Open Access Highly Accessed Research article

Effects of self-care, self-efficacy, social support on glycemic control in adults with type 2 diabetes

Junling Gao1, Jingli Wang2, Pinpin Zheng1, Regine Haardörfer3, Michelle C Kegler3, Yaocheng Zhu3 and Hua Fu1*

Author Affiliations

1 School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, PO Box 248 138 Yixueyuan Road, Shanghai 200032, People’s Republic of China

2 Dachang Center of Primary Health Care, Shanghai, People’s Republic of China

3 Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA

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BMC Family Practice 2013, 14:66  doi:10.1186/1471-2296-14-66

Published: 24 May 2013



A number of studies have examined the influence of self-efficacy, social support and patient-provider communication (PPC) on self-care and glycemic control. Relatively few studies have tested the pathways through which these constructs operate to improve glycemic control, however. We used structural equation modeling to examine a conceptual model that hypothesizes how self-efficacy, social support and patient-provider communication influence glycemic control through self-care behaviors in Chinese adults with type 2 diabetes.


We conducted a cross-sectional study of 222 Chinese adults with type 2 diabetes in one primary care center. We collected information on demographics, self-efficacy, social support, patient-provider communication (PPC) and diabetes self-care. Hemoglobin A1c (HbA1c) values were also obtained. Measured variable path analyses were used to determine the predicted pathways linking self-efficacy, social support and PPC to diabetes self-care and glycemic control.


Diabetes self-care had a direct effect on glycemic control (β = −0.21, p = .007), No direct effect was observed for self-efficacy, social support or PPC on glycemic control. There were significant positive direct paths from self-efficacy (β = 0.32, p < .001), social support (β = 0.17, p = .009) and PPC (β = 0.14, p = .029) to diabetes self-care. All of them had an indirect effect on HbA1c (β =–0.06, β =–0.04, β =–0.03 respectively). Additionally, PPC was positively associated with social support (γ = 0.32, p < .001).


Having better provider-patient communication, having social support, and having higher self-efficacy was associated with performing diabetes self-care behaviors; and these behaviors were directly linked to glycemic control. So longitudinal studies are needed to explore the effect of self-efficacy, social support and PPC on changes in diabetes self-care behaviors and glycemic control.

Self-efficacy; Social support; Patient-provider communication; Glycemic control