Factors Associated With Individual Components of Diabetes Self-Care Activities Among Outpatients With Type 2 Diabetes Mellitus in Indonesia: A Cross-Sectional Study

Background: Diabetes self-care is essential for preventing complications and improving health outcomes among individuals with type 2 diabetes mellitus (T2DM).Although locus of control, diabetes self-efficacy, and family attitudes are theorized to influence whether individuals engage in self-care behaviors, evidence regarding the factors associated with individual self-care components remains limited and inconsistent.Therefore, this study examined the independent associations of these factors with individual self-care components among T2DM outpatients.Methods: This cross-sectional study was conducted between November 2024 and April 2025 in six outpatient healthcare facilities (four hospitals and two community health centers) in South Sulawesi Province, Indonesia.Adults with T2DM were recruited using convenience sampling from routine outpatient visits and the chronic-disease management program.Of 407 questionnaires returned, 239 with complete data were analyzed.Participants involved in this study were measured using self-administered validated questionnaires of diabetes-specific locus of control (internal, external, and chance), diabetes care selfefficacy, family attitudes, and diabetes self-care activities scale.Data were analyzed using Pearson correlation, followed by multiple linear regression analyses adjusted for demographic characteristics.Results: Chance locus of control (B = -0.466;95% CI: -0.770 to -0.163) and positive family attitudes (B = -0.785;95% CI: -1.218 to -0.351) were negatively associated with general diet, while negative family attitudes were positively associated (B = 0.829; 95% CI: 0.419 to 1.240).For specific diet, external locus of control was positively associated (B = 0.407; 95% CI: 0.112 to 0.702), whereas chance locus of control was negatively associated (B = -0.269;95% CI: -0.506 to -0.032).Physical activity was positively associated with chance locus of control (B = 0.357; 95% CI: 0.071 to 0.643), self-efficacy (B = 0.331; 95% CI: 0.133 to 0.530), and negative family attitudes (B = 0.813; 95% CI: 0.426 to 1.200), whereas positive family attitude was negatively associated (B = -0.421;95% CI: -0.830 to -0.013).Chance locus of control was negatively associated with blood glucose monitoring (B = -0.143;95% CI: -0.281 to -0.005), whereas positive family attitudes were positively associated (B = 0.260; 95% CI: 0.062 to 0.457).For foot care, chance locus of control (B = 0.791; 95% CI: 0.458 to 1.124), self-efficacy (B = 0.620; 95% CI: 0.389 to 0.851), and negative family attitudes (B = 0.802; 95% CI: 0.352 to 1.252) were positively associated, while internal locus of control (B = -0.620;95% CI: -1.017 to -0.222) and positive family attitudes (B = -0.518;95% CI: -0.994 to -0.043) were negatively associated.Conclusion: No single factor was consistently associated with all components of diabetes self-care, indicating that the associations varied across self-care domains.Educational programs that address selfefficacy and family attitudes may be potential targets for future research.Strategies addressing locus of control may also need to be tailored to specific self-care domains.However, these findings should be interpreted cautiously because of the risk of false-positive findings due to multiple comparisons.