This cross‑sectional study investigated associations among illness perception, resignation coping, social support, and self‑regulatory fatigue (SRF) in patients with Type 2 diabetes (T2DM). The primary focus was whether resignation coping and social support operate as indirect pathways linking patients' illness perceptions to SRF. The authors framed the investigation to identify cognitive, behavioural, and resource factors that together relate to SRF in adults living with T2DM.
The study used a convenience sample drawn from a tertiary general hospital in China. From November 2024 to October 2025, 302 adult patients with T2DM were recruited. Participants completed a battery of validated instruments: the Brief Illness Perception Questionnaire to assess illness perceptions, the Medical Coping Modes Questionnaire to measure coping styles (including resignation coping), the Perceived Social Support Scale to quantify social support, and the Self‑Regulatory Fatigue Scale to evaluate SRF.
Statistical procedures reported in the source included Spearman correlation analysis to examine bivariate associations and serial mediation analysis using the PROCESS Macro (Model 6) with bias‑corrected bootstrapping to test indirect effects. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross‑sectional studies.
Bivariate correlations revealed significant associations among the primary variables. Self‑regulatory fatigue showed a positive correlation with negative illness perception (Spearman r = 0.579, p < 0.01) and with resignation coping (r = 0.612, p < 0.01). Conversely, SRF was negatively correlated with social support (r = -0.598, p < 0.01). These correlations indicate that patients reporting more negative perceptions of their illness and greater use of resignation as a coping strategy also reported higher levels of SRF, while higher perceived social support was associated with lower SRF.
The authors applied a serial mediation model (PROCESS Model 6) to examine indirect pathways from illness perception to SRF through resignation coping and social support. The mediation analysis used bias‑corrected bootstrapping to estimate indirect effects. Results indicated that illness perception was associated with SRF via multiple indirect routes: resignation coping alone, social support alone, and a sequential pathway in which illness perception related to resignation coping which in turn related to social support, ultimately linking to SRF.
Figure 1 in the source displays the serial mediation model with standardized regression coefficients. All paths were adjusted for prespecified covariates: gender, age, educational level, diabetes duration, diabetes‑related complications, and other chronic comorbidities. Reported model R2 values were: Resignation coping = 0.467, Social support = 0.311, and Self‑Regulatory Fatigue = 0.565, indicating the proportion of variance explained by the predictors in each intermediate and outcome model.
Findings show a pattern in which negative illness perception is linked to greater self‑regulatory fatigue, and this relationship is partially explained by behavioural (resignation coping) and resource (social support) factors. The mediation results suggest that patients who hold more negative beliefs about their diabetes are more likely to use resignation coping and report lower social support, both of which are associated with higher SRF.
The authors emphasize clinical implications for nursing practice: integrated assessment and interventions that address patients' illness beliefs, reduce maladaptive coping such as resignation, and strengthen social support networks could be relevant strategies to mitigate SRF and support diabetes self‑management. These implications derive directly from the observed interrelated cognitive, behavioural, and social factors associated with SRF in this cross‑sectional sample.
The study conforms to STROBE reporting guidelines for cross‑sectional studies. Patient involvement was limited to serving as survey respondents; patients provided written informed consent prior to questionnaire completion and were not involved in study design, conduct, analysis, interpretation, or manuscript preparation. The authors declared no conflicts of interest.
Note on source details
The content above is drawn solely from the source abstract and accompanying figure legend. Specifics beyond those reported (for example, detailed demographic breakdowns, effect sizes for individual indirect paths, exact bootstrap confidence intervals, or questionnaire score distributions) were not reported in the provided source text and therefore are not included here.