Moderating The Relationship Of Self-empowerment And Quality-of-life Among Type 2 Diabetic Patients In Shandong

Background:Diabetes mellitus is a common chronic disease that imposes a serious disease burden on society and individuals.Patient empowerment is proposed as an important concept in diabetes self-education management.Higher educated patient is more conducive to the concept of selfempowerment,and is more capable and motivated to control his or her own health.In order to improve health outcomes of diabetic patients and reduce the economic burden of disease on individuals and society,it is necessary to take the advantage of patient empowerment in diabetes self-management,while also paying attention to the differences in education attainment between patients.Previous literature has confirmed the correlation between patient self-empowerment and quality-of-life,but the role of educational attainment played in the underlying mechanisms of this relationship remains unclear.Objectives:The study aims to measure the current status and influencing factors of self-empowerment and diabetes-specific quality-of-life and generic quality-of-life among patients with type 2 diabetes in two cities in Shandong Province,investigate the impact of patients’ selfempowerment level on quality of life,and investigate the moderating role played by education level in this relationship.Based on the findings,suggestions for further design of diabetes selfmanagement intervention programs will be provided to improve patients’ quality-of-life.Methods:In this study,a convenience sampling method was used to survey 1084 inpatients with type 2 diabetes in two tertiary hospitals in Qingdao and Yantai,Shandong Province.The simplified diabetes empowerment scale,24-item diabetes-specific quality of life(DQOL)scale,EQ-5D-5L scale,and SF-12 scale were used.The questionnaire was administered face-to-face.Data were coded using Epidata 3.1 and analysis were performed by R.A descriptive analysis was conducted to examine the basic characteristics of patient self-empowerment and diabetesspecific/generic quality-of-life and factors.Structural equation modeling was used to explore the relationship between patient self-empowerment and diabetes-specific/generic quality-oflife,and the moderating effect of educational level was tested using the multi-group structural equation model and the product indicator approach.Results:The mean age of the sample was 57 years,42%were female,70%lived in urban areas,88%of patients were married,and 50%had a junior or senior high school education.The mean value of patient self-empowerment was 4.29(SD:0.61),the mean values of the four dimensions of diabetes-specific quality of life(satisfaction with condition management,satisfaction with living with diabetes,impact of diabetes,and diabetes worry)were 1.62(SD:0.64),2.03(SD:0.69),2.29(SD:0.84),and 2.04(SD:0.79),respectively.The mean values of EQ-5D-5L health utility score,SF-6D health utility score(converted from the SF-12 scale)and SF-12 MCS,were 0.87(SD:0.22),0.69(SD:0.16)and 45.52(SD:6.42),respectively.The older the patients were,the longer the duration of the disease,and the lower for self-empowerment and quality-of-life.Women were significantly lower than men,and the quality-of-life in the group of patients with complications was significantly lower than in the group without complications.Self-empowerment had a protective effect on all four dimensions of diabetes-specific qualityof-life and on all three indicators of generic quality-of-life.The moderating effect results showed that a high level of education enhanced the degree of protection of self-empowerment against diabetes worry.Conclusions and suggestions:Inpatients with type 2 diabetes in Shandong Province had high levels of selfempowerment,moderate levels of diabetes-specific quality-of-life and generic quality-of-life.Higher self-empowerment was associated with better quality-of-life,and educational level played a moderating role in the relationship between patient self-empowerment and diabetes worry.The higher the educational level,the stronger the protective effect of patient selfempowerment on diabetes worry.The role played by self-empowerment of diabetic patients is important in diabetes management.For the less educated patient groups,personalized and specialized selfmanagement intervention programs should be developed.Guiding patient participation through the intervention programs can improve the self-empowerment ability of vulnerable patients and develop their self-management beliefs and abilities.The role of patient groups can be leveraged to establish diabetic patient mutual support circles in conjunction with families,hospitals,and community health service centers to fully mobilize the initiative of patient groups and carry out health education programs that benefit everyone and alleviate diabetes worry.Limitations:The innovation of this study is that it is the first time to study the relationship between education level,self-authorization,and quality-of-life.And two methods were used,which expand the research in this field.The limitations of this study are that the sample is limited to Shandong Province,and the moderating effect of education level may be influenced by patients’ own cognitive differences in the understanding the quality-of-life scale.