Aim: The aim of this study was to examine a causal model of self-care agency by exploring the relationship between the structure of "body self-awareness" and the structure of the Instrument of Diabetes Self-Care Agency (IDSCA). Methods: The participants were 353 patients with diabetes. The internal consistency of the six items for body self-awareness was examined by calculating the factor structure using principal factor analysis and Cronbach's alpha. In order to examine the relationship between the seven factors in the IDSCA, a path analysis was conducted. Results: With regard to the factor structure, the factor loading of these five items was 0.511-0.743 (α = 0.739). In the path analysis, "body self-awareness" was influenced by the "ability to acquire knowledge" and had a direct effect (0.33) on the "motivation to self-manage", while "motivation to selfmanage" had an effect (−0.32) on the "ability to self-manage". The Goodness-of-Fit Index was 0.974. Conclusion: "Body self-awareness" plays a part in the self-care operation process and serves as an intermediary factor to enable the performance of self-care operations by making the most use of self-care agency. Moreover, striking a proper balance between self-management that is focused on the treatment of diabetes and a person's ability for self-management of diabetes was found to be important.

Objective: In the present study, outpatients with diabetes were encouraged to perform self-evaluation in order to clarify their responses on how they perceived self-care and the significance they attached to it. Methods: The approach of encouraging patients to perform self-evaluation was then qualitatively assessed. Five patients with diabetes performed the self-evaluation using a self-care evaluation scale displayed on a touch panel. All patients were then interviewed while referring to their responses. The study data were collected between June 2011 and April 2012 during outpatient visits scheduled once or twice a month. The data were analyzed using the total quality control method proposed by Jiro Kawakita (the "KJ Method"). Results: During their visits, the patients who performed the self-evaluation told the study investigators the following: 1) although they had tried to shut themselves off from the barriers posed by living with diabetes, they also seized opportunities to face them; (2) by recognizing their lack of self-confidence, they were motivated from their hesitation to take a step forward; (3) they had a willingness both to recognize the positive and negative aspects of living with diabetes and to adopt an objective view of self-care; and (4) they could communicate their needs and their own next step to medical personnel. Conclusions: The way that these patients with diabetes perceived self-care and the significance they attached to it changed according to daily occurrences, life events, and response to treatment. The self-evaluation was an important activity in promoting the patients' self-development and independence, suggesting that awareness, understanding, and support for self-evaluation of patients with diabetes and evaluation by supporting nurses can, in the context of the patient-nurse relationship, give rise to mutual responsibilities and put patients on the road to achieving self-care firmly grounded in self-awareness and independence.