Theory of Planned Behavior and Social Cognitive Theory on the Effect of the Community Health Center Tertiary Preventive Behavior among Patients with Type 2 Diabetes Mellitus: A Multilevel Analysis

Yudi Andriyaningtiyas, Didik Gunawan Tamtomo, Bhisma Murti


Background: Type 2 diabetes mellitus (DM) accounts for 90% to 95% of all diabetes cases. Complications of type 2 diabetes increase the risk of death for suf­ferers. Complications and deaths from type 2 dia­betes can be prevented by changes in behavior. This study aimed to determine the effect of health cen­­ters and other factors on the prevention of ter­­tiary diabetes type 2, using the theory of plan­ned behavior and social cognitive theory.

Subjects and Method: This was an analytic ob­ser­­vational study with cross sectional de­sign, conducted at 25 community health centers, in Bantul Re­gen­cy, Yogyakarta, Indonesia. A sample of 200 type 2 DM patients was selected by exha­ustive samp­­ling. The dependent variable was type 2 DM tertiary prevention. The indepen­dent vari­ables at level 1 are intention, attitude, sub­jective norm, perceived behavior con­trol/ self-efficacy, experience, modelling, self-re­gu­­­­lation, and out­come expectation. Community health center was an independent variable at level 2. The data were col­­lected by questionnaire and analyzed by a mul­ti­level multiple linear regression.

Results: Tertiary preventive behavior in type 2 DM patients increased with strong intention (b= 1.19; 95% CI= 0.62 to 1.76; p <0.001), positive atti­tude (b= 1.19; 95% CI= 0.58 to 1.80; p <0.001), supportive subjec­­tive norm (b= 0.79; 95% CI= 0.12 to 1.45; p= 0.019), perceived be­ha­vior control (b= 1.16; 95% CI= 0.60 to 1.72; p <0.001), abundant experience (b= 0.65; 95% CI= 0.62 to 1.25; p<0.001), strong modelling (b= 1.07; 95% CI= 0.53 to 1.67; p= 0.030), strong self-regulation (b= 0.87; 95% CI= 0.34 to 1.40; p= 0.001), and positive outcome expectation (b= 0.82; 95% CI= 0.25 to 1.38; p = 0.004). Commu­nity health center had con­textual effect on the tertiary pre­ventive behavior in type 2 DM patients with ICC= 19.18%.

Conclusion: Tertiary preventive behavior in type 2 DM patients increases with strong intent­ion, positive atti­tude, supportive subjec­­tive norm, perceived be­ha­vior control, abundant experience, strong modelling, strong self-regula­tion, and positive outcome expectation. Commu­nity health center has con­textual effect on the tertiary pre­ventive behavior in type 2 DM patients.

Keywords: tertiary prevention behavior, type 2 diabetes, TBP, SCT, multilevel analysis.


Yudi Andriyaningtiyas. Masters Program in Pub­lic Health, Universitas Sebelas Maret, Jl. Ir. Su­tami No. 36A, Surakarta. Email: yudi.andriya­ning­­ Mobile: +6281392704899

Journal of Health Promotion and Behavior (2020), 05(01): 59-71

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