Socio-Ecological Determinants and Health Literacy: A Path Analysis of Self-Management Agency Among Patients With Diabetes Mellitus

This study aims to examine the relationships between socio-ecological determinants, health literacy, and self-management agency among patients with diabetes mellitus. Using a path analysis framework, the study investigates how multi-level socio-ecological factors and different dimensions of health literacy influence patients' capacity for diabetes self-management. Understanding these pathways will support the development of comprehensive, context-sensitive interventions to improve diabetes outcomes.

Inclusion Criteria: * \- Adults aged 18 years and older. * Diagnosed with type 1 or type 2 diabetes mellitus. * Receiving follow-up care in outpatient or primary healthcare settings. * Able to communicate verbally and provide informed consent. Exclusion Criteria: * \- Patients with severe cognitive impairment. * Patients with acute medical conditions preventing participation. * Pregnant women diagnosed with gestational diabetes.