Diabetes mellitus (DM) is a group of metabolic diseases of carbohydrate, fat, and

protein metabolism with hyperglycemic characteristics resulting from defects in insulin

secretion, insulin action, or both (Katadi et al., 2019). In general, diabetes mellitus will start
in adulthood because most of it occurs in late adulthood to the elderly stage. However, young
people today can also suffer from type 2 diabetes, and women are more at risk of developing
diabetes because women have a hormonal imbalance from the monthly cycle syndrome
(premenstrual syndrome) and post-menopause (Pratiwi et al., 2019). Diabetes mellitus
prevention can be done by controlling normal blood sugar levels, overcoming comorbid
diseases, preventing and overcoming complications, and instill self-confidence in carrying
out certain medications and therapies. Keeping blood sugar at normal levels, in addition to
consuming drugs and physical exercises are dietary management or a healthy lifestyle
(American Diabetes Association, 2018). The most important is the main factor in the success
of treatment can be associated with changes in an unhealthy lifestyle and this is greatly
influenced by the individuals who undergoing treatment, especially those who have chronic
diseases such as diabetes mellitus (Awasthi et al., 2018).
The World Health Organization (WHO) predicts an increase in the number of people
with diabetes in Indonesia from 8.4 million in 2000 to be around 21.3 million in 2030. This
report shows that there is an increase in people with diabetes by 2-3 times in 2035 (Perkeni et
al., 2015). In 2019, the number of people with diabetes was 10.7 million which has made
Indonesia become one of the countries with the second-highest number of people with
diabetes in the West Pacific region (International Diabetes Federation, 2019). In 2018,
according to the Basic Health Research (Riskesdas) data of people with diabetes in Indonesia
found a prevalence of diabetes mellitus of 2.6% in East Java, this prevalence has increased by
0.5 compared to the results of Basic Health Research (Riskesdas) in 2013. According to the
Basic Health Research (Riskesdas) and the 2018 National Institute of Health Research and
Development, the number of women with diabetes in Indonesia is higher (1.8%) than men
(1.2%). Women are more prone to suffering from chronic diseases such as diabetes and
suffering from disabilities than men. It is estimated that in 2015-2050, the majority of
diabetes mellitus cases occur in women (Pratiwi et al., 2019).
Diabetes mellitus prevention with the basic principles of diabetes mellitus
management control includes lifestyle modification by changing the unhealthy lifestyle into a
healthy lifestyle in the form of dietary management, physical exercise or physical training,
and changes in risky behavior. Diabetes mellitus is a disease that can be controlled because
almost 90% of it is related to an unhealthy lifestyle, people with diabetes mellitus can live a
healthy life and coexist with diabetes mellitus, as long as they comply and control regularly
(IDF, 2019). Compliance is extremely important for every individual in the treatment of
diabetes mellitus, with the ability to manage the disease effectively, people with diabetes
mellitus must have knowledge, skills, and most importantly have self-efficacy in the
treatment process of diabetes mellitus. Self-efficacy is the most effective predictor in
evaluating changes in a person’s behavior. Individuals with better self-efficacy will have
stronger self-control abilities in facing problems. However, low self-efficacy can be seen in
the problems that often happen when keeping a lifestyle which can have an impact on the low
level of success in controlling diabetes mellitus (Shao et al., 2017).
The increased cases of diabetes mellitus are caused by problems in patients’ behavior
related to changes in behavior made by people with diabetes such as getting used to eating on
time resulting in no changes in blood glucose levels (Nusantara et al, 2019). Behavior begins
with an intention. The intention to behave is influenced by the attitude towards the behavior,
the more positive the attitude, the stronger the effort to turn the intention into a behavior. If
the individual does not have the intention to carry out behavior, the individual is less likely to
carry out the behavior (Haskas, 2017). People with diabetes carrying out diabetes prevention
by changing lifestyles for each individual and adjusting their life patterns such as complying
the dietary management and choosing physical activities that can be done. Each person has
self-efficacy in behavior related to controlling diabetes mellitus, this self-efficacy can lead to
a form of intention to behave by choosing to make or not to make changes in the lifestyle.
Based on previous research, the researcher aims to determine the relationship between self-
efficacy and intention as well as lifestyle modification in women with diabetes.
This study used a descriptive correlational method with a cross-sectional approach.
The data collection process was conducted on 27th April to 21st May 2020 in the working
area of Kebonsari health centers and Tuban health centers. The research variables are self-
efficacy, intention, and lifestyle modification. The population used in this study is Tuban.
Samples were obtained using consecutive sampling with inclusion criteria: 1) People with
diabetes aged 40-70 years, 2) People who were diagnosed with diabetes for more than a year.
The number of samples in this study was 111 respondents. The data collection technique was
conducted using a diabetes self-efficacy questionnaire to measure self-efficacy, an intention
questionnaire to measure intention, and a health-promoting lifestyle profile II questionnaire to
measure lifestyle modification. Data analysis used SPSS 25.0 programs for Windows and
tested using the Spearman’s rho statistic, which is p ≤ 0.05. This study obtained ethical
approval from the Health Research Ethics Commission of the Faculty of Nursing, Universitas
Airlangga, and received approval for the research protocol number 1996-KEPK.

Table 1 Distribution of the demographic characteristics of respondents in the two

working areas of Kebonsari health centers and Tuban health centers in the period of
April-May 2020
Table 1 the largest age group data in this study were aged 51-60 years, as many as 47
respondents (42.3%). From the distribution of the data in terms of the occupation of the
respondents in this study, the majority were housewives as many as 33 respondents (29.7%).
The condition of the majority of respondents who had a random blood sugar level with
diabetes criteria were 72 respondents (64.9%). In terms of consumption of drugs, the
respondents with diabetes were mostly consumed metformin and glimepiride as many as 44
respondents (39.6%). In terms of the duration suffering from diabetes, most results are
suffering from> 2 years as many as 103 respondents (92.8%).
Table 2 shows that the majority of the respondents as many as 47 respondents
(42.3%) out of 111 respondents have good self-efficacy and have a pretty good level of
lifestyle modification. The results of the statistical test of the relationship between the self-
efficacy variable and the lifestyle modification of people with diabetes used the Spearman’s
Rho test. The results obtained showed p = 0.002 and r = 0.294, which means that there is a
relationship between self-efficacy and lifestyle modification of people with diabetes with a
sufficient correlation coefficient. The correlation coefficient is positive, which means that the
relationship between self-efficacy and lifestyle modification of people with diabetes is
unidirectional. This means that the hypothesis (H1) is accepted, which means that there is a
relationship between self-efficacy and lifestyle modifications of people with diabetes.
Table 3 shows that the majority of the respondents as many as 59 respondents
(53.2%) out of 111 respondents have great intentions and have a pretty good level of lifestyle
modification. The results of statistical tests on the relationship between the intention variable
and the lifestyle modification of people with diabetes used the Spearman’s Rho test. The
results showed p = 0.000 and r = 0.480, which means that there is a relationship between
intention and lifestyle modification of people with diabetes with a sufficient correlation
coefficient. The correlation coefficient is positive, which means that the relationship between
intention and lifestyle modification of people with diabetes is unidirectional. This means that
the hypothesis (H1) is accepted, which means that there is a relationship between intention
and lifestyle modification of people with diabetes.
1. The results showed a relationship between self-efficacy and lifestyle modification in
people with diabetes using the Spearman’s rho correlation test, the value of p <α was
obtained and had a sufficient correlation coefficient and unidirectional. The results in this
study regarding the relationship between self-efficacy and lifestyle modification showed that
the majority of respondents have good self-efficacy with sufficient lifestyle modifications.
Good self-efficacy is described in the frequency distribution of respondents’ answers where
the majority of respondents have the confidence to take medication regularly in the treatment
process which is the aspect of adherence in diabetes mellitus treatment. This indicates that the
respondents can maintain their self-confidence in carrying out the stages of the treatment
process to achieve success. It can be concluded that the majority of the respondents’ self-
efficacy is in the aspect of treatment adherence. Meanwhile, in the overview of self-efficacy,
there is a belief with a comparison of practices related to the 3J diet which is still low because
there are still many respondents with low self-confidence to adjust their diet. Self-efficacy in
people with type 2 diabetes are mostly women, this is due to several risk factors experienced
by women, especially in women who find it difficult to manage their lifestyle.
The research results are in line with previous research conducted by Nusantara and
Wahyuningsih (2019), showed that there are still many people with diabetes who do not
comply with changes in physical activity, while self-efficacy in the diabetes mellitus
treatment process can increase adherence and achievement in controlling blood sugar levels.
Self-efficacy in behavior related to the management of diabetes mellitus treatment can be
proven by statements of self-efficacy in dietary management and self-efficacy for physical
activity. This will relate to previous research which shows that gender differences in self-
efficacy explain the relationship between anxiety and the stability of self-efficacy. This is
because women are more prone to have good self-efficacy. After all, women have greater
demands on physical and psychological problems (Cherrington et al., 2010). In terms of
gender, women have better self-efficacy than men. Women are considered more adherent in
undergoing medication and self-care than men, besides that women have better coping
mechanisms than men in dealing with a problem (Ngurah et al. 2014).
Malayanita (2017) states that self-efficacy in individuals does not only depend on
their own experiences of failure and success as a source of self-efficacy. Self-efficacy is also
influenced by the experiences of other individuals. Individuals persuade themselves by saying
if other individuals can do it well. Two conditions allow self-efficacy to be easily influenced
by the experiences of others including by a lack of understanding of other people’s abilities
and a lack of understanding of their abilities, resulting in individuals who have high self-
efficacy are not necessarily capable of a good healthy lifestyle (Huda et al., 2020).
Therefore, the longer a person suffers from diabetes, the better the coping mechanism and the
more experiences each individual has in dealing with the disease. According to this study,
female respondents are considered more obedient with a good coping mechanism in
undergoing treatment and doing the physical activity than men. Efforts to improve lifestyle
can be a basic thought for preventing diabetes mellitus by making this lifestyle modification
so it can delay or even prevent diabetes mellitus.
2. Based on the research results showed that there is a relationship between intention and
lifestyle modification in people with diabetes using the Spearman’s rho correlation test,
obtained the value of p <α, which means that there is a relationship between intention and
lifestyle modification in people with diabetes. The correlation coefficient value shows that
there is a relationship between intention and lifestyle modification in people with diabetes
which has sufficient value of correlation coefficient. The correlation coefficient is positive,
which means that the relationship between intention and compliance with the type of diabetes
mellitus diet is unidirectional. This means that the respondents can maintain their own
intention to take the action chosen by people with diabetes in self-care management, which
concludes that the majority of the respondents’ intentions are in the aspect of treatment
adherence which is indicated by the respondent having good intentions to take the prescribed
medication. While, in the overview of the intention, there is a lack of intention in
management related to the value of weight, height, and BMI resulting in respondents do not
know the fluctuating conditions of in values of weight, height, and BMI when carrying out
routine controls. According to Lestarina (2018), the results had a significant effect on gender
and knowledge of the main factors (attitudes, subjective norms, and perceived behavioral
control). This is assessed by the parameter background factor with a positive influence which
explains that gender is a factor that influences a person to behave and to have a certain
attitude, apart from environmental factors. Women are better than boys in carrying out a
healthy life. This can be influenced by other factors, such as environmental factors, if the
surrounding environment always implements healthy living behaviors then it can lead to
positive attitudes to behave. This research is in line with the research conducted by Haskas
(2017) which states that intention does not have a significant effect on control behavior of
diabetes mellitus, but people with diabetes still have a strong intention to control it.
Supported by the distribution of data that all respondents who have a negative attitude
regarding the control of diabetes mellitus have a strong intention to control diabetes mellitus.
This proves that negative and positive attitudes regarding the control of diabetes mellitus,
people with diabetes will still have good intentions to control diabetes mellitus.
According to Bandura and Ancok (1998) in the research of Haskas (2017), reveal that
people who have a positive attitude towards something will influence their intention. This is
supported by research conducted by Wismanto, Bagus, dan Budi (2010) which states that the
intention to keep a healthy lifestyle is influenced by several factors including support and the
ability to realize these desires. Therefore, in this study, perceptions will create an intention to
behave, if a person has the intention and there are an opportunity and a strong will, concrete
behavior will occur. In association with diabetes management compliance, the intention to
comply with the management of diabetes is shown in the motivation of the individuals who
want to change their behavior.
People with diabetes often have the intention that cannot be implemented into action
because of the barriers to self-control. This is proven by the fact that respondents often eat
foods that are not recommended in the diet program, for example, snacks that contain oil
(fried foods), foods that are high in cholesterol such as offal, skin, fast food/instant food, and
the like. According to (Malayanita, 2017), gender will influence the belief of each individual
in managing diet because women tend to often manage food in the household, and women’s
appetite for snacking is greater than men. Based on this, the researcher argues that to make
intention as an act of obedient behavior other factors are needed. Intention can be determined
by the extent to which each individual has a positive attitude towards certain behaviors and to
what extent if they choose to do certain other behaviors. This is because there are other
factors such as background factors that influence the behavior of changes in lifestyle that are
at risk of suffering from Type 2 diabetes. This is because lifestyle is characterized by
people’s behavior in their activities, interests, and intentions related to the self-image of each
individual in women with diabetes.
K = Self-efficacy relates to lifestyle modification which has a positive relationship with each
other. This is proven by people with diabetes who have self-efficacy which is consistent with
the experiences that they have experienced, better self-efficacy does not guarantee a good
lifestyle, while changes in lifestyle that are good enough do not reduce the understanding of
the concept of self-efficacy. The intention and lifestyle modification have a relationship with
each other in a positive way. This is proven by the individual having good intentions which
can be determined by the extent to which each individual has a positive attitude towards
certain behaviors that influence lifestyle modifications in women with type 2 diabetes.
S = It is expected that the health workers in the health center will routinely provide education
related to the modification of a healthy lifestyle which is suitable to patients with diabetes
that aims to increase self-efficacy and can increase the intention to make lifestyle
modifications, patients with diabetes can always attend counseling or related events regularly
in a series of management programs of diabetes mellitus and routine health control to
determine current health conditions, especially in increasing self-efficacy and good intentions
in lifestyle modification. Further researchers should expand the research in terms of other
factors that can influence how to familiarize themselves with the lifestyle modifications in
women with diabetes. Further research is needed related to factors that can influence the
lifestyle modification variables including factors from the respondent’s experience and
occupation.