, E., Rebora, P., Fabrizi, D., Coghi, C., Luciani, M., Vellone, E., Di Mauro, S., & Riegel, B. (2017). Development and psychometric testing of a theory-based tool to measure self-care in diabetes patients: the Self-Care of Diabetes Inventory. BMC Endocrine Disorders, 17, 66. https:\/\/doi.org\/10.1186\/s12902-017-0218-y","DOI":"10.1186\/s12902-017-0218-y"},{"key":"130218","doi-asserted-by":"crossref","unstructured":"Buck, H. G., Shadmi, E., Topaz, M., & Sockolow, P. S. (2021). An integrative review and theoretical examination of chronic illness mHealth studies using the Middle\u2010Range Theory of Self\u2010care of Chronic Illness. Research in Nursing & Health, 44(1), 47-59. https:\/\/doi.org\/10.1002\/nur.22073","DOI":"10.1002\/nur.22073"},{"key":"130219","doi-asserted-by":"crossref","unstructured":"Burroughs, T. E., Desikan, R., Waterman, B. M., Gilin, D., & McGill, J. (2004). Development and validation of the diabetes quality of life brief clinical inventory. Diabetes Spectrum, 17(1), 41-49. https:\/\/doi.org\/10.2337\/diaspect.17.1.41","DOI":"10.2337\/diaspect.17.1.41"},{"key":"130220","doi-asserted-by":"crossref","unstructured":"Chali, S. W., Salih, M. H., & Abate, A. T. (2018). Self-care practice and associated factors among Diabetes Mellitus patients on follow up in Benishangul Gumuz Regional State Public Hospitals, Western Ethiopia: A cross-sectional study. BMC Research Notes, 11, 833. https:\/\/doi.org\/10.1186\/s13104-018-3939-8","DOI":"10.1186\/s13104-018-3939-8"},{"key":"130221","doi-asserted-by":"crossref","unstructured":"Cunningham, A. T., Crittendon, D. R., White, N., Mills, G. D., Diaz, V., & LaNoue, M. D. (2018). The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: A systematic review and meta-analysis. BMC Health Services Research, 18, 367. https:\/\/doi.org\/10.1186\/s12913-018-3186-7","DOI":"10.1186\/s12913-018-3186-7"},{"key":"130222","doi-asserted-by":"crossref","unstructured":"Farahani, M. F., Purfarzad, Z., Ghorbani, M., Zare, Z. G., & Ghorbani, F. (2016). The impact of multimedia software support on the knowledge and self-care behaviors of patients with type 2 diabetes: A randomized clinical trial. Journal of Caring Sciences, 5(2), 111-120. https:\/\/doi.org\/10.15171\/jcs.2016.012","DOI":"10.15171\/jcs.2016.012"},{"key":"130223","doi-asserted-by":"crossref","unstructured":"Hamid, A., Dawson, A. Z., Xu, Y., & Egede, L. E. (2024). Independent correlates of glycemic control among adults with diabetes in South Africa. International Journal of Environmental Research and Public Health, 21(4), 486. https:\/\/doi.org\/10.3390\/ijerph21040486","DOI":"10.3390\/ijerph21040486"},{"key":"130224","unstructured":"International Diabetes Federation [IDF]. (2021). IDF Diabetes Atlas 2021. 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Association between self-care behaviors and quality of life among elderly minority groups on the border of Thailand. Journal of Multidisciplinary Healthcare, 12, 1049-1059. https:\/\/doi.org\/10.2147\/JMDH.S227617","DOI":"10.2147\/JMDH.S227617"},{"key":"130229","doi-asserted-by":"crossref","unstructured":"Prajapati, V. B., Blake, R., Acharya, L. D., & Seshadri, S. (2018). Assessment of quality of life in type II diabetic patients using the modified diabetes quality of life (MDQoL)-17 questionnaire. Brazilian Journal of Pharmaceutical Sciences, 53(4). https:\/\/doi.org\/10.1590\/s2175-97902017000417144","DOI":"10.1590\/s2175-97902017000417144"},{"key":"130230","doi-asserted-by":"crossref","unstructured":"Ridderstr\u00e5le, M., Evans, L. M., Jensen, H. H., B\u00f8gelund, M., Jensen, M. M., Ericsson, \u00c5., & Jendle, J. (2016). Estimating the impact of changes in HbA 1c, body weight and insulin injection regimen on health related quality-of-life: A time trade off study. Health and Quality of Life Outcomes, 14, 13. https:\/\/doi.org\/10.1186\/s12955-016-0411-0","DOI":"10.1186\/s12955-016-0411-0"},{"key":"130231","doi-asserted-by":"crossref","unstructured":"Riegel, B., Jaarsma, T., & Str\u00f6mberg, A. (2012). A middle-range theory of self-care of chronic illness. Advances in Nursing Science, 35(3), 194-204. https:\/\/doi.org\/10.1097\/ANS.0b013e318261b1ba","DOI":"10.1097\/ANS.0b013e318261b1ba"},{"key":"130232","doi-asserted-by":"crossref","unstructured":"Samah, S., Neoh, C. F., Wong, Y. Y., Hassali, M. A., Shafie, A. A., Lim, S. M., Ramasamy, K., Nasir, N. M., Han, Y. W., & Burroughs, T. (2017). Linguistic and psychometric validation of the Malaysian version of Diabetes Quality of Life-Brief Clinical Inventory (DQoL-BCI). Research in Social and Administrative Pharmacy, 13(6), 1135-1141. https:\/\/doi.org\/10.1016\/j.sapharm.2016.10.017","DOI":"10.1016\/j.sapharm.2016.10.017"},{"key":"130233","doi-asserted-by":"crossref","unstructured":"Skevington, S. 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Jurnal Keperawatan Muhammadiyah, 151-155. https:\/\/doi.org\/10.30651\/jkm.v4i2.2347"}],"container-title":["Belitung Nursing Journal"],"original-title":[],"link":[{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/3882\/1240","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/3882\/1254","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/download\/3882\/1240","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T11:41:37Z","timestamp":1759664497000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.belitungraya.org\/BRP\/index.php\/bnj\/article\/view\/3882"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,5]]},"references-count":22,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,10,5]]}},"URL":"https:\/\/doi.org\/10.33546\/bnj.3882","relation":{},"ISSN":["2477-4073"],"issn-type":[{"value":"2477-4073","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,5]]},"assertion":[{"value":"2025-02-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-10","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}