Using the common-sense model to explicate the role of illness representation in self-care behaviours and anxiety symptoms among patients with Type 2 diabetes

Objectives: Based on the common-sense model of self-regulation, this study aimed to explicate the mechanism underlying the effect of illness representations on self-care behaviours and anxiety symptoms among patients with type 2 diabetes. Methods: A telephone survey was administered to 473 patients in Hong Kong. Structural equation modelling was used to test if threat and control perceptions regarding diabetes would be associated with self-reported self-care behaviours and anxiety symptoms through adoption of adaptive/maladaptive coping strategies and diabetes-related self-efficacy. Results: Control perceptions but not threat perceptions were positively associated with self-care behaviours. Control perceptions had a positive indirect association with self-care behaviours through more problem-focused coping and diabetes-related self-efficacy. Threat perceptions simultaneously had a positive indirect association through more problem-focused coping and a negative indirect association through more avoidant coping and lower diabetes-related self-efficacy. In contrast, threat and control perceptions were positively and negatively, respectively, associated with anxiety symptoms. Problem-focused and avoidant coping consistently mediated the indirect association between threat perceptions and anxiety symptoms. Conclusion: Threat and control perceptions were associated with diabetes self-care behaviours and anxiety symptoms through different self-regulation pathways. Practice implications: Our findings inform possible targets for self-management interventions to simultaneously enhance self-care behaviours and alleviate diabetes-associated anxiety.