Direct and indirect effects of stress, health literacy, social media use, and
self-efficacy on diabetes prevention behaviors in youth: A path analysis
Dublin Core
Title
Direct and indirect effects of stress, health literacy, social media use, and
self-efficacy on diabetes prevention behaviors in youth: A path analysis
self-efficacy on diabetes prevention behaviors in youth: A path analysis
Subject
Health literacy; prevention behavior; self-efficacy; social media;
stress type 2 diabetes mellitus; youth
stress type 2 diabetes mellitus; youth
Description
Background: Type 2 diabetes mellitus (T2DM) is increasingly affecting
youth, particularly in low- and middle-income countries like Indonesia.
Psychosocial and informational factors such as stress, health literacy, self-
efficacy, and social media exposure may influence diabetes prevention
behaviour. However, the interrelationships among these variables remain
understudied.
Purpose: This study aimed to assess the direct and indirect effects of stress,
T2DM knowledge, health literacy, self-efficacy, social media exposure, and
nutritional status on diabetes prevention behaviour among Indonesian
university students using path analysis.
Methods: A cross-sectional study was conducted among 380 undergraduate
students aged 18–25 years at Universitas Indonesia Maju, Jakarta. Diabetes
prevention behavior was measured using the Diabetes Prevention Behavior
Questionnaire (DPBQ). Validated instruments assessed perceived stress
(PSS-10), diabetes knowledge (modified DKQ-24), social media exposure
to health information, health literacy (HLQ subscales 1, 2, 3, 5), and general
self-efficacy (GSES). Body Mass Index (BMI) was calculated from self-
reported height and weight. Path analysis evaluated direct and indirect
effects and indirect effects were tested via bootstrapping (5,000 resamples).
Results: Participants reported moderately high engagement in T2DM
prevention behaviors (M = 3.72, SD = 0.46). The final model showed good
fit to the data. T2DM prevention behavior was positively predicted by self-
efficacy (β = 0.31, p < 0.001), health literacy (β = 0.25, p = 0.001), social
media exposure (β = 0.21, p = 0.008), and diabetes knowledge (β = 0.18, p
= 0.015), and negatively predicted by perceived stress (β = −0.23, p = 0.002)
and BMI (β = −0.12, p = 0.031). Self-efficacy mediated the relationship
between stress and prevention behavior (indirect β = −0.08, p = 0.012),
while health literacy mediated the effects of diabetes knowledge (indirect β
= 0.10, p = 0.046) and social media exposure (indirect β = 0.07, p = 0.046)
on prevention behavior.
Conclusion: Diabetes prevention behaviors in Indonesian youth are
shaped by an interrelated network of psychosocial and digital factors. Self-
efficacy and health literacy play central mediating roles, suggesting that
future interventions should combine psychological empowerment, health
literacy enhancement, and strategic use of social media to strengthen T2DM
prevention in young populations. Longitudinal research is needed to confirm
causal pathways.
youth, particularly in low- and middle-income countries like Indonesia.
Psychosocial and informational factors such as stress, health literacy, self-
efficacy, and social media exposure may influence diabetes prevention
behaviour. However, the interrelationships among these variables remain
understudied.
Purpose: This study aimed to assess the direct and indirect effects of stress,
T2DM knowledge, health literacy, self-efficacy, social media exposure, and
nutritional status on diabetes prevention behaviour among Indonesian
university students using path analysis.
Methods: A cross-sectional study was conducted among 380 undergraduate
students aged 18–25 years at Universitas Indonesia Maju, Jakarta. Diabetes
prevention behavior was measured using the Diabetes Prevention Behavior
Questionnaire (DPBQ). Validated instruments assessed perceived stress
(PSS-10), diabetes knowledge (modified DKQ-24), social media exposure
to health information, health literacy (HLQ subscales 1, 2, 3, 5), and general
self-efficacy (GSES). Body Mass Index (BMI) was calculated from self-
reported height and weight. Path analysis evaluated direct and indirect
effects and indirect effects were tested via bootstrapping (5,000 resamples).
Results: Participants reported moderately high engagement in T2DM
prevention behaviors (M = 3.72, SD = 0.46). The final model showed good
fit to the data. T2DM prevention behavior was positively predicted by self-
efficacy (β = 0.31, p < 0.001), health literacy (β = 0.25, p = 0.001), social
media exposure (β = 0.21, p = 0.008), and diabetes knowledge (β = 0.18, p
= 0.015), and negatively predicted by perceived stress (β = −0.23, p = 0.002)
and BMI (β = −0.12, p = 0.031). Self-efficacy mediated the relationship
between stress and prevention behavior (indirect β = −0.08, p = 0.012),
while health literacy mediated the effects of diabetes knowledge (indirect β
= 0.10, p = 0.046) and social media exposure (indirect β = 0.07, p = 0.046)
on prevention behavior.
Conclusion: Diabetes prevention behaviors in Indonesian youth are
shaped by an interrelated network of psychosocial and digital factors. Self-
efficacy and health literacy play central mediating roles, suggesting that
future interventions should combine psychological empowerment, health
literacy enhancement, and strategic use of social media to strengthen T2DM
prevention in young populations. Longitudinal research is needed to confirm
causal pathways.
Creator
Nina Nina1* , Achmad Lukman Hakim1 , Hidayani Hindayani1 , Tukimin
Bin Sansuwito2
Bin Sansuwito2
Source
http://jkp.fkep.unpad.ac.id/index.
php/jkp
php/jkp
Date
December 20, 2025
Contributor
peri irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Nina Nina1* , Achmad Lukman Hakim1 , Hidayani Hindayani1 , Tukimin
Bin Sansuwito2, “Direct and indirect effects of stress, health literacy, social media use, and
self-efficacy on diabetes prevention behaviors in youth: A path analysis,” Repository Horizon University Indonesia, accessed February 12, 2026, https://repository.horizon.ac.id/items/show/10832.
self-efficacy on diabetes prevention behaviors in youth: A path analysis,” Repository Horizon University Indonesia, accessed February 12, 2026, https://repository.horizon.ac.id/items/show/10832.