kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2015.15.4.235 kjhp-15-235 Original Article Mediating Effects of Perceived Barriers on the Relationship between Depression and Diabetes Management Self-efficacy in Type 2 Diabetes Patients HurHeakung 1 ChoiJihea 1 ChoiEunhee 2 KohJinhwa 1 MoonHakhee 3 Department of Nursing, Wonju College of Medicine, Yonsei University, Wonju, Korea Institute of Lifestyle Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea Department of Nursing, Yeoju Institute of Technology, Yeoju, Korea ￭ Corresponding author：Jihea Choi, PhD Department of Nursing, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 06273, Korea Tel: +82-33-741-0379, Fax: +82-33-743-9490 E-mail: jiheachoi@yonsei.ac.kr 122015 19122015 154 235243 09072015 12102015 Copyright © 2015 The Korean Society of Health Promotion and Disease Prevention 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

Diabetes mellitus is a life threatening disease that one out of ten Korean adults aged over 30 has it. Depression of diabetes patients affects the perception on their health negatively and self-management inefficiently, and then leads to a failure in blood sugar control. Therefore, it is necessary to investigate the relationships among depression, perceived barriers and self-efficacy on diabetes management in depth.

 Methods

This descriptive study was undertaken to identify the mediating effects of perceived barriers on the relationship between depression and self-efficacy on diabetes management among type 2 diabetes patients. 173 patients with type 2 diabetes were recruited from an out-patient clinic of Y university hospital. Data were collected from June 26 to July 18, 2014 using a structured self-report questionnaire, and analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, multiple regressions, and Sobel test.

 Results

Among173 participants, 12.1% were classified as depressed group. Self-efficacy on diabetes management was found to be significantly associated with education level and the presence of complications. Depression and perceived barriers were positively related to each other, but both were negatively related to self-efficacy on diabetes management. In addition, perceived barriers were found to mediate the relationship between depression and diabetes management self-efficacy.

 Conclusions

Strategic nursing interventions based on considerations of the relationship between perceived barriers and self-efficacy on diabetes management need to be provided for type 2 diabetes patients with depression.

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Mediation model

Depression, perceived barriers, and self-efficacy on diabetes management (N＝173)

Variables Total number of items Scale Possible range Actual range Mean±SDa
Depression 9 0-3 0-27 0-21 0.48±0.47
Perceived barriers 8 1-5 8-40 8-27 1.79±0.59
Diabetes management self- efficacy 20 1-5 20-100 30-99 3.18±0.53

Mean and SD were divided by total number of items to compare variables.

Depression, perceived barriers, and self-efficacy on diabetes management according to general characteristics (N＝ 173)

Characteristics N (%) Mean±SD (range) Depression Perceived barriers self-efficacy on diabetes management
Mean±SD (range) t/F/r (P) Mean±SD (range) t/F/r (P) Mean±SD (range) t/F/r (P)
Age, y 59.42±10.1 - -0.01 - 0.07 - 0.07
(31-75) (0.087) (0.362) (0.369)
Sex Female 79(45.7) 0.47±0.51 -0.46 1.77±0.60 -0.68 3.18±0.56 0.07
Male 94(54.3) 0.57±0.44 (0.646) 1.82±0.57 (0.499) 3.17±0.49 (0.946)
Education Not educated (A) 12(6.9) 0.82±0.31 2.26 2.02±0.55 1.28 2.78±0.73 4.65
Elementary school (B) 21(12.1) 0.60±0.63 (0.066) 1.77±0.65 (0.280) 3.10±0.55 (0.001)
Junior school (C) 45(26.0) 0.46±0.39 1.87±0.57 3.20±0.47 (A＜E)a
High school (D) 71(41.0) 0.42±0.49 1.77±0.57 3.14±0.47
College or over (E) 24(13.9) 0.42±0.46 1.61±0.63 3.51±0.49
Income Very low (A) 13(7.5) 0.74±0.47 3.60 1.84±0.61 0.29 3.02±0.85 1.29
Low (B) 54(31.2) 0.52±0.45 (0.015) 1.83±0.54 (0.831) 3.10±0.48 (0.280)
Moderate (C) 88(50.9) 0.47±0.51 (A＞D)a 1.75±0.61 3.21±0.48
High (D) 18(10.4) 0.20±0.23 1.86±0.65 3.31±0.60
BMI, kg/m2 24.53±3.40 - 0.06 0.06 - 0.01
(17.31-39.06) (0.422) (0.416) (0.894)
Type of treatment Diabetes pills (A) 113(65.3) 0.38±0.43 8.71 1.82±0.60 0.41 3.20±0.50 0.45
Insulin (B) 29(16.8) 0.66±0.48 (＜0.001) 1.77±0.58 (0.667) 3.16±0.55 (0.638)
Diabetes pills & Insulin (C) 31(17.9) 0.70±0.52 (A＜B, C)a 1.72±0.58 3.10±0.61
Duration of diabetes, mo 138.7±108.47 - 0.08 - -0.14 - -0.08
(2-480) (0.299) (0.061) (0.317)
Complications Yes 52(30.1) 0.66±0.50 3.41 1.74±0.53 -0.77 3.04±0.59 -2.25
No 121(69.9) 0.40±0.45 (0.001) 1.82±0.61 (0.438) 3.23±0.49 (0.026)

Abbreviation: BMI, body mass index.

Post-hoc: Scheffe test.

Relationship among depression, perceived barriers, and self-efficacy on diabetes management (N＝173)

Variables Perceived barriers self-efficacy on diabetes management
r (P) r (P)
Depression 0.16 (0.035) -0.20 (0.010)
Perceived barriers -0.31 (＜0.001)

Influencing of covariate variables and depression to perceived barriers (path a) (N＝ 173)

Variables path a
β (P)
Education status High school or over 1.00
Junior school or below -.10 (0.189)
Complications Yes 1.00
No -.11 (0.184)
Depression .17 (0.028)

Influence of covariate variables and perceived barriers on self-efficacy on diabetes management (path b) (N＝173)

Variables path b
β (P)
Education status High school or over 1.00
Junior school or below 0.05 (0.469)
Complications Yes 1.00
No -0.17 (0.018)
Perceived barriers -0.31 (＜0.001)

Influence of covariate variables, depression, and perceived barriers on self-efficacy on diabetes management (path c, path c´) (N＝ 173)

Variables path c path c´
β (P) β (P)
Education status High school or over 1.00 1.00
Junior school or below 0.08 (0.325) 0.05 (0.537)
Complications Yes 1.00 1.00
No -0.12 (0.132) -0.15 (0.049)
Depression -0.16 (0.047) -0.10 (0.168)
Perceived barriers -0.30 (＜0.001)

Sobel test Z＝-1.98, P＝0.047