Factors Affecting Self-Care Behaviors Among Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease in Lopburi Province

Abstract

            Patients with type 2 diabetes mellitus and chronic kidney disease require appropriate self-care behaviors to reduce renal complications. This cross-sectional analytical study aimed to examine the levels of health literacy, social support, and self-care behaviors, and the factors affecting these behaviors among such patients in Lopburi Province. A total of 173 patients aged ≥ 40 years with an eGFR of 30–59 mL/min/1.73 m² were recruited through multistage random sampling. Data were collected using a questionnaire with established validity and reliability (Cronbach's alpha = 0.884-0.936, KR-20 = 0.795) and analyzed using descriptive statistics, Pearson's correlation coefficient, and stepwise multiple regression.

            Most participants were female (63.0%), with a mean age of 69.03 years. Health literacy and social support were at high levels (means of 93.90 and 79.92, respectively), whereas overall self-care behavior was at a moderate level (mean of 72.49). Stepwise multiple regression identified four significant factors: health decision-making skills (β = .617, p < .001), instrumental social support (β = .257, p < .001), average monthly income (β = .118, p = .012), and knowledge and understanding of the disease (β = .093, p = .046), which together explained 64.7% of the variance in self-care behavior (R² = .647, F(4, 168) = 76.81, p < .001).

            This study demonstrates that health decision-making skills are the strongest factor affecting self-care behavior, with instrumental social support exerting a greater effect than emotional support, which had the highest mean score but did not enter the model. The findings support integrating health literacy and social support into the design of self-care promotion programs for this patient group within primary care services, emphasizing health decision-making skills as the core component.