Workplace culture of health and self-management behaviours among employees with type 2 diabetes: a cross-sectional moderated mediation study in urban China.

OBJECTIVES: To examine (1) the mediating roles of self-efficacy and future-oriented time perspective (FTP) in the association between workplace culture of health (COH) and diabetes self-management and (2) the moderating effect of diabetes distress on the relationship between self-efficacy and FTP among employees with type 2 diabetes mellitus (T2DM). DESIGN: A cross-sectional survey. SETTING: This study was conducted among employees with T2DM recruited from the Endocrinology Outpatient Departments at three tertiary hospitals in Taiyuan City, Shanxi Province, China, between March and October 2024. PARTICIPANTS: The participants were 462 employees with T2DM who had been employed at their current organisations for at least 3 months following their T2DM diagnosis. METHODS: Data on demographics, diabetes-related and work-related factors, workplace COH, self-efficacy, time perspective, diabetes distress and self-management performance were collected via a survey. The moderated mediation effects were examined using Hayes's PROCESS macro. RESULTS: Workplace COH was associated with diabetes self-management both directly (β=0.251, 95% CI 0.080 to 0.422, p<0.01) and indirectly (indirect effect=0.303, 95% CI 0.190 to 0.419). Two significant indirect pathways were identified: (1) workplace COH → self-efficacy → diabetes self-management (indirect effect=0.207, 95% CI 0.110 to 0.308); (2) workplace COH → self-efficacy → FTP → diabetes self-management (indirect effect=0.093, 95% CI 0.051 to 0.144). However, the indirect pathway: workplace COH → FTP → diabetes self-management was not significant (indirect effect=0.004, 95% CI -0.055 to 0.063). Additionally, a significant interaction (β=-0.356, 95% CI -0.566 to -0.146, p<0.01) indicated that diabetes distress moderated the relationship between self-efficacy and FTP. CONCLUSION: This study demonstrated that workplace COH was associated with diabetes self-management both directly and indirectly, specifically through self-efficacy alone and serially through self-efficacy and FTP; it also confirmed that diabetes distress weakens the effect of self-efficacy on FTP, thereby providing a basis for developing interventions to improve self-management among employees with T2DM.