Diabetes Distress, Burnout, and Self-Efficacy in Relation to Self-Care Among Adults with Type 2 Diabetes in Banda Aceh, Indonesia
DOI:
https://doi.org/10.33755/jkk.v12i4.1060Keywords:
Type 2 Diabetes mellitus, self-care adherence, diabetes distress, diabetes burnout, self-efficacyAbstract
Background: Self-management in type 2 diabetes mellitus (T2DM) requires sustained daily behavior. Distress, burnout, and self-efficacy may be related to these practices, but their conceptual overlap and local measurement validity warrant examination.
Objective: To assess the separate cross-sectional associations of diabetes distress, diabetes burnout, and self-efficacy with self-reported diabetes self-care among outpatients in Banda Aceh, Indonesia.
Methods: A cross-sectional study enrolled 86 adults with T2DM at Meuraxa Hospital using purposive sampling. Self-reported self-care, distress, burnout, and confidence were assessed using reported adaptations of the SDSCA, DDS-17, 12-item DBS, and 14-item DMSES-I. Descriptive analyses and three separate unadjusted linear regressions were available. No joint adjusted regression was reported.
Results: Higher distress (B = −0.395; 95% CI −0.476 to −0.314; p < 0.001) and burnout (B = −0.361; 95% CI −0.458 to −0.264; p < 0.001) were associated with lower self-care scores. Higher self-efficacy was associated with higher scores (B = 0.302; 95% CI 0.025 to 0.579; p = 0.033). Model R² values were 0.530, 0.394, and 0.053, respectively.
Conclusion: Distress and burnout were inversely associated with self-care, while self-efficacy showed a positive association in separate unadjusted regressions. The findings support comprehensive psychosocial nursing assessment but do not establish independent predictor effects or causality.
References
1. Davies MJ, Aroda VR, Collins BS, Gabbay RA, Green J, Maruthur NM, et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022;45(11):2753-2786. doi:10.2337/dci22-0034.
2. International Diabetes Federation. IDF Diabetes Atlas. 11th ed. Brussels: International Diabetes Federation; 2025. Available from: https://diabetesatlas.org/.
3. Perkumpulan Endokrinologi Indonesia. Pedoman pengelolaan dan pencegahan diabetes melitus tipe 2 dewasa di Indonesia. Jakarta: PB PERKENI; 2021.
4. American Diabetes Association Professional Practice Committee. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S77-S110. doi:10.2337/dc24-S005.
5. Morales-Brown LA, Perez Algorta G, Salifu Y. Understanding experiences of diabetes distress: a systematic review and thematic synthesis. J Diabetes Res. 2024;2024:3946553. doi:10.1155/2024/3946553.
6. Paudel G, Vandelanotte C, Dahal PK, Shrestha A, Karmacharya B, Sugishita T, et al. Physical activity, diet, medication adherence, blood glucose monitoring and foot care in people with type 2 diabetes in Nepal. SSM Health Syst. 2025;5:100083. doi:10.1016/j.ssmhs.2025.100083.
7. Jafari A, Naddafi F, Gholian-Aval M, Tehrani H. Relationship between diabetes health literacy, distress, burnout, social support, complications, self-care behaviors, and quality of life among patients with type 2 diabetes: a path analysis study. Diabetol Metab Syndr. 2024;16:150. doi:10.1186/s13098-024-01391-z.
8. El Kader AIA, Ibrahim ME, Mohamed HS, Osman BM. Diabetes distress and self-care activities among patients with diabetes type II: a correlation study. SAGE Open Nurs. 2023. doi:10.1177/23779608231189944.
9. Polonsky WH, Fisher L, Earles J, Dudl RJ, Lees J, Mullan J, et al. Assessing psychosocial distress in diabetes. Diabetes Care. 2005;28(3):626-631. doi:10.2337/diacare.28.3.626.
10. Abdoli S, Miller-Bains K, Fanti P, Silveira MS, Hessler D. Development and validation of a scale to measure diabetes burnout. J Clin Transl Endocrinol. 2021;23:100251. doi:10.1016/j.jcte.2021.100251.
11. Fisher L, Polonsky WH, Hessler D. Addressing diabetes distress in clinical care: a practical guide. Diabet Med. 2019;36(7):803-812. doi:10.1111/dme.13967.
12. van der Bijl J, van Poelgeest-Eeltink A, Shortridge-Baggett L. The psychometric properties of the diabetes management self-efficacy scale for patients with type 2 diabetes mellitus. J Adv Nurs. 1999;30(2):352-359. doi:10.1046/j.1365-2648.1999.01077.x.
13. Fereidooni GJ, Ghofranipour F, Zarei F. Interplay of self-care, self-efficacy, and health deviation self-care requisites: a study on type 2 diabetes patients through the lens of Orem’s self-care theory. BMC Prim Care. 2024;25:48. doi:10.1186/s12875-024-02276-w.
14. Zu W, Zhang S, Du L, Huang X, Nie W, Wang L. The effectiveness of psychological interventions on diabetes distress and glycemic level in adults with type 2 diabetes: a systematic review and meta-analysis. BMC Psychiatry. 2024;24(1):660. doi:10.1186/s12888-024-06125-z.
15. Agustin H, Arifianto A, Winarti R. The relationship of the incident of diabetes distress and self care in diabetes mellitus patients. J Ilmu Teknol Kesehat. 2024;15(2):50-54.
16. Samsuddin, Sastria A, Asriadi. Hubungan self-management dan self-efficacy terhadap kualitas hidup pasien diabetes melitus tipe 2. Mega Buana J Nurs. 2025;4(2):68-80. doi:10.59183/sks54935.
17. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943-950. doi:10.2337/diacare.23.7.943.
18. Marlina TT, Haryani, Widyawati. The validity and reliability of the Indonesian version of the Diabetes Mellitus Self-Efficacy Scale (DMSES-I). J Res Nurs. 2024;29(8):666-678. doi:10.1177/17449871241276816.
19. Ramadhani DY, Rukmini, Anggraeni SM, Larasati DS, Elisya I, Vidia I. Family-based diabetes self-management education terhadap self care dan self-efficacy. Indones J Nurs Res. 2024;7(1).
20. Susanti N, Nadatien I. Pengaruh education and support group berbasis teori self care terhadap kepatuhan, kemandirian perawatan kaki dan kadar glukosa darah pada pasien diabetes melitus tipe 2. J Keperawatan Suaka Insan. 2023;8(1):21-29. doi:10.51143/jksi.v8i1.413.
21. Wicaksana AL, Apriliyasari RW, Tsai PS. Effect of self-help interventions on psychological, glycemic, and behavioral outcomes in patients with diabetes: a meta-analysis of randomized controlled trials. Int J Nurs Stud. 2024;149:104626. doi:10.1016/j.ijnurstu.2023.104626.
