[Home ] [Archive]   [ فارسی ]  
:: Main :: About :: Current Issue :: Archive :: Search :: Submit :: Contact ::
Main Menu
Home::
Journal Information::
About the Journal
Editorial Board
Aims & Scopes
Indexing and Abstracting
Articles archive::
All Issues
Current Issue
Browse by Authors
Browse by Keywords
For Authors::
Author’s Guideline
Refrence Style
Submission Form
Publication Ethics::
Editorial policy::
Contact us::
Contact Information
Contact us
Site Facilities::
Site map
Search contents
Top 10 contents
Inform to friends
Reviewe::
Guide for Reviewer
Peer-review process
::
Citation Impact
..
Search in website

Advanced Search
..
COPE Membership

AWT IMAGE
..
Creative Commons Licence
..
Open access
..
:: ::
Back to the articles list Back to browse issues page
Evaluation of Adherence to Self-care and Associated Socioeconomic and Psychological Factors in Patients with Type 2 Diabetes in Iran: A Systematic Review and Meta-analysis
Ali Vahab Moravvej , Safoura Saadatpour , Saha Sadeghi Sedeh , Bahman Sadeghi Sedeh *
Abstract:   (20 Views)
Background and Objective: Self-care plays a fundamental role in the management of type 2 diabetes mellitus (T2DM) and the prevention of its complications. Adherence to self-care behaviors is influenced by various socioeconomic factors, and findings from studies conducted in Iran have been inconsistent. Therefore, this study aimed to assess the level of adherence to self-care and socio-economic and psychological factors among Iranian patients with T2DM.

Materials and Methods: This systematic review and meta-analysis were conducted following ethical approval and in accordance with the PRISMA guidelines. Iranian observational studies published between 2015 and 2025 were identified through searches of PubMed, Web of Science, Scopus, CINAHL, SID, ISC, and Magiran databases. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers. Methodological quality was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool. Data were analyzed using a random-effects model, and the pooled standardized mean percentage of self-care adherence was calculated using Stata version 19. Heterogeneity, sensitivity analyses, meta-regression, and publication bias were also assessed.

Results: Of the 246 records initially identified, 25 cross-sectional studies conducted in Iran between 2015 and 2025, comprising a total of 8,402 patients with T2DM, were included in the final analysis. The mean age of participants was 54.5 years, and the mean duration of diabetes was 8.9 years. Meta-analysis using a random-effects model showed that the pooled adherence rate to self-care behaviors was 49.96% (95% CI: 45.09–54.82). Substantial heterogeneity was observed across studies (I² = 99.45%). Sensitivity analyses confirmed the robustness of the findings, while meta-regression indicated that sample size, age, sex, and duration of diabetes were not significantly associated with adherence levels. The results of the narrative synthesis showed that among socioeconomic determinants, education level and economic status, and among psychological factors, self-efficacy and health literacy are the most important factors associated with increasing adherence to self-care.

Conclusion: Adherence to self-care behaviors among Iranian patients with T2DM is suboptimal and remains at a moderate-to-low level. Educational attainment, socioeconomic status, self-efficacy, and health literacy were identified as key determinants of adherence. These findings highlight the need for targeted educational, psychosocial, and supportive interventions aimed at enhancing health literacy and empowering patients to improve self-care practices.
Keywords: Type 2 Diabetes Mellitus, Self-efficacy, Adherence, Socioeconomic Factors, Health Literacy
     
Type of Study: Meta-analysis | Subject: Health Education & Health Promotion
Received: 2026/04/25 | Accepted: 2026/09/19
References
1. Federation ID. IDF Diabetes Atlas Brussels. Belgium: international diabetes federation. 2021.
2. Summary of revisions: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47(Supplement_1):S5-S10.
3. Farrokhi M, Taheri F, Moeini A, Farrokhi M, Rabiei S, Farahmandsadr M, et al. Sex and gender differences in the pathogenesis and treatment of diseases. Kindle. 2023;3(1):1-168.
4. Elsayed NA, Aleppo G, Bannuru RR, Beverly EA, Bruemmer D, Collins BS, et al. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024. Diabetes care. 2024;47. [DOI:10.2337/dc24-S005] [PMID]
5. Shrivastava SR, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus. Journal of diabetes & Metabolic disorders. 2013;12(1):1-5. [DOI:10.1186/2251-6581-12-14] [PMID] [PMCID]
6. Powers MA, Bardsley JK, Cypress M, Funnell MM, Harms D, Hess-Fischl A, et al. Diabetes self-management education and support in adults with type 2 diabetes: a consensus report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Journal of the American Pharmacists Association. 2020;60(6):e1-e18. [DOI:10.1016/j.japh.2020.04.018] [PMID]
7. Opoku R, Ackon SK, Kumah E, Botchwey CO-A, Appiah NE, Korsah S, et al. Self-care behaviors and associated factors among individuals with type 2 diabetes in Ghana: a systematic review. BMC Endocrine Disorders. 2023;23(1):256. [DOI:10.1186/s12902-023-01508-x] [PMID] [PMCID]
8. Khosravizadeh O, Ahadinezhad B, Maleki A, Yousefy S, Momeni Z. Diabetes self-care activities among patients with type 2 diabetes: A systematic review and meta-analysis. International Journal of Diabetes in Developing Countries. 2024;44(1):10-9. [DOI:10.1007/s13410-023-01214-3]
9. Organization WH. Integrating the social determinants of health into health workforce education and training: World Health Organization; 2023.
10. Walker RJ, Smalls BL, Hernandez-Tejada MA, Campbell JA, Davis KS, Egede LE. Effect of diabetes fatalism on medication adherence and self-care behaviors in adults with diabetes. General hospital psychiatry. 2012;34(6):598-603. [DOI:10.1016/j.genhosppsych.2012.07.005] [PMID] [PMCID]
11. Dimou K, Dragioti E, Tsitsas G, Mantzoukas S, Gouva M. Association of personality traits and self-care behaviors in people with type 2 diabetes mellitus: a systematic review and meta-analysis. Cureus. 2023;15(12). [DOI:10.7759/cureus.50714]
12. Tsokani S, Seitidis G, Christogiannis C, Kontouli K-M, Nikolakopoulos S, Zevgiti S, et al., editors. Exploring the effectiveness of self-management interventions in type 2 diabetes: A systematic review and network meta-analysis. Healthcare; 2023: MDPI. [DOI:10.3390/healthcare12010027] [PMID] [PMCID]
13. Polsook R, Aungsuroch Y, Thontham A. The effect of self‐management intervention among type 2 diabetes: A systematic review and meta‐analysis. Worldviews on Evidence‐Based Nursing. 2024;21(1):59-67. [DOI:10.1111/wvn.12688] [PMID]
14. Hahn EA, Burns JL, Jacobs EA, Ganschow PS, Garcia SF, Rutsohn JP, et al. Health literacy and patient-reported outcomes: a cross-sectional study of underserved English-and Spanish-speaking patients with type 2 diabetes. Journal of health communication. 2015;20(sup2):4-15. [DOI:10.1080/10810730.2015.1061071] [PMID]
15. Huang Y-M. A Mixed Methods Investigation of the Barriers and Facilitators to Medication Adherence in Patients with Type 2 Diabetes across Different Health Literacy Levels: The University of Wisconsin-Madison; 2019.
16. Tol A, Shojaeezadeh D, Sharifirad G, Alhani F, Tehrani MM. Determination of empowerment score in type 2 diabetes patients and its related factors. JPMA-Journal of the Pakistan Medical Association. 2012;62(1):16.
17. Didarloo A, Shojaeizadeh D, Asl RG, Habibzadeh H, Niknami S, Pourali R. Prediction of self-management behavior among Iranian women with type 2 diabetes: application of the theory of reasoned action along with self-efficacy (etra). Iranian Red Crescent Medical Journal. 2012;14(2):86. [DOI:10.4093/dmj.2011.35.5.513] [PMID] [PMCID]
18. EFTEKHAR H, SHOJAEIZADEH D, Mohammad K, NAKHJAVAN M, GHOFRANIPOUR RF. Behavior, metabolic control and health-related quality of life in diabetic patients at bandar abbas diabetic clinic. 2003.
19. Babazadeh T, Dianatinasab M, Daemi A, Nikbakht HA, Moradi F, Ghaffari-Fam S. Association of self-care behaviors and quality of life among patients with type 2 diabetes mellitus: Chaldoran County, Iran. Diabetes & metabolism journal. 2017;41(6):449. [DOI:10.4093/dmj.2017.41.6.449] [PMID] [PMCID]
20. Jalilian F, Motlagh FZ, Solhi M, Gharibnavaz H. Effectiveness of self-management promotion educational program among diabetic patients based on health belief model. Journal of education and health promotion. 2014;3(1):14. [DOI:10.4103/2277-9531.127580] [PMID] [PMCID]
21. Bigdeli MA, Hashemi Nazari SS, Khodakarim S, Brodati H, Mafi H, gafari Z, et al. Factors Associated with Self-care Behavior in Patients with Type II Diabetes. Journal of Mazandaran University of Medical Sciences. 2015;25(125):61-72.
22. Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z. editors. JBI manual for evidence synthesis. Adelaide: JBI. 2020.
23. Parkhurst J. The politics of evidence: from evidence-based policy to the good governance of evidence: Taylor & Francis; 2016. [DOI:10.4324/9781315675008]
24. Borenstein M HL, Higgins JP, Rothstein HR. John Wiley & Sons; . . Introduction to meta-analysis. sizes) CCae, editor2021. [DOI:10.1002/9781119558378]
25. Lockwood C, Porritt K, Munn Z, Rittenmeyer L, Salmond S, Bjerrum M, et al. Systematic reviews of qualitative evidence. JBI manual for evidence synthesis. 2020;46658:1-4. [DOI:10.46658/JBIMEI-20-01]
26. Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. bmj. 2020;368. [DOI:10.1136/bmj.l6890] [PMID]
27. Aromataris E, Munn Z. editors. JBI manual for evidence synthesis. Adelaide: JBI. 2020.
28. AbbasZadeh Bazzi M, Karimiaval M. Relationship between health literacy and self-care behaviors in diabetic patients type II referred to the center of diabetes control and prevention in zabol. Journal of Health Literacy. 2018;3(1):10-9.
29. Alizadeh L, Salehi L. Diabetes Knowledge and Self-care Practice in Type II Diabetic Patients: An Immigrant Population-based Study. Journal of Diabetes Nursing. 2018;6(1):352-64.
30. baji z, Zamani alavijeh F, Nouhjah S, haghighizadeh MH. Self-care Behaviors and Related Factors in Women with Type 2 Diabetes. Iranian Journal of Endocrinology and Metabolism. 2015;16(6):393-401.
31. Dehghani-Tafti A, Mazloomy Mahmoodabad SS, Morowatisharifabad MA, Afkhami Ardakani M, Rezaeipandari H, Lotfi MH. Determinants of Self-Care in Diabetic Patients Based on Health Belief Model. Glob J Health Sci. 2015;7(5):33-42. [DOI:10.5539/gjhs.v7n5p33] [PMID] [PMCID]
32. EBADI FAF, HEIDARI H, Solhi M. Relationship between self-care behavior and health locus of control in patients with type II diabetes. 2016.
33. Esbochin F, Abbasi G, Akha O. Investigating the Relationship between Perceived Spousal Sacrificial Behavior and Self-Efficacy with Behavior Management in Patients with Type 2 Diabetes. Iranian Journal of Diabetes and Lipid Disorders. 2026;25(6):544-54. [DOI:10.18502/ijdl.v25i6.20859]
34. Fereidooni GJ, Ghofranipour F, Zarei F. Interplay of self-care, self-efficacy, and health deviation self-care requisites: a study on type 2 diabetes patients through the lens of Orem's self-care theory. BMC primary care. 2024;25(1):48. [DOI:10.1186/s12875-024-02276-w] [PMID] [PMCID]
35. Ghaedi M, Banihashemi F, Latifi M, Soleymaninejad M. The relationship between health literacy and self-care among patients with type 2 diabetes residing in the city of Bastak. 2016.
36. Haji-Arabi E, Nobahar M, Ghorbani R. Relationship between depression and knowledge about diabetes with the amount of self-care in patients with type 2 diabetes. Koomesh. 2018;20(20):210-20. e152951.
37. Jahangirimehr A, Azizpour M, Kalanfarmanfarma K, Yarmohammadi S. Prediction of self-care behaviors among type 2 diabetes patients in Tehran based on health literacy in 2020: a cross-sectional study. 2025.
38. Khosravan S, Njafi M, Alami A. Self-care ability of women with diabetes who suffered from peripheral neuropathy and its related needs based on Orem's self-care model. Medical-Surgical Nursing Journal. 2015;4(3):44-51.
39. Mazloomi S, Mody M, Malakimoghadam H, Tavasoli E, Vahdani Nia Z. Predictors of self-care in type 2 diabetic patients in Birjand and Yazd city. Iranian Journal of Diabetes and Metabolism. 2018;17(2):97-104.
40. Montazeri N, Bakhshi S, Malekzadeh R, Ziapour A, Chaboksavar F, Yazdi F, et al. Investigating the factors affecting the self-care behaviors of patients with type II diabetes and the role of demographic variables: A case study in Iran. Journal of Education and Health Promotion. 2023;12(1):291. [DOI:10.4103/jehp.jehp_1307_22] [PMID] [PMCID]
41. Chaleshgar-kordasiabi M, Ramezani A, Bakhshavand A. Relationship between health literacy and self-care behaviors in patients with type 2 diabetes. J Health Syst Res. 2020;15(4):262-71.
42. Nejaddadgar N, Solhi M, Jegarghosheh S, Abolfathi M, Ashtarian H. Self-care and related factors in patients with type 2 diabetes. Asian J Biomed Pharm Sci. 2017;7(61):6-10.
43. Nikbina M, Doostifar K, Rusdiana R, Moradi A, Marashi T, Nikzadian M. The status of self-care behaviors among type 2 diabetic patients: a cross-sectional study. Romanian Journal of Diabetes Nutrition and Metabolic Diseases. 2023;30(2):188-93.
44. Ramesh S, Ghazian M, Rafiepoor A, Safari A. The Mediator Role of Depression and Anxiety in the Relationship between Cognitive Emotional Regulation and Self-care in Type 2 Diabetes. Pajouhan Scientific Journal. 2018;16:37-45. [DOI:10.21859/psj.16.4.37]
45. Reisi M, Mostafavi F, Javadzade H, Mahaki B, Tavassoli E, Sharifirad G. Impact of health literacy, self-efficacy, and outcome expectations on adherence to self-care behaviors in Iranians with type 2 diabetes. Oman medical journal. 2016;31(1):52. [DOI:10.5001/omj.2016.10] [PMID] [PMCID]
46. RobatSarpooshi D, Mahdizadeh M, Alizadeh Siuki H, Haddadi M, Robatsarpooshi H, Peyman N. The relationship between health literacy level and self-care behaviors in patients with diabetes. Patient related outcome measures. 2020:129-35. [DOI:10.2147/PROM.S243678] [PMID] [PMCID]
47. Sadeghi S, Borzu ZA, Shirzadi S, Jahanfar S, Abadi YG, Taziki M. Investigating e-health literacy and its relationship with self-care behaviors among Iranian Middle-aged type 2 diabetes: a cross-sectional study. BMC Public Health. 2025;25(1):1376. [DOI:10.1186/s12889-025-22648-w] [PMID] [PMCID]
48. Sadri M, Einolghozati M, Barati M, Mohammadi Y. The factors related to self-treatment behaviors among type 2 diabetic patients: application of the theory of planned behavior. Evidence Based Care. 2023;13(3):27-34.
49. Sedaei M, Mohamadi MA, Dadkhah B. Investigating the relationship between social stigma and treatment adherence in type 2 diabetes patients at healthcare centers in Northwest Iran. BMC Public Health. 2025;25(1):815. [DOI:10.1186/s12889-025-22014-w] [PMID] [PMCID]
50. Shabibi P, Mansourian M, Abedzadehzavareh M, Sayehmiri K. The status of self-care behaviors in patients with type 2 diabetes in the city of Ilam in 2014. 2016. [DOI:10.18869/acadpub.sjimu.24.2.63]
51. Taghipour A, Moshki M, Mirzaei N. Determination of effective factors on self-care behaviors in women with diabetes referring to Mashhad health centers. Iranian Journal of Health Education and Health Promotion. 2018;5(4):328-35. [DOI:10.30699/acadpub.ijhehp.5.4.320]
52. Guo XM, Zhai X, Hou BR. Adequacy of health literacy and its effect on diabetes self-management: a meta-analysis. Aust J Prim Health. 2020;26(6):458-65. [DOI:10.1071/PY20079] [PMID]
53. Butayeva J, Ratan ZA, Downie S, Hosseinzadeh H. The impact of health literacy interventions on glycemic control and self-management outcomes among type 2 diabetes mellitus: A systematic review. J Diabetes. 2023;15(9):724-35. [DOI:10.1111/1753-0407.13436] [PMID] [PMCID]
54. Carvalho M, Dunne P, Kwasnicka D, Byrne MISTDMPAP, McSharry J. Barriers and enablers to maintaining self-management behaviours after attending a self-management support intervention for type 2 diabetes: a systematic review and qualitative evidence synthesis. Health Psychol Rev. 2024;18(3):478-507. [DOI:10.1080/17437199.2023.2268731] [PMID]
55. Chrvala CA, Sherr D, Lipman RD. Diabetes self-management education for adults with type 2 diabetes mellitus: A systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99(6):926-43. [DOI:10.1016/j.pec.2015.11.003] [PMID]
56. Hosseinzadeh H, Verma I, Gopaldasani V. Patient activation and Type 2 diabetes mellitus self-management: a systematic review and meta-analysis. Aust J Prim Health. 2020;26(6):431-42. [DOI:10.1071/PY19204] [PMID]
57. Studer CM, Linder M, Pazzagli L. A global systematic overview of socioeconomic factors associated with antidiabetic medication adherence in individuals with type 2 diabetes. J Health Popul Nutr. 2023;42(1):122. [DOI:10.1186/s41043-023-00459-2] [PMID] [PMCID]
58. Shahabi N, Fakhri Y, Aghamolaei T, Hosseini Z, Homayuni A. Socio-personal factors affecting adherence to treatment in patients with type 2 diabetes: A systematic review and meta-analysis. Prim Care Diabetes. 2023;17(3):205-20. [DOI:10.1016/j.pcd.2023.03.005] [PMID]
59. Woodward A, Walters K, Davies N, Nimmons D, Protheroe J, Chew-Graham CA, et al. Barriers and facilitators of self-management of diabetes amongst people experiencing socioeconomic deprivation: A systematic review and qualitative synthesis. Health Expect. 2024;27(3):e14070. [DOI:10.1111/hex.14070] [PMID] [PMCID]
60. Parmar J, El Masri A, MacMillan F, McCaffery K, Arora A. Health literacy and medication adherence in adults from ethnic minority backgrounds with Type 2 Diabetes Mellitus: a systematic review. BMC Public Health. 2025;25(1):222. [DOI:10.1186/s12889-024-20734-z] [PMID] [PMCID]
61. Seo S, Kang HS, Kim C-J, Schlenk EA. Application of the Information-Motivation-Behavioral Skills Model of Medication-Taking Behavior in People With Diabetes. The Science of Diabetes Self-Management and Care. 2026;52(3):219-28. [DOI:10.1177/26350106261434496] [PMID]
62. Shrestha M, Ng A, Al-Ghareeb A, Alenazi F, Gray R. Association between subthreshold depression and self-care behaviors in people with type 2 diabetes: a systematic review of observational studies. Syst Rev. 2020;9(1):45. [DOI:10.1186/s13643-020-01302-z] [PMID] [PMCID]
63. Baroni I, Caruso R, Dellafiore F, Ausili D, Barello S, Vangone I, et al. Self-care and type 2 diabetes mellitus (T2DM): a literature review in sex-related differences. Acta Biomed. 2022;93(4):e2022277.
Send email to the article author

Add your comments about this article
Your username or Email:

CAPTCHA

Ethics code: IR.MUI.MED.REC.1404.328

XML   Persian Abstract   Print

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Back to the articles list Back to browse issues page
فصلنامه آموزش بهداشت و ارتقاء سلامت ایران Iranian Journal of Health Education and Health Promotion
Persian site map - English site map - Created in 0.1 seconds with 44 queries by YEKTAWEB 4774