Associations of health locus of control with diabetes self-care: the role of illness perceptions among adults with diabetes in Saudi Arabia

Diabetes self-care is essential for achieving optimal glycemic control and preventing long-term complications. Health locus of control has been identified as an important determinant of health-related behaviors; however, the relationships between different control beliefs, illness perceptions, and diabetes self-care remain insufficiently understood. This study examined the associations between multidimensional health locus of control and diabetes self-care and investigated the potential role of illness perceptions in these relationships among adults with diabetes in Saudi Arabia. We used a cross-sectional study among 413 adults with diabetes attending primary healthcare centers in Riyadh, Saudi Arabia. Participants completed the 18-item Multidimensional Health Locus of Control Scale (MHLC; the Brief Illness Perception Questionnaire (Brief-IPQ), assessing multiple illness-perception domains; and the Summary of Diabetes Self-Care Activities (SDSCA. We used a multivariable linear regression to examine associations between health locus of control dimensions and diabetes self-care while adjusting for sociodemographic and clinical characteristics. Structural equation modeling was subsequently performed to evaluate the direct and indirect associations of health locus of control dimensions with diabetes self-care through positive illness perceptions. Among 413 participants, approximately one-third (31.0%) had lived with diabetes for more than 10 years, and 26.9% reported diabetes-related complications. In adjusted multivariable linear regression analyses, Internal Health Locus of Control (β = 0.29, 95% CI: 0.11 to 0.47) and Powerful Others Health Locus of Control (β = 0.28, 95% CI: 0.09 to 0.47) were positively associated with diabetes self-care, whereas Chance/Fate Health Locus of Control was not associated with self-care. Internal Health Locus of Control was positively associated with positive illness perceptions (β = 0.620, p < 0.001), and Positive Illness Perceptions were positively associated with diabetes self-care (β = 0.506, p < 0.001). Significant indirect associations with diabetes self-care were observed for Internal Health Locus of Control (β = 0.314, 95% CI: 0.126–0.502) and Chance/Fate Health Locus of Control (β = 0.113, 95% CI: 0.025–0.201) through Positive Illness Perceptions. Health locus of control dimensions were differentially associated with diabetes self-care among adults with diabetes. Internal Health Locus of Control and Chance/Fate Health Locus of Control were associated with diabetes self-care primarily through their relationships with illness perceptions, whereas Powerful Others Health Locus of Control showed a direct association with self-care behaviors. Not applicable.