The longitudinal association between chronic disease resource utilization and self-management behaviors in newly diagnosed type 2 diabetes patients: The mediating role of health literacy.

The aim of this study is to investigate the dynamic interaction among chronic disease resource utilization, health literacy, and self-management behaviors in individuals newly diagnosed with type 2 diabetes mellitus. This study was conducted from November 2022 to August 2024 using a longitudinal design. Participants were recruited via convenience sampling from the Department of Endocrinology, Nantong Sixth People's Hospital in Jiangsu Province. Eligible patients were those newly diagnosed with T2DM within 1 month. A total of 354 patients completed all 3 waves of the survey. Core variables, including chronic disease resource utilization, diabetes health literacy, and diabetes self-management behavior, were assessed at 3-time points: baseline (T1, approximately 7 days after enrollment), 3 months (T2), and 6 months (T3), using the Chronic Disease Resource Questionnaire, the Diabetes Health Literacy Scale, and the Diabetes Self-Management Behavior Scale, respectively. After controlling for covariates such as age, gender, and residential area, cross-lagged panel modeling and the Bootstrap method were employed to analyze longitudinal predictive relationships and mediation effects among the variables. Health literacy and self-management behavior showed reciprocal positive predictions across T1→T2 (β = 0.32, P < .01; β = 0.23, P = .016) and T2→T3 (β = 0.28, P = .003; β = 0.31, P < .001). Resource utilization significantly predicted improved health literacy at T1→T2 (β = 0.24, P < .01), but not at T2→T3 (β = 0.11, P = .108). During T1→T2, resource utilization indirectly enhanced self-management via health literacy (mediation effect β = 0.067, P = .008), accounting for 30.9% of the effect. A bidirectional promotive relationship exists between health literacy and self-management. The positive effect of resource utilization is most effective within the first 3 months post-diagnosis. During the initial phase (0-3 months post-diagnosis), efforts should focus on strengthening the integration and accessibility of resources such as community healthcare and digital health tools, aiming to rapidly improve patients' health literacy. After 3 months, the intervention emphasis should shift towards promoting the autonomous reinforcement and maintenance of self-management capabilities through methods such as behavioral feedback and goal setting, so as to achieve precision management.