DOI: https://doi.org/10.14710/nmjn.v16i1.73159

Path Analysis of Family Communication, Decision-Making, and Caregiver Burden on Family Caregivers’ Quality of Life: The Mediating Role of Self-Efficacy

*Setyoadi Setyoadi orcid scopus publons  -  Department of Nursing, Faculty of Health Sciences, Universitas Brawijaya, Indonesia
Dina Dewi Sartika Lestari Ismail orcid  -  Department of Nursing, Faculty of Health Sciences, Universitas Brawijaya, Indonesia
Yati Sri Hayati orcid  -  Department of Nursing, Faculty of Health Sciences, Universitas Brawijaya, Indonesia
Ferry Efendi orcid  -  Faculty of Nursing, Universitas Airlangga, Indonesia
Joni Haryanto orcid  -  Faculty of Nursing, Universitas Airlangga, Indonesia
Open Access Copyright (c) 2026 by the Authors, Published by Department of Nursing, Faculty of Medicine, Universitas Diponegoro
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

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Abstract

Background: Type 2 Diabetes Mellitus (T2DM) presents a chronic health challenge that extends beyond the patients, significantly affecting family members who assume caregiving responsibilities. Family caregivers often experience emotional, physical, and psychological burdens, particularly in low-resource settings. However, the interplay between family communication, decision-making, caregiver burden, and self-efficacy, and how these factors jointly influence caregiver quality of life, remains insufficiently explored, particularly in culturally specific and resource-limited settings.

Purpose: This study aimed to examine the structural relationships among family communication, shared decision-making, caregiver burden, self-efficacy, and their influence on the quality of life of family caregivers of individuals with T2DM.

Methods: A cross-sectional study was conducted involving 327 family caregivers recruited from 16 primary health centers using cluster random sampling. Data were collected using validated instruments to measure family communication, decision-making, caregiver burden, self-efficacy, and quality of life. Structural Equation Modeling (SEM) was used to analyze both direct and indirect relationships among the variables.

Results: The findings revealed that family communication (β = 0.35) and decision-making (β = 0.42) had significant positive effects on self-efficacy, whereas caregiver burden (β = -0.33) had a significant negative effect. Self-efficacy, in turn, significantly improved caregivers’ quality of life (β = 0.51). Furthermore, self-efficacy mediated the indirect effects of family communication, decision-making, and caregiver burden on quality of life. The model explained 49% of the variance in self-efficacy and 64% of the variance in caregiver quality of life.

Conclusion: Self-efficacy plays a central role in enhancing caregiver well-being and quality of life. Interventions that promote open family communication, shared decision-making, and burden reduction are essential. Nursing implications include the need for culturally sensitive, family-centered nursing interventions to enhance caregiver self-efficacy through communication training, psychosocial support, and empowerment in decision-making. Nurses should be equipped to assess caregiver burden and facilitate supportive family dynamics to promote sustainable diabetes care.

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Keywords: Caregiver burden; decision-making; family communication; quality of life; self-efficacy
Funding: Faculty of Health Sciences, Universitas Brawijaya, Malang, Indonesia

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