The mediating role of generative artificial intelligence acceptance in the relationship between diabetes self-management and health literacy among individuals with diabetic retinopathy

This descriptive study aimed to evaluate the mediating role of Generative Artificial Intelligence (GenAI) acceptance in the relationship between Health Literacy (HL) and Diabetes Mellitus (DM) self-management (DSM) among individuals with Diabetic Retinopathy (DR). The study was conducted between December 2024 and April 2025 with DR patients at Ankara Training and Research Hospital and the Altı Nokta Association of the Blind, following ethical and legal approvals. Data were collected using a Demographic Questionnaire, the Short Form of the Health Literacy Scale (HLS-SF12), the Type 2 Diabetes Self-Management Scale (T2DSMS), and the Generative Artificial Intelligence Acceptance Scale (GenAIAS). Analyses were performed using IBM SPSS 27 and Jamovi. For two-group comparisons, the independent samples t-test was used; for three or more groups, ANOVA or the Kruskal–Wallis H test was applied. Relationships between scales were assessed using Pearson's correlation coefficient. Mediation analysis employed Hayes' regression-based PROCESS macro to test indirect effects. The findings indicated that the acceptance level of generative AI among individuals with DR was above the mean (59.81 ± 21.26). A moderate positive correlation was found between HLS-SF12 and T2DSMS (r = 0.354, p <0.05), while a stronger positive correlation was observed between HLS-SF12 and GenAIAS (r = 0.530, p <0.05). T2DSMS and GenAIAS were also significantly and positively correlated (r = 0.384, p <0.05). Moreover, HL's effect on DSM was both direct and indirectly mediated through GenAI acceptance (p <0.05). Mediation analysis showed that HL influenced both GenAI acceptance and DSM, while GenAI acceptance affected both HL and DSM. Thus, GenAI acceptance partially mediated the effect of HL on DSM among individuals with DR. Although participants were aware of GenAI's potential, they require greater support to effectively apply it in managing their diabetes.