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Direct and indirect effects of stress, health literacy, social media use, and self-efficacy on diabetes prevention behaviors in youth: A path analysis

Year: 2025

Type: article

Abstract: Background: Type 2 diabetes mellitus (T2DM) is increasingly affecting youth, particularly in low-and middle-income countries like Indonesia.Psychosocial and informational factors such as stress, health literacy, selfefficacy, and social media exposure may influence diabetes prevention behaviour.However, the interrelationships among these variables remain understudied.Purpose: This study aimed to assess the direct and indirect effects of stress, T2DM knowledge, health literacy, self-efficacy, social media exposure, and nutritional status on diabetes prevention behaviour among Indonesian university students using path analysis.Methods: A cross-sectional study was conducted among 380 undergraduate students aged 18-25 years at Universitas Indonesia Maju, Jakarta.Diabetes prevention behavior was measured using the Diabetes Prevention Behavior Questionnaire (DPBQ).Validated instruments assessed perceived stress (PSS-10), diabetes knowledge (modified DKQ-24), social media exposure to health information, health literacy (HLQ subscales 1, 2, 3, 5), and general self-efficacy (GSES).Body Mass Index (BMI) was calculated from selfreported height and weight.Path analysis evaluated direct and indirect effects and indirect effects were tested via bootstrapping (5,000 resamples).Results: Participants reported moderately high engagement in T2DM prevention behaviors (M = 3.72, SD = 0.46).The final model showed good fit to the data.T2DM prevention behavior was positively predicted by selfefficacy (β = 0.31, p < 0.001), health literacy (β = 0.25, p = 0.001), social media exposure (β = 0.21, p = 0.008), and diabetes knowledge (β = 0.18, p = 0.015), and negatively predicted by perceived stress (β = -0.23,p = 0.002) and BMI (β = -0.12,p = 0.031).Self-efficacy mediated the relationship between stress and prevention behavior (indirect β = -0.08,p = 0.012), while health literacy mediated the effects of diabetes knowledge (indirect β = 0.10, p = 0.046) and social media exposure (indirect β = 0.07, p = 0.046) on prevention behavior.Conclusion: Diabetes prevention behaviors in Indonesian youth are shaped by an interrelated network of psychosocial and digital factors.Selfefficacy and health literacy play central mediating roles, suggesting that future interventions should combine psychological empowerment, health literacy enhancement, and strategic use of social media to strengthen T2DM prevention in young populations.Longitudinal research is needed to confirm causal pathways.

Source: Jurnal Keperawatan Padjadjaran

DOI: 10.24198/jkp.v13i3.2809

Authors: Nina Nina, Achmad Lukman Hakim, Hidayani Hidayani, Tukimin Bin Sansuwito

Institutions: Universitas Indonesia Maju, Lincoln University College

Language: English

Topic: Diabetes Management and Education

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $65