Background: Type 2 diabetes mellitus (DM) accounts for 90% to 95% of all diabetes cases. Complications of type 2 diabetes increase the risk of death for sufferers. Complications and deaths from type 2 diabetes can be prevented by changes in behavior. This study aimed to determine the effect of health centers and other factors on the prevention of tertiary diabetes type 2, using the theory of planned behavior and social cognitive theory. Subjects and Method: This was an analytic observational study with cross sectional design, conducted at 25 community health centers, in Bantul Regency, Yogyakarta, Indonesia. A sample of 200 type 2 DM patients was selected by exhaustive sampling. The dependent variable was type 2 DM tertiary prevention. The independent variables at level 1 are intention, attitude, subjective norm, perceived behavior control/ self-efficacy, experience, modelling, self-regulation, and outcome expectation. Community health center was an independent variable at level 2. The data were collected by questionnaire and analyzed by a multilevel multiple linear regression. Results: Tertiary preventive behavior in type 2 DM patients increased with strong intention (b= 1.19; 95% CI= 0.62 to 1.76; p <0.001), positive attitude (b= 1.19; 95% CI= 0.58 to 1.80; p <0.001), supportive subjective norm (b= 0.79; 95% CI= 0.12 to 1.45; p= 0.019), perceived behavior control (b= 1.16; 95% CI= 0.60 to 1.72; p <0.001), abundant experience (b= 0.65; 95% CI= 0.62 to 1.25; p<0.001), strong modelling (b= 1.07; 95% CI= 0.53 to 1.67; p= 0.030), strong self-regulation (b= 0.87; 95% CI= 0.34 to 1.40; p= 0.001), and positive outcome expectation (b= 0.82; 95% CI= 0.25 to 1.38; p = 0.004). Community health center had contextual effect on the tertiary preventive behavior in type 2 DM patients with ICC= 19.18%. Conclusion:Tertiary preventive behavior in type 2 DM patients increases with strong intention, positive attitude, supportive subjective norm, perceived behavior control, abundant experience, strong modelling, strong self-regulation, and positive outcome expectation. Community health center has contextual effect on the tertiary preventive behavior in type 2 DM patients.

Background: Global diabetes prevalence increases by 48%. Primary prevention is particularly important in type 2 diabetes, because the time of diagnosis and the severity of the disease course can be influenced beneficially by changing daily lifestyle and dietary practices. The purpose of this study was to examine the determinants of tertiary preventive behavior among patients with type 2 diabetes mellitus using theory of planned behavior, social cognitive theory, and path model. Subjects and Method: A cross sectional study was conducted at 25 community health centers in Bantul, Yogyakarta, Indonesia. A sample of 200 patients with type 2 DM was selected by exhaustive sampling. The dependent variable was tertiary preventive behavior toward type 2 DM. The independent variables were intention, attitude, self-efficacy, experience, modeling, self-regulation, outcome expectation, and subjective norm. The data were collected by questionnaire and analyzed by path analysis run on Stata 13. Results: Tertiary preventive behavior toward type 2 DM was directly increased by strong intention (b= 1.29; 95% CI= 0.48 to 2.10; p= 0.002), positive attitude (b= 2.06; 95% CI= 1.26 to 2.85; p<0.001), strong self-efficacy (b= 1.38; 95% CI= 0.59 to 2.18; p= 0.001), and strong modeling (b= 1.52; 95% CI= 0.66 to 2.37; p= 0.001). It was indirectly affected by good experience, self-regulation, positive outcome expectation, and supportive subjective norm. Conclusion: Tertiary preventive behavior toward type 2 DM was directly increased by strong intention, positive attitude, strong self-efficacy, and strong modeling. It was indirectly affected by good experience, self-regulation, positive outcome expectation, and supportive subjective norm. Keywords: tertiary preventive behavior, type 2 diabetes mellitus Correspondence: YudiAndriyaningtiyas. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: yudi.andriyaning-tiyas@gmail.com. Mobile: +6281392704899. DOI: https://doi.org/10.26911/the6thicph.02.55