Factors Predicting Self-Management Behaviors among Persons with Diabetic Retinopathy


  • Sornthai Kaewjaiboon -
  • Pratum Soivong Faculty of nursing, Chiang Mai university
  • Benjamas Suksatit Faculty of nursing, Chiang Mai university


self-management, perceived barriers to performing self-management behavior, social support, person with diabetic retinopathy


              Persons with diabetic retinopathy who engage in consistent and appropriate self-management behavior (SMB) can decrease the severity of this issue. This study aimed to determine SMB and factors predicting SMB among persons with diabetic retinopathy, including perceived barriers to performing SMB and social support. Purposive sampling was applied to recruit 88 persons with diabetic retinopathy who received service at the outpatient department of the retina clinic at a university hospital. Research instruments included a demographic data record form, the SMB Questionnaire, the Perceived Barriers to Performing SMB Questionnaire, and Social Support Questionnaire. Their reliabilities were .88, .81, and .91, respectively. The interview method was used to collect data. Data were analyzed using descriptive statistics, Pearson product-moment correlation coefficient, and stepwise multiple regression statistics.

             The results revealed that 79.55% of participants had insufficient overall SMB (x̅ = 99.70, S.D. = 9.60). Perceived barriers to performing SMB and social support predicted 17% (R2 = .17) of SMB (SEest= ±8.84). The findings of this study demonstrate that interventions for enhancing SMB among persons with diabetic retinopathy should be developed. Furthermore, although perceived barriers to performing SMB and social support can predict SMB, the percentage is low. Thus, further studies should explore other factors influencing SMBs.


Download data is not yet available.


Al-Jarrah, M. A., & Shatnawi, H. (2017). Non-proliferative diabetic retinopathy symptoms detection and classification using neural network. Journal of Medical Engineering and Technology, 41(6), 498–505.

American Diabetes Association.(2021).Microvascular complications and foot care: Standards of medical care in diabetes. Diabetes Care, 44 (Suppl. 1), S151-S167.

American Diabetes Association. (2021). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes 2021. Diabetes Care, 44(Suppl.1), S111-S124.

Angermann, R., Rauchegger, T., Nowosielski, Y., Casazza, M., Bilgeri, A., Ulmer, H., & Zehetner, C. (2019). Treatment compliance and adherence among patients with diabetic retinopathy and age-related macular degeneration treated by anti-vascular endothelial growth factor under universal health coverage. Graefe's Archive for Clinical and Experimental Ophthalmology, 257(10), 2119–2125.

Ariani, A., & Utami, L. A. (2020). Human problems: Sick role behavior among chronic disease sufferers and various treatment models to increase it. Advances in Social Science, Education and Humanities Research, 395, 39-43.

Becker, M. H. (1974). The health belief model and personal health behavior. Thorofare: Slack.

Bloom, B.S., & Krathwohl, D.R. (1975). Taxonomy of educational objectives: The classification of educational goals, handbook 1: Cognitive domain. New York: McKay.

Bloom, J. M., Mason, J. O., Mason, L., & Swain, T. A. (2020). Fears, depression, and anxieties of patients with diabetic retinopathy and implications for education and treatment. Journal of Vitreoretinal Diseases, 4(6), 484-489.

Chiangmai Provincial Public Health Office. (2018). Health screening guide for the elderly health promotion. Chiang Mai: Author. Retrieved 10 May 2020 from https://smart-ageing.chiangmaihealth.go.th/web/index.php?r=report/group. [In Thai].

Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates Publishers.

Colberg, S. R., Sigal, R. J., Yardley, J. E., Riddell, M. C., Dunstan, D. W., Dempsey, P. C., Horton, E. S., Castorino, K., & Tate, D. F. (2016). Physical activity/exercise and diabetes: A position statement of the American diabetes association. Diabetes Care, 39(11), 2065–2079.

Cooper, O. A. E., Taylor, D. J., Crabb, D. P., Sim, D. A., & McBain, H. (2020). Psychological, social and everyday visual impact of diabetic macular oedema and diabetic retinopathy: A systematic review. Diabetic Medicine, 37(6), 924- 933.

Euswas, N., Phonnopparat, N., Morasert, K., Thakhampaeng, P., Kaewsanit, A., Mungthin, M., ...Sakboonyarat, B. (2021). National trends in the prevalence of diabetic retinopathy among Thai patients with type 2 diabetes and its associated factors from 2014 to 2018. Plos One, 16(1), e0245801.

Fajnkuchen, F., Delyfer, M. N., Conrath, J., Baillif, S., Mrejen, S., Srour, M., ... Giocanti-Aurégan, A. (2020). Expectations and fears of patients with diabetes and macular edema treated by intravitreal injections. Acta Diabetologica, 57(9), 1081-1091.

Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using g* power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149-1160.

Feng, Z., Cramm, J. M., & Nieboer, A. P. (2020). Social participation is an important health behavior for health and quality of life among chronically ill older Chinese people. BMC Geriatrics, 20(1), 299.

Fenwick, E. K., Cheng, G. H., Man, R. E., Khadka, J., Rees, G., Wong, T. Y., ... Lamoureux, E. L. (2018). Inter-relationship between visual symptoms, activity limitation and psychological functioning in patients with diabetic retinopathy. British Journal of Ophthalmology, 102(7), 948-953.

Fenwick, E. K., Khadka, J., Pesudovs, K., Rees, G., Wong, T. Y., & Lamoureux, E. L. (2017). Diabetic retinopathy and macular edema quality-of-life item banks: Development and initial evaluation using computerized adaptive testing. Investigative Ophthalmology and Visual Science, 58(14), 6379–6387.

Grove, S.K., Burns, N., & Gray, J.R. (2013). The practice of nursing research: Appraisal, synthesis, and generation of evidence (7th ed.) St.Louis, Missouri: Elsevier Saunders.

Gupta, P., Aravindhan, A., Gan, A. T., Man, R. E., Fenwick, E. K., Mitchell, P., ... Lamoureux, E. L. (2017). Association between the severity of diabetic retinopathy and falls in an Asian population with diabetes: The Singapore epidemiology of eye diseases study. Jama Ophthalmology, 135(12), 1410-1416.

Habib, A. E., Abdel-Kader, A. A., Eissa, I. M., & Awadein, A. (2019). Adherence to intravitreal anti-vascular endothelial growth factor drugs in diabetic macular edema in an Egyptian population: A health belief model. Current Eye Research, 44(3), 303–310.

Hanucharurnkul, S. (1988). Social support, self-care, and quality of life cancer patients receiving radiation in Thailand (Doctoral thesis of nursing science). Wayne State University.

International council of ophthalmology. (2017). Updated 2017 guidelines for diabetic eye care. Retrieved 10 May 2020 from https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/eye-institute/images/ICOPH.pdf

Kanan, P., Piaseu, N., Malathum, P. and Belza, B. (2019). Predictors of diabetes self-management in older adults with poorly controlled type 2 diabetes mellitus. Pacific Rim International Journal of Nursing Research. 23(4), 357- 367.

Kawitu, M., & Mattavangkul, C. (2019). Factors associated with blood sugar controlling among the elderly with diabetes living in communities nearby Siam university. Journal of Nursing Siam University, 20(38), 82-95. [In Thai].

Kong, S. Y., & Cho, M. K. (2020). Factors related to self-care in patients with type 2 diabetes. The Open Nursing Journal, 14(1), 64-73.

Lael-Monfared, E., Tehrani, H., Moghaddam, Z. E., Ferns, G. A., Tatari, M., & Jafari, A. 2019). Health literacy, knowledge and self-care behaviors to take care of diabetic foot in low-income individuals: Application of extended parallel process model. Diabetes and Metabolic Syndrome, 13(2), 1535–1541.

Liu, Y., Jiang, J., You, W., Gong, D., Ma, X., Wu, M., & Li, F. 2022). Exploring facilitators and barriers to self- management engagement of Chinese people with type 2 diabetes mellitus and poor blood glucose control: A descriptive qualitative study. BMC endocrine disorders, 22(1), 1-13.

Lorig, K., & Holman, H. (2003). Self-management education: History, definition, outcomes, and mechanisms. Annals of Behavioral Medicine, 26(1), 1-7.

Mahaputera, D., Hutapea, M., Thaniwattananon, P., Yodchai, K., & Hutapea, A. M. 2017). Perceived benefits to treatment adherence, perceived barriers to treatment adherence, and level of treatment adherence among Indonesian older adults with type 2 diabetes mellitus. Gstf Journal of Nursing and Health Care, 4(2), 93-98.

Mohebi, S., Parham, M., Sharifirad, G., Gharlipour, Z., Mohammadbeigi, A., & Rajati, F. (2018). Relationship between perceived social support and self-care behavior in type 2 diabetics: A cross-sectional study. Journal of Education and Health Promotion, 7, 48.

Muksiritipanun, B., & Monthaisong, D. (2014). Factors related to quality of life in patients with diabetic retinopathy. Journal of The Royal Thai Army Nurses, 15(2), 395-404. [In Thai].

National statistical office. (2022). The 2021 household socio-economic survey. Bangkok: Bangkok blocks. [In Thai]

Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of The American Geriatrics Society, 23(10), 433–441.

Qaseem, Y., Samra, S., German, O., Gray, E., & Gill, M. K. (2020). Self-reported awareness of retinopathy severity in diabetic patients. Clinical Ophthalmology, 14, 2855-2863.

Schaefer, C., Coyne, J. C., & Lazarus, R. S. (1981). The health-related functions of social support. Journal of Behavioral Medicine, 4(4), 381–406.

Schwennesen, N., Barghadouch, A., & Olesen, K. (2019). Health literacy and self-care among visually impaired people with type 1 diabetes in Denmark. Chronic Illness, 15(2), 157–164.

Shayeghian, Z., Aguilar-Vafaie, M. E., Besharat, M. A., Amiri, P., Parvin, M., Gillani, K. R., & Hassanabadi, H. (2015). Self-care activities and glycated haemoglobin in Iranian patients with type 2 diabetes: Can coping styles and social support have a buffering role?. Psychology and Health, 30(2), 153–164.

Silpa-archa, S., & Ruamviboonsuk, P. (2017). Diabetic retinopathy: Current treatment and Thailand perspective. Journal of The Medical Association of Thailand, 100(Suppl. 1), S136-47.

Simakurthy, S., & Tripathy, K. (2023). Valsalva retinopathy. Retrieved 10 May 2020 from https://www.ncbi.nlm.nih.gov /books/NBK545219/

Sirikaensine, S. (2019). Health belief related to blood glucose control among patients with diabetes mellitus type 2 in Kutchik subdistrict, mueang district, Nongbua Lamphu province. Southeast Bangkok Journal, 5(1), 55-68. [In Thai].

Sittikankaew, K., & Navicharoen, R. (2014). Factors related to health promoting behaviors of type 2 diabetes patients with insulin and oral agent therapy. Journal of The Police Nurse, 6(1), 102-112. [In Thai].

Sturrock, B. A., Rees, G., Lamoureux, E. L., Wong, T. Y., Holloway, E., & Fenwick, E. K. 2018). Individuals' perspectives on coping with vision loss from diabetic retinopathy. Optometry and Vision Science, 95(4), 362– 372.

Teo, Z. L., Tham, Y. C., Yu, M., Chee, M. L., Rim, T. H., Cheung, N., ... & Cheng, C. Y. (2021). Global prevalence of diabetic retinopathy and projection of burden through 2045: Systematic review and meta-analysis. Ophthalmology, 128(11), 1580-1591.

World Health Organization. (2003). Consultation on development of standards for characterization of vision loss and visual functioning. Retrieved 10 May 2020 from https://apps.who.int/iris/handle/10665/68601

World Health Organization. (2017).Healthy lifestyles for patients with diabetes. Retrieved 10 May 2020 from https:// apps.who.int/iris/bitstream/handle/10665/254746/9789290618058-diab-mod2-eng.pdf?sequence=9&isAllowed=y

Xu, X., Zhao, X., Qian, D., Dong, Q., & Gu, Z. (2015). Investigating factors associated with depression of type 2 diabetic retinopathy patients in China. Plos One, 10(7), e0132616.

Yang, L., Wu, Q., Hao, Y., Cui, Y., Liang, L., Gao, L., Jiao, M., Ning, N., Sun, H., Kang, Z., Han, L., Li, Y., & Yin, H. (2017). Self-management behavior among patients with diabetic retinopathy in the community: A structural equation model. Quality of Life Research, 26(2), 359–366.

Zhang, X., Low, S., Kumari, N., Wang, J., Ang, K., Yeo, D., Yip, C. C., Tavintharan, S., Sum, C. F., & Lim, S. C. (2017). Direct medical cost associated with diabetic retinopathy severity in type 2 diabetes in Singapore. Plos One, 12(7), e0180949.




How to Cite

Kaewjaiboon, S., Soivong, P., & Suksatit, B. (2023). Factors Predicting Self-Management Behaviors among Persons with Diabetic Retinopathy. NU Journal of Nursing and Health Sciences, 17(3). Retrieved from https://he01.tci-thaijo.org/index.php/NurseNu/article/view/263019