Longitudinal Relationship of eHealth Literacy With Self-Management Via Self-efficacy in Individuals With Type 2 Diabetes: Autoregressive Cross-Lagged Modeling

Background: In the internet era, eHealth literacy has become a recognized predictor of self-management in people with diabetes. Self-efficacy as a mediator of the relationship between eHealth literacy and self-management has been explored in cross-sectional studies only, which ignores its temporal sequence. Longitudinal studies on this mediated relationship in individuals with chronic diseases have not been previously conducted. Purpose: The purpose of this study was to explore the longitudinal relationship between eHealth literacy and self-management via self-efficacy in patients with type 2 diabetes. Methods: A prospective longitudinal survey was conducted using an autoregressive cross-lagged model. Measurements were made at three time points separated by 3-month intervals in 390 adults with type 2 diabetes at an outpatient clinic in a university hospital from May 2022 to January 2024 using a questionnaire consisting of several scales (i.e., the Condition-Specific eHealth Literacy Scale, Diabetes Management Self-Efficacy Scale, and Diabetes Self-Management Scale). The data were analyzed using structural equation modeling. Results: The autoregressive paths of all study variables were found to be significant across all time points, with eHealth literacy, self-efficacy, and self-management scores at each time point influencing their respective values at the subsequent time point ( β = .95–.62, p < .001). Also, all of the cross-lagged paths were found to be significant across the investigated time points ( β = .07–.21, p < .001). At the first time point, eHealth literacy was found to have a significant indirect effect on self-management at the third time point via self-efficacy at the second time point (bootstrap estimate B = 0.010, 95% confidence interval = [0.001, 0.028]). Conclusions/Implications for Practice: The results support that the longitudinal relationship between eHealth literacy and self-management is completely mediated by self-efficacy in people with type 2 diabetes. Health professionals should enhance the eHealth literacy of patients to boost their self-efficacy, making them better able to perform the regular tasks and behaviors required for diabetes self-management.