Original Research
Diabetes & Chronic Disease Management

Health Beliefs Predict Self-Care Practices and Glycaemic Control in Malaysian Patients with Insulin-Treated Diabetes: A Longitudinal Study

Summary

Diabetes mellitus represents one of the most pressing chronic disease challenges in Malaysia and across Southeast Asia. Data from the Malaysian National Diabetes Registry have shown that the mean HbA1c among patients with type 2 diabetes in the country was approximately 8.1%, with only about 23.8% achieving the glycaemic target of below 6.5%. These figures underscore the critical importance of effective self-care practices in managing diabetes, particularly among patients who require insulin therapy.

This longitudinal study, published in the Malaysian Journal of Public Health Medicine, examined whether health beliefs—as conceptualised within the Health Belief Model (HBM)—could predict self-care behaviours and glycaemic outcomes in Malaysian adults with insulin-treated diabetes. The HBM is a well-established psychological framework that posits that health-related behaviour is influenced by an individual’s perception of susceptibility to a condition, perceived severity, perceived benefits of action, perceived barriers to action, self-efficacy, and cues to action.

Study Design

The research employed a longitudinal design with data collected at two time points: baseline (Time 1) and six months later (Time 2). Participants were recruited from three endocrinology clinics in Malaysia, with a focus on adults aged 18 to 40 years who were receiving insulin therapy. This age group was specifically chosen because of the dynamic lifestyle changes common during this life phase, which may significantly impact diabetes self-care behaviours.

Self-reported questionnaire measures were administered at both time points, assessing health beliefs across the six HBM constructs, self-care practices (including dietary habits, insulin injection adherence, physical activity, and self-blood glucose monitoring), and clinical outcomes including HbA1c levels. In addition to the quantitative component, qualitative data were collected from 27 diabetes educators working in the study settings to provide contextual understanding of the educational support available to patients.

Key Results: Health Beliefs and Self-Care Practices

The study demonstrated that health beliefs were significantly associated with specific self-care behaviours. Dietary habit adherence was predicted by health beliefs at baseline, with participants who held stronger beliefs about the benefits of dietary management being approximately twice as likely to adhere to recommended eating patterns (OR 1.92). However, this association weakened at Time 2 (OR 0.23), suggesting that initial motivation may diminish over time without reinforcement.

Insulin injection adherence showed the strongest and most consistent relationship with health beliefs, with odds ratios of 3.17 at Time 1 and 2.68 across the Time 1 to Time 2 period. This indicates that patients who believed more strongly in the necessity and benefit of insulin therapy were substantially more likely to maintain their injection regimens.

Health Beliefs and Glycaemic Control

With the exception of perceived severity, all HBM constructs demonstrated predictive relationships with HbA1c levels. Perceived benefits showed the strongest inverse relationship (β = −0.397), indicating that patients who more clearly recognised the advantages of self-care activities tended to achieve better glycaemic control. Perceived barriers also showed a meaningful inverse relationship (β = −0.206), suggesting that patients who perceived fewer obstacles to self-care had lower HbA1c values.

Interestingly, perceived susceptibility showed a positive association with HbA1c (β = 0.169). This finding suggests that patients who felt more vulnerable to diabetes complications actually had poorer glycaemic control—a pattern that may reflect the reality that patients who are already experiencing poor control may be more acutely aware of their susceptibility to adverse outcomes, rather than that fear of complications drives self-care behaviour.

Gaps in Diabetes Education

The qualitative findings from diabetes educator interviews revealed significant deficiencies in the educational support provided to patients. Some patients in the study had reportedly never received formal diabetes education, while those who had been educated described receiving inconsistent and sometimes inaccurate information about their self-care activities. These findings are particularly concerning in the Malaysian context, where the multi-ethnic population—comprising Malay, Chinese, and Indian communities—may require culturally tailored educational approaches.

Research elsewhere in Malaysia has confirmed that diabetes-related knowledge deficits are common, with studies finding that approximately 53% of diabetic patients scored below 50% on diabetes knowledge assessments. The combination of inadequate education and diverse cultural health beliefs creates a complex environment for diabetes self-management support.

Implications for Clinical Practice

This study provides evidence that health beliefs represent modifiable targets for intervention in Malaysian patients with insulin-treated diabetes. Healthcare providers should assess patients’ health beliefs as part of routine diabetes care and tailor educational interventions to address specific belief patterns. Strengthening perceived benefits while reducing perceived barriers may be particularly effective strategies for improving both self-care practices and glycaemic outcomes.

The finding that diabetes education was inconsistent across settings underscores the need for standardised, evidence-based educational programmes in Malaysian endocrinology clinics. Such programmes should address the cultural context of health beliefs in Malaysia’s multi-ethnic population and ensure that all insulin-treated patients receive comprehensive, accurate information about self-care practices.

Limitations

The study focused on adults aged 18 to 40 years recruited from endocrinology clinics, which limits generalisability to older patients and those managed in primary care settings. The six-month follow-up period, while sufficient to demonstrate longitudinal associations, may not capture longer-term patterns of belief change and behaviour. Self-reported measures of self-care practices may be subject to social desirability bias, and the relatively small sample from three clinics may not represent the full diversity of the Malaysian diabetes population. The qualitative component involving diabetes educators, while valuable, did not include patient perspectives on educational experiences.

← Back to MJPHM Homepage