Cognitive and Behavioral Transformation in Type 2 Diabetes Through a Self-Efficacy-Focused Structured Education Program: A Descriptive Qualitative Study

Xinjun Jiang,1 Hua Jiang,2 Rongsong Tang,3 Mingzi Li2 1School of Nursing, Hainan Medical University, Haikou, Hainan, People’s Republic of China; 2School of Nursing, Peking University, Beijing, People’s Republic of China; 3Department of Endocrinology, Peking University Third Hospital, Beijing, People’s Republic of ChinaCorrespondence: Mingzi Li, School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, People’s Republic of China, Email [email protected]: To explore how adults with type 2 diabetes perceived and sustained self-management 12 months after completing a Self-Efficacy-Focused Structured Education Program (SSEP).Methods: A descriptive qualitative design was employed. Seventeen participants from a multicenter randomized controlled trial in China completed in-depth, semi-structured interviews. Data were analyzed using Braun and Clarke’s reflexive thematic analysis with NVivo 11.Results: Five researcher-constructed themes were identified: (1) restructuring of diabetes cognition, (2) enhancement of self-efficacy, (3) reshaping of mindset through learning, (4) reconstruction and internalization of behaviors, and (5) factors influencing behavioral persistence. Participants experienced a cognitive-behavioral transformation in which reflective learning facilitated sustained behavioral change.Conclusion: The findings reveal a dual-process mechanism: reflective System 2 learning evolved into automatic System 1 habits supported by heuristic tools. Integrating contextual cues, visual prompts, and mobile-based nudges into future SSEP delivery may enhance habit formation and long-term adherence. Combining reflective training with ongoing family and community support could further strengthen diabetes self-management behaviors sustainability.Keywords: type 2 diabetes mellitus, self-efficacy-focused structured education, self-management behaviors, cognitive restructuring, dual-process perspective, qualitative research