H-type hypertension, defined in the study as hypertension accompanied by plasma homocysteine of at least 10 μmol/L, combines elevated blood pressure with hyperhomocysteinemia. The authors noted that the two abnormalities together are associated with a greater risk of stroke than either elevated blood pressure or homocysteine alone, while high homocysteine has also been linked with endothelial dysfunction, vascular oxidative stress, arterial stiffening, coronary artery disease, heart failure and the progression of chronic kidney disease. The findings concern a population for which sustained patient-led management may be particularly important, although the study did not test whether any self-management pattern reduced cardiovascular events or improved long-term blood-pressure control.

Participants were recruited by convenience sampling from the outpatient department and health-examination center of one tertiary hospital in Shandong Province between June and December 2024. Eligible adults were at least 18 years old, had H-type hypertension for at least six months and provided informed consent. Patients with secondary hypertension or serious conditions that could limit the exercise, dietary and monitoring behaviors assessed by the questionnaire were excluded, including New York Heart Association class III–IV heart failure, recent acute coronary syndrome, disabling residual stroke, advanced chronic kidney disease or dialysis, oxygen-dependent chronic obstructive pulmonary disease and active malignancy. Of 323 returned paper questionnaires, 13 were excluded for incomplete or patterned responses, leaving 310 complete cases for analysis.

The investigators assessed six dimensions of behavior with a 33-item hypertension self-management scale covering medication adherence, self-monitoring, diet, exercise, activity and rest, and emotion regulation. Mean scores for these dimensions ranged from 2.77 out of 5 for exercise management to 3.94 for medication adherence. The standardized overall self-management score was 67.34 ± 13.82 on a theoretical scale of 20 to 100, which the researchers categorized as moderate. That aggregate figure nevertheless combined patients with very different behavioral configurations. Latent profile analysis of the six dimension scores identified the four groups, with an entropy of 0.883 and average posterior probabilities ranging from 0.878 to 0.999. The profile labels describe multidimensional patterns and do not correspond directly to the scale’s low, moderate and high overall-score thresholds.

The largest group, the high self-management profile, accounted for 41.6% of the sample and had the highest scores across all six dimensions, although exercise remained a relative weakness. The low self-management group, representing 18.4%, had the lowest scores throughout and, in unadjusted comparisons, the lowest eHealth literacy, perceived social support and psychological resilience as well as the highest perceived stress. Patients in the moderate treatment-monitoring profile, 21.0% of the sample, scored relatively better on lifestyle behaviors but less well on medication adherence and self-monitoring. The lifestyle-focused moderate group, comprising 19.0%, retained comparatively stronger medication adherence and monitoring but had lower scores for exercise, activity and rest, and emotion regulation.

Multinomial logistic regression used the high self-management profile as its reference category and accounted for uncertainty in class assignment through the R3STEP method. Compared with patients without comorbidity, those with one or more of the included, relatively mild comorbidities had lower odds of belonging to the low self-management group, with an odds ratio of 0.067 and a 95% confidence interval of 0.005 to 0.889, and to the moderate treatment-monitoring group, with an odds ratio of 0.240 and a 95% confidence interval of 0.096 to 0.602. The association with the moderate lifestyle profile was not statistically significant. Because the study was cross-sectional and lacked measures of healthcare contact, treatment burden and health awareness, the authors could not determine why comorbidity showed this relationship.

Higher eHealth literacy was associated with a lower likelihood of membership in the moderate lifestyle profile rather than the high self-management group, with an odds ratio of 0.927 per additional point and a 95% confidence interval of 0.890 to 0.966. Perceived social support showed a similar association for both moderate groups: the odds ratios were 0.951 for the treatment-monitoring comparison and 0.942 for the lifestyle comparison, with respective 95% confidence intervals of 0.911 to 0.993 and 0.899 to 0.987. Its association with the low profile was not significant. Hypertension duration, hospital anxiety, occupation and medical-insurance type also failed to reach statistical significance in the final model. The null findings do not demonstrate that these distal social or structural factors are unimportant, particularly because the smallest group contained 57 participants and the model had about 7.1 events per parameter.

The results suggest that a single “moderate” average conceals clinically distinct needs. Patients in the treatment-monitoring profile may require support for taking medicines and recording relevant measures, whereas those in the lifestyle profile may have greater needs around exercise, rest and emotion regulation. The study did not measure the reasons for these weaknesses, and the authors cautioned that the treatment-monitoring label should not be interpreted as a validated H-type-specific phenotype: the instrument did not directly assess folic acid or B-vitamin use, dietary folate or homocysteine retesting. The findings therefore support further development and prospective evaluation of profile-sensitive strategies, but they do not show that tailoring care to a profile improves outcomes.

Several limitations constrain the interpretation and potential reach of the results. Recruitment from one hospital and the high proportion of participants using tertiary hospitals as their usual source of care mean the profiles may differ from those in primary care and rural communities. Excluding serious comorbidities likely produced a healthier sample than the wider H-type hypertension population, while self-reported behavior was vulnerable to recall and social-desirability bias. A single baseline blood-pressure reading could not establish sustained control, and data on medication regimens, treatment burden, objective adherence, renal function and longitudinal cardiovascular outcomes were unavailable. The profiles were not externally validated, their prognostic value remains unknown, and the sample was below the more conservative size of approximately 500 sometimes recommended for reliable class enumeration. Multicenter, community-based and longitudinal studies are therefore needed to test whether the four patterns persist, predict clinical endpoints and meaningfully guide individualized care.

Subject of Research: Latent profiles and associated factors in self-management behaviors among adults with H-type hypertension

Article Title: Self-management behaviors in patients with H-type hypertension: a latent profile analysis within the health ecological model

Article References: Ma, L., Liang, J., Fang, X., Yang, M., Zhang, H., Zhao, T., & Liu, T. (2026). Self-management behaviors in patients with H-type hypertension: a latent profile analysis within the health ecological model. Frontiers in Cardiovascular Medicine, 13, Article 1903891. https://doi.org/10.3389/fcvm.2026.1903891

Image Credits: AI Generated

DOI: 10.3389/fcvm.2026.1903891

Keywords: H-type hypertension, self-management, latent profile analysis, homocysteine, eHealth literacy, social support, health ecological model, cross-sectional study, patient behavior, hypertension, behaviors, patients

The study was led by Majed M. Aljabri, Alya Alghamdi, and Bandar S. Alharbi, researchers in the Community and Psychiatric Mental Health Nursing Department at the College of Nursing, King Saud University in Riyadh. The team recruited 413 adults with diabetes who were attending primary healthcare centers in the Saudi capital. Roughly one-third of the participants — 31.0 percent — had lived with diabetes for more than a decade, and just over a quarter, 26.9 percent, reported experiencing diabetes-related complications, a reminder that the cohort included many people for whom the stakes of good self-care were already painfully concrete. Ethical approval was obtained from the Research Ethics Committee of King Saud University, and the study was conducted in accordance with the principles of the Declaration of Helsinki, with informed consent from all participants.

To capture the psychological dimensions of the problem, the researchers deployed three well-established instruments. The 18-item Multidimensional Health Locus of Control Scale, or MHLC, breaks health-related beliefs into distinct components: Internal Health Locus of Control, reflecting confidence in one’s own agency; Powerful Others Health Locus of Control, reflecting reliance on healthcare professionals and other authority figures; and Chance or Fate Health Locus of Control, reflecting the sense that health outcomes are determined by luck or destiny. Illness perceptions were measured with the Brief Illness Perception Questionnaire, which probes how patients understand their condition — its consequences, its timeline, its controllability, and the emotional weight it carries. Self-care behavior was assessed with the Summary of Diabetes Self-Care Activities, a validated measure covering domains such as diet, exercise, blood glucose testing, foot care, and medication adherence.

The analytical strategy unfolded in two stages, each answering a different question. First, the team used multivariable linear regression to ask whether each locus-of-control dimension was associated with diabetes self-care after statistically adjusting for sociodemographic and clinical characteristics — a crucial step, because raw correlations between beliefs and behavior can easily be distorted by age, education, disease duration, or the presence of complications. Second, the researchers turned to structural equation modeling, a statistical framework that allows investigators to test hypothesized pathways linking variables simultaneously, including indirect effects that pass through an intermediate variable. Here, the intermediate variable was positive illness perception, and the question was whether locus of control influences self-care directly, or whether it works by first shaping how patients mentally frame their disease.

The regression results were striking in their asymmetry. Internal Health Locus of Control showed a positive association with diabetes self-care, with a standardized coefficient of 0.29 and a 95 percent confidence interval running from 0.11 to 0.47. Powerful Others Health Locus of Control was nearly identical in magnitude, with a coefficient of 0.28 and a confidence interval of 0.09 to 0.47. In plain terms, people who believed they controlled their own health, and people who trusted the power of their healthcare providers, both tended to report better self-care. The Chance and Fate dimension, by contrast, showed no significant direct association with self-care at all — a finding that might seem to suggest fatalism is irrelevant to diabetes management, until the structural equation modeling revealed otherwise.

That second stage of analysis is where the study becomes genuinely illuminating. Internal Health Locus of Control was strongly and positively associated with positive illness perceptions, with a coefficient of 0.620 and a p-value below 0.001. Positive illness perceptions, in turn, were strongly associated with better diabetes self-care, with a coefficient of 0.506, again at p below 0.001. When the researchers traced the indirect pathway — from internal control beliefs, through more constructive perceptions of the illness, to self-care behavior — the indirect effect was 0.314, with a confidence interval of 0.126 to 0.502 that excluded zero. In other words, a substantial share of the relationship between believing in one’s own agency and actually practicing good self-care appears to run through the way patients conceptualize their disease: how controllable they judge it to be, how serious they consider its consequences, and how coherent their understanding of it feels.

Perhaps the most unexpected result concerned the Chance and Fate dimension. Although fatalistic beliefs showed no direct link to self-care in the regression models, the structural equation model detected a significant indirect association: the pathway from Chance Health Locus of Control through positive illness perceptions to self-care carried a coefficient of 0.113, with a confidence interval of 0.025 to 0.201. This suggests that the relationship between fatalism and diabetes behavior is more nuanced than a simple negative correlation. The authors concluded that Internal and Chance dimensions of health locus of control are associated with self-care primarily through their relationships with illness perceptions, whereas the Powerful Others dimension showed a direct association with self-care behavior — implying that trust in clinicians may motivate action more immediately, without needing to first reshape how the patient views the disease.

The clinical implications of this pathway analysis are considerable. Diabetes self-care is the foundation of glycemic control and the primary defense against the long-term complications that make diabetes one of the world’s most burdensome chronic diseases — retinopathy, nephropathy, neuropathy, and cardiovascular disease among them. Yet self-care is notoriously difficult to change through education alone. If the Saudi findings generalize, interventions that target illness perceptions — for example, helping patients develop a more coherent and controllable mental model of their diabetes — could unlock self-care improvements that information-only programs fail to achieve. The results also hint that different patients may need different psychological levers: those with strong internal control beliefs might benefit most from perception-focused work, while those who defer heavily to their doctors may respond well to structured clinical support and clear, actionable guidance from trusted providers.

The study’s context matters as well. Saudi Arabia faces a substantial and growing diabetes burden, and primary healthcare centers in Riyadh serve a diverse population in which cultural and religious framings of health and destiny can shape how illness is understood. The cross-sectional design, however, imposes an important limitation: because beliefs, perceptions, and behaviors were all measured at a single point in time, the analysis cannot prove that locus of control causes illness perceptions, or that illness perceptions cause self-care. Reverse pathways — in which successful self-management fosters a stronger sense of control, for instance — remain plausible, and longitudinal or interventional studies will be needed to establish directionality. The authors also relied on self-report instruments, which are vulnerable to social desirability and recall bias, although all three scales are widely validated in diabetes research.

Even with those caveats, the research adds a compelling piece to the psychology of chronic disease management. It suggests that the mind’s model of an illness is not merely a passive reflection of medical facts but an active mechanism that converts belief into behavior. For the 413 adults in Riyadh who participated, and for the hundreds of millions of people worldwide living with diabetes, the message is that how you think about your disease — whether you see it as manageable, coherent, and within your influence — may matter almost as much as the medications in your cabinet. And for the clinicians treating them, the study argues that listening to how patients perceive their illness could be as clinically productive as prescribing the next dose.

Subject of Research: Health locus of control, illness perceptions, and diabetes self-care among adults with diabetes in Saudi Arabia

Article Title: Associations of health locus of control with diabetes self-care: the role of illness perceptions among adults with diabetes in Saudi Arabia

Article References: Aljabri, M. M., Alghamdi, A., & Alharbi, B. S. (2026). Associations of health locus of control with diabetes self-care: the role of illness perceptions among adults with diabetes in Saudi Arabia. BMC Endocrine Disorders. https://doi.org/10.1186/s12902-026-02567-6

Image Credits: AI Generated

DOI: 10.1186/s12902-026-02567-6

Keywords: diabetes, health locus of control, illness perceptions, diabetes self-care, self-management, health psychology, structural equation modeling, Saudi Arabia, primary health care, chronic disease, patient behavior, endocrinology