Application of Social Cognitive Theory: Tertiary Prevention Behavior in Patients with Type 2 Diabetes Mellitus in Ponorogo Hospital, East Java, Indonesia

Nur Aida Yuliana, Pawito Pawito, Bhisma Murti


Background: Diabetes Mellitus (DM) is a non-com­municable disease that becomes a serious threat to global health. This disease is a serious chronic disease because it cannot be cured. An increasing number of cases of non-communicable diseases that are associated with risk factors are in line with lifestyle changes that increasingly mo­dern. This study aimed to analyze the effect of the variables in Social Cognitive Theory on ter­tiary prevention behavior in patients with type 2 Dia­betes Mellitus.

Subjects and Method: This was a cross-sec­tio­nal study design. This study was conducted on pa­tients with type 2 DM in the hospital in Po­no­rogo Regency, East Java, from January to Feb­ruary 2020. There were 200 patients with type 2 DM as the sample of the study. The sample was taken by random sampling. The dependent vari­able was Tertiary prevention behavior of type 2 DM. The independent variables were obser­va­tio­nal learning, role model, vicarious experience, imi­tation, attitude, outcome expectations, know­led­ge, reinforcement, self-efficacy, and self-mana­ge­ment. The data were collected through a set of ques­tionnaires. The data were analyzed based on Path Analysis using stata 13 application.

Results: Tertiary prevention behavior of type 2 DM was directly increased by strong imi­tation (b= 1.40; 95% CI= 0.51 to 2.28; p= 0.002), good knowledge (b= 1.36; 95% CI= 0.48 to 2.25; p= 0.002), positive attitude (b= 1.32; 95% CI­= 0.44 to 2.19; p= 0.003), strong self-efficacy (b= ­1.­07; 95% CI= 0.18 to 1.96; p= 0.018), and good self-management (b= 2.26; 95% CI= 1.31 to 3.22; p <0.001). Ter­tiary prevention behavior of type 2 DM was in­directly affected by observational learning, role model, vicarious experience, outcome expectation, and reinforce­ment.

Conclusion: Tertiary prevention behavior of type 2 DM is directly increased by strong imi­tation, good knowledge, positive attitude, strong self-efficacy, and good self-management. Ter­tiary prevention behavior of type 2 DM is in­directly affected by observational learning, role model, vicarious experience, outcome expectation, and reinforce­ment.

Keywords: social cognitive theory, type 2 Dia­be­tes Mellitus.

Correspondence: Nur Aida Yuliana. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: +628-5790767582.

Journal of Health Promotion and Behavior (2020), 5(1): 157-168

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Aweko J, Man DJ, Absetz P, Ostenson CG, Peterson SS, Alvesson MH, Daivad-anam M (2018). Patient and provider dilemmas of type 2 diabetes selfmanagement: A qualitative study in socio-economically disadvantaged communities in Stockholm. Int J Environ Res

Public Health, 15 (9): 18-10. 15091810.

Chai S, Yao B, Xu L, Wang D, Sun J, Yuan N. (2018). The effect of diabetes self-management education on psychological status and blood glucose in newly diagnosed patients with diabetes type 2. Patient Education and Counseling, 101 (8): 1427– 1432.

Ghoreishi MS, Shahroodi VM, Jafari A, The-ranid H (2019). Self-care behaviors in patients with type 2 diabetes: Education intervention base on social cogni-tive theory,Diabetol Metab Syndr: Clinical Research and Reviews. Elsevier Ltd, 13(3): 2049–2056.

Herawati R, Pamungkasari EP, Sugiarto (20-18). The Association between Knowledge, Family Support, and Blood Sugar Level in Type 2 Diabetes Mellitus Patients, IJM, 3(1): 49-55.

Hidayah M (2019). The Relationship between Self-Management Behaviour and Blood Glucose Level in Diabetes Mellitus Type 2 Patients in Pucang Sewu Health Center, Surabaya. Amerta Nutr, 176-182.

IDF (2015). IDF Diabetes Atlas. Seventh ed, International Diabetes Federation. Seventh Ed. 10.1289/image.ehp.v119.i03.

IDF (2017). IDF Diabetes Atlas. Seventh Ed, International Diabetes Federation. Seventh Ed.

Javalkar K, Williamson N, Vaidya S, Vaidya A, Ferris M (2016). The association between educational resource utilization and knowledge/ self-management among patients with Type 2 Diabetes in Pune, India. Diabetes & Metabolic Syndrome: Clinical

Research & Reviews, 10(4): 186–189.

Kueh YC, Morris T, Ismail (2016). The effect of diabetes knowledge and attitudes on self-management and quality of life among people with type 2 diabetes. Psychol Med,22(2): 138–144.

Luo L, Pang B, Chen J, Li Y, Xie X (2019). Assessing the Impact of Lifestyle Interventions on Diabetes Prevention in China: A Modeling Approach. Int J of Environ Res Public Health, 16(10): 16-77.

Murti B (2018). Teori promosi dan perilaku kesehatan. Edisi kesatu. Surakarta: Program Studi Ilmu Kesehatan Masyarakat, Universitas Sebelas Maret

Nuryanto (2019). The Correlation of Family Support, Viewed from the Dimensions of Emphaty/Emotion, Recognition, Instrumental, and Information with the Life Quality of DM Type 2 Patients at Helvetia Health Center, Medan. JHSP: 18-24. Retrieved from

Ponzo V, Rosato R, Tarsia E, Goitre I, Michieli DF, Fadda M (2017). Self-reported adherence to diet and preferences to wards type of meal plan in patient with type 2 diabetes mellitus. A cross-sectional study. NMCD, 27(7): 642-650.

Ramkisson S, Pillay BJ, Sibanda W (2017). Social support and coping in adults with type 2 diabetes. Afr J Prim Health Care Fam Med, 9(1).

Riset Kesehatan Dasar. (2013). Hasil Riskesdas 2018. Jakarta: Riset Kesehatan Dasar. Retrieved from

Risti KN, Isnaeni FN (2017).Hubungan motivasi diri dan pengetahuan gizi terhadap kepatuhan diet dm pada pasien diabetes mellitus tipe II rawat jalan di rsud karanganyar. Jurnal Kesehatan, 10(2): 94-102.

Shamizadeh T, Jahangiry L, Sarbakhsh P, Ponnet K (2019). Social cognitive theory-based intervention to promote physical activity among prediabetic rural people: a cluster randomized controlled, Trials. BMCHealth Promot Pract, 20(1): 1–10.

Sharoni ASK, Rahman AH, Minhat HS, Ghazali SS, Ong AMH (2018). The effects of self-efficacy enhancing program on foot self-care behaviour of older adults with diabetes: A randomised controlled trial in elderly care facility, Peninsular Malaysia. PLOS

ONE, 13(3): 192-417.

Suyanto E, Mutalazimah, Akhyar M (2016). Social cognitive theory: the relationship between knowledge, environmental ob-servation, outcome expectation, self-efficacy, and preventive behavior of over weight in adolescent, JHPB: 64-69.

Taylor LM, Raine KD, Plotnikoff RC, Vallance JK, Sharma AM, Spence JC (2016) Understanding physical activity in individuals with prediabetes: An application of social cognitive theor, Psychology, BMJ, 21(2): 254–260.

WHO (2016). Global Report On Diabetes. World health Organization.


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