Exploring the Self-Efficacy of Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Assessment Focusing on a Low-Income, Less-Educated Community of Quetta City, Pakistan.

PURPOSE: Self-efficacy is an individual's belief in their ability to perform a specific task or achieve a desired outcome successfully. Self-efficacy plays a significant role in developing health sensibility in chronic patients. Within this context, low income and lack of education are important social determinants of health, overwhelmingly affecting overall well-being and health outcomes. We therefore conducted this study to establish the self-efficacy profile and identify the predictors of self-efficacy in a low-income, less-educated cohort of diabetes patients in Quetta city, Pakistan.

PATIENTS AND METHODS: A cross-sectional study was conducted among established Type 2 Diabetes patients approaching Sandeman Provincial Hospital, Quetta, from January 2024 to December 2024. In addition to the demographics, the validated Urdu version of the Diabetes Management Self-Efficacy Scale (DMSES) was used to assess diabetes patients' self-efficacy in managing Type 2 Diabetes Mellitus (T2DM). Self-efficacy was measured as proposed by the developers. The chi-square test identified the relationships, and significant associations were interpreted through Cramér's phi where applicable. Binary logistic linear regression was used to highlight the predictors of self-efficacy. For all analyses, p<0.05 was considered significant.

RESULTS: In this study, 6951 patients were enrolled. Three thousand and eighty-seven (44.5%) patients were above 47 years of age, and males (58%) dominated the cohort. Fine thousand one hundred and forty-three (74%) patients had uncontrolled blood glucose levels (> 199 mg/dl), while 81.5% had HbA1c values > 6.5%. Poor self-efficacy was reported for the entire scale and the five domains of the DMSES (≤ 10). Six out of the twelve (income, education, duration of disease, treatment module, fasting blood sugar, and HbA1c) independent variables were significantly associated with self-efficacy, with a φc of ≤ 0.495. The strongest predictor of self-efficacy reported by the regression model was education, with an odds ratio of 2.250, indicating an increase in self-efficacy to 2.250 times while controlling for all other factors in the model.

CONCLUSION: The overall self-efficacy of our study population was low. Income, education, duration of disease, treatment module, fasting blood glucose, and HbA1c were significantly associated with self-efficacy. Our results underscore the importance of education as a predictor of self-efficacy among T2DM patients. Enhancing self-efficacy through improved education must be taken into consideration in diabetes management plans.