Predictors of Diabetes Self-Management Behaviors among Thai Adolescents with Type 1 Diabetes: A Cross-Sectional Study
DOI:
https://doi.org/10.60099/prijnr.2026.280671Keywords:
Adolescent, Diabetes self-management, Glycemic control, Intrinsic motivation, Outpatient care, Pediatric nursing, Perceived health status, Social stigma, Social support, Type 1 diabetesAbstract
Effective diabetes self-management behaviors are essential for optimal glycemic control in adolescents with type 1 diabetes. However, global evidence suggests that many current interventions fail to achieve sustained clinical improvements, highlighting a need to identify modifiable factors. In Thailand, research addressing the psychological and contextual determinants of adherence remains scarce, leaving a critical gap in localized evidence. This cross-sectional design study aimed to examine predictors of diabetes self-management behaviors among Thai adolescents with type 1 diabetes. Ninety adolescents (aged 10–19 years) receiving basal-bolus injections and their primary caregivers were recruited via convenience sampling from pediatric diabetes clinics at two university hospitals in Bangkok, Thailand. Data were collected using validated instruments assessing intrinsic motivation, perceived health status, family and friend support, perceived social stigma, patient-nurse relationship, and diabetes self-management behaviors. Descriptive statistics, Pearson’s and Spearman’s correlations, and stepwise regression were performed.
Results showed that intrinsic motivation, perceived health status, and family support significantly correlated with diabetes self-management behaviors. However, intrinsic motivation was the sole significant predictor, explaining 9.5% of the variance. Findings underscore the critical role of intrinsic motivation in adolescents. Thus, nurses should be trained in strategies to increase this motivation. However, given that 90.5% of the variance remains unexplained, future research should utilize qualitative and mixed-method designs to deeply explore additional contextual factors in more diverse healthcare settings.
References
International Diabetes Federation. IDF Diabetes Atlas 11th Edition [Internet]. Brussels, Belgium: International Diabetes Federation; 2025 [cited 2026 Apr.9]. Available from: https://diabetesatlas.org/media/uploads/sites/3/2025/04/IDF_Atlas_11th_Edition_2025.pdf
Rittiphairoj T, Owais M, Ward ZJ, Reddy CL, Yeh JM, Atun R. Incidence and prevalence of type 1 diabetes and diabetic ketoacidosis in children and adolescents (0–19 years) in Thailand (2015–2020): A nationwide population-based study. Lancet Reg Health West Pac. 2022;21:100392. doi:10.1016/j.lanwpc.2022.100392.
Russo K. Assessment and treatment of adolescents with chronic medical conditions. J Health Serv Psychol. 2022;48(2):69–78. doi:10.1007/s42843-022-00059-4.
Harris MA, Wysocki T, Sadler M, Wilkinson K, Harvey LM, Buckloh LM, et al. Validation of a structured interview for the assessment of diabetes self-management. Diabetes Care. 2000;23(9):1301–1304. doi:10.2337/diacare.23.9.1301.
American Diabetes Association Professional Practice Committee. 9. Pharmacologic approaches to glycemic treatment: Standards of Care in Diabetes—2024. Diabetes Care. 2023;47(Suppl 1):S158–S178. doi:10.2337/dc24-S009.
Morales-Brown LA, Perez Algorta G, Salifu Y. Understanding experiences of diabetes distress: A systematic review and thematic synthesis. J Diabetes Res. 2024;2024(1):3946553. doi:10.1155/2024/3946553.
American Diabetes Association Professional Practice Committee. 14. Children and adolescents: Standards of Care in Diabetes—2025. Diabetes Care. 2024;48(Suppl 1):S283–S305. doi:10.2337/dc25-S014.
Cockcroft EJ, Clarke R, Dias RP, Lloyd J, Mann RH, Narendran P, et al. Effectiveness of educational and psychoeducational self-management interventions in children and adolescents with type 1 diabetes: A systematic review and meta-analysis. Pediatr Diabetes. 2024;2024(1):2921845. doi:10.1155/2024/2921845.
Diabetes Association of Thailand under the Patronage of Her Royal Highness Princess Maha Chakri Sirindhorn. Clinical practice guideline for diabetes 2023. Bangkok: Diabetes Association of Thailand; 2023. Available from: https://www.dmthai.org/new/index.php/sara-khwam-ru/sahrab-bukhkhl-thawpi/diabetes-book/naewthang-wech-ptibati-sahrab-rokh-bea-hwan-2566 (in Thai).
Grey M, Knafl K, McCorkle R. A framework for the study of self- and family management of chronic conditions. Nurs Outlook. 2006;54(5):278-286. doi:10.1016/j.outlook.2006.06.004.
Grey M, Schulman-Green D, Knafl K, Reynolds NR. A revised self- and family management framework. Nurs Outlook. 2015;63(2):162–170. doi:10.1016/j.outlook.2014.10.003.
Delamater AM, Daigre AL, Marchante AN, Pulgarón ER, Patiño-Fernandez AM, Sanchez J. Intrinsic motivation in ethnic minority youth with type 1 diabetes. Child Health Care. 2017;46(3):215–229. doi:10.1080/02739615.2015.1124777.
Kwansomkid S, Sanasuttipun W, Nookong A. Predictive factors of self-management behavior among type 1 diabetes adolescents. Nurs Sci J Thail [Internet]. 2022 Dec.15 [cited 2026 Apr.9];41(1):27-43. Available from: https://he02.tci-thaijo.org/index.php/ns/article/view/256436 (in Thai).
Kraja F, Kellici I, Cakerri L. Determinants of self-perceived health status in population-based studies. Albanian Med J. 2013;2:106–108.
Tusa N, Kautiainen H, Elfving P, Sinikallio S, Mäntyselkä P. Relationship between patient activation measurement and self-rated health in patients with chronic diseases. BMC Fam Pract. 2020;21(1):225. doi:10.1186/s12875-020-01301-y.
Boontein P, Poungkaew A, Praphasil O, Kuakool P. Factors predicting self-management behavior in patients with type II diabetes. Nurs Sci J Thail [Internet]. 2021 Jan.12 [cited 2026 Apr.9];39(1):13-23. Available from: https://he02.tci-thaijo.org/index.php/ns/article/view/243540 (in Thai).
Narit N. Perceived self-efficacy, social support and factors related self-care behavior of adolescents with type 1 diabetes mellitus [Master’s thesis]. Bangkok, Thailand: Mahidol University; 2007.
Hung LC, Huang CY, Lo FS, Cheng SF. The self-management experiences of adolescents with type 1 diabetes: A descriptive phenomenology study. Int J Environ Res Public Health. 2020;17(14). doi:10.3390/ijerph17145132.
Commissariat PV, Kenowitz JR, Trast J, Heptulla RA, Gonzalez JS. Developing a personal and social identity with type 1 diabetes during adolescence: A hypothesis generative study. Qual Health Res. 2016;26(5):672–684. doi:10.1177/1049732316628835.
Sangngam J, Prasopkittikun T, Nookong A, Pacharn P, Chamchan C. Causal relationships among self-management behaviors, symptom control, health-related quality of life and the influencing factors among Thai adolescents with asthma. Int J Nurs Sci. 2023;10(3):309–317. doi:10.1016/j.ijnss.2023.06.001
Suratham S, Srichantaranit A, Wongmuan K, Klainin-Yobas P. Exploring self-management among adolescents with type 2 diabetes mellitus: A descriptive-qualitative study. Nurs Open. 2025;12(10):e70314. doi:10.1002/nop2.70314.
Ortiz-Domenech S, Cumba-Avilés E. Diabetes-related stigma among adolescents: emotional self-efficacy, aggressiveness, self-care, and barriers to treatment compliance. Salud Conducta Humana. 2021;8(1):82–96.
Luo D, Cai X, Zhou M, Xu J, Wang Y. Stigma in adolescents with type 1 diabetes: Consequences and the moderating role of intentional self-regulation. Pediatr Diabetes. 2025;2025(1):8369221. doi:10.1155/pedi/8369221.
Kajonwiboolpol S, Patoomwan A, Punyoo J. A cross-sectional study of predictive factors of self-management among adolescents with type 1 diabetes. Pac Rim Int J Nurs Res Thail. 2025;29(3):605–618. doi:10.60099/prijnr.2025.272686.
Dai H, Chen Q, Huang H, Wu K, Yang X. The role of nurses in taking care of children with type 1 diabetes. Altern Ther Health Med. 2022;28(1):107–113.
Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. Andover, Hampshire, UK: Cengage Learning; 2019.
Diabetes Research in Children Network (DirecNet) Study Group. Diabetes self-management profile for flexible insulin regimens: cross-sectional and longitudinal analysis of psychometric properties in a pediatric sample. Diabetes Care. 2005;28(8):2034–5. doi:10.2337/diacare.28.8.2034.
Kunthamas M, Prasopkittikun T, Suratham S, Santiprabhob J. Preliminary psychometric testing of a newly developed scale to assess perceived social stigma of Thai adolescents with type 1 diabetes. J Holist Nurs Sci. 2025;13:75–85. doi:10.31603/jhns.v13i1.14955.
Au N, Johnston DW. Self-assessed health: What does it mean and what does it hide? Soc Sci Med. 2014;121:21–8. doi:10.1016/j.socscimed.2014.10.007.
Procidano ME, Heller K. Measures of perceived social support from friends and from family: Three validation studies. Am J Community Psychol. 1983;11(1):1–24. doi:10.1007/BF00898416.
Schabert J, Browne JL, Mosely K, Speight J. Social stigma in diabetes : A framework to understand a growing problem for an increasing epidemic. Patient. 2013;6(1):1–10. doi:10.1007/s40271-012-0001-0.
Van der Feltz-Cornelis CM, Van Oppen P, Van Marwijk HW, De Beurs E, Van Dyck R. A patient-doctor relationship questionnaire (PDRQ-9) in primary care: Development and psychometric evaluation. Gen Hosp Psychiatry. 2004;26(2):115–120. doi:10.1016/j.genhosppsych.2003.08.010.
Ryan RM, Deci EL. Intrinsic and extrinsic motivations: Classic definitions and new directions. Contemporary Educational Psychology. 2000;25(1):54–67. doi:10.1006/ceps.1999.1020.
Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68–78. doi:10.1037//0003-066x.55.1.68.
Powell PW, Hilliard ME, Anderson BJ. Motivational interviewing to promote adherence behaviors in pediatric type 1 diabetes. Curr Diab Rep. 2014;14(10):531. doi:10.1007/s11892-014-0531-z.
Espinoza P, Varela CA, Vargas IE, Ortega G, Silva PA, Boehmer KB, et al. The burden of treatment in people living with type 2 diabetes: A qualitative study of patients and their primary care clinicians. PLoS One. 2020;15(10):e0241485. doi:10.1371/journal.pone.0241485.
Pozzar RA, Tulsky JA, Berry DL, Batista J, Yackel HD, Phan H, et al. Developing a collaborative agenda-setting intervention (CASI) to promote patient-centered communication in ovarian cancer care: A design thinking approach. Patient Educ Couns. 2024;120:108099. doi:10.1016/j.pec.2023.108099.
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2026 Pacific Rim International Journal of Nursing Research

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright: The Pacific Rim International Journal of Nursing Research, Thailand Nursing & Midwifery Council has exclusive rights to publish, reproduce and distribute the manuscript and all contents therein.








.png)


