Perceived severity and benefits show a preliminary conditional association with kidney-protective behaviors in type 2 diabetes with early kidney function decline: an exploratory health belief model analysis

Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease (CKD) and end-stage kidney disease, and early-stage CKD represents a critical window to slow progression through self-management behaviors. The Health Belief Model (HBM) posits that perceived severity, benefits, barriers, and self-efficacy shape health behaviors; however, whether these constructs operate independently or interact in adults with type 2 diabetes and early kidney function decline remains unclear. This cross-sectional study examined four selected HBM constructs—perceived severity, perceived benefits, perceived barriers, and self-efficacy—both individually and through their interaction, as predictors of self-reported kidney-protective health behaviors, assessed simultaneously via questionnaires, among 123 adults with type 2 diabetes and early-stage CKD or at high risk for CKD (eGFR 45–89 mL/min/1.73m2; G3a, n = 26; G2 without albuminuria confirmation, n = 97) at a tertiary hospital in Bangkok. The four HBM constructs did not independently predict behaviors (F = 2.161, p = 0.078). Simple slopes analysis revealed that perceived severity was significantly associated with health behaviors at high perceived benefits (+1 SD: slope = 0.187, p = 0.041) but not at low levels (−1 SD: p = 0.524). These preliminary, hypothesis-generating findings suggest a potential conditional association between perceived severity and perceived benefits; however, the interaction term did not reach statistical significance (p = 0.289). Educational strategies targeting both disease severity awareness and self-management benefits may warrant further investigation. Longitudinal and adequately powered studies are needed to confirm these interaction patterns and establish directionality.