Diabetes is becoming a severe health problem, especially in low- and middle-income countries such as Iran. This study aimed to investigate Investigating the Factors Affecting the self-care behaviors Status of Patients with Type II diabetes and the Role of Demographic Variables living in Kermanshah. Our study's findings showed that the self-care status of the studied patients was not in good condition in general, which is consistent with the results of other studies in this field [31-33]. In the studies of Anbari et al. , Sorani et al.  and Jordan et al.  reported low to moderate self-care of diabetic patients, which is consistent with the present study. The present study seems to have poor performance because patients in the diabetes center or health centers do not receive self-care guidance from the center and the doctor and nurses, and the media.
Among the self-care behaviors associated with diabetes, regular use of medications and diet were more common. They were due to the fear of diabetes and severe hyperglycemia, which is consistent with the results of the study of Anbari et al. , Nouhjah , and Vaezi et al. . One of the reasons that can be considered for patients' acceptable performance in the use of prescribed drugs is the patients' belief in the method of disease control. Most people believe that they have to take medicine to treat the disease while believing in making some lifestyle changes to overcome the disease when they get sick. For the reasons mentioned above, it is seen that the medication has been used at an acceptable level. However, personal blood sugar measurements were at the lowest level, consistent with the study of Anbari et al.  and Nouhjah . It should be noted that patients mentioned that not having a personal blood sugar measurement is not having a blood sugar testing device, and not using this device.
Self-care behaviors in diabetes are an essential and special need throughout life. People with diabetes need regular access to equipment such as a glucometer and blood glucose test strip to regularly measure blood sugar, despite the need for knowledge and skills in this area. It is seen that most patients with diabetes have an inability to pay the costs, lack of skills to measure blood sugar, and lack of education. Therefore, it is necessary to emphasize the intensity and seriousness of these behaviors and their possible consequences for the individual in educational programs, taking into account the above issues.
The findings showed that self-care performance lacked exercise, blood-glucose testing, foot care, and smoking status, which may be due to the difficulty of going to the laboratory or financial ability and insufficient skills to use the glomerulus. This finding is consistent with the results of a study by Vaezi et al.  that self-care performance in the areas of blood glucose monitoring and physical activity was low. In the study of Jordan et al. , the most insufficient self-care activity was in daily control of blood sugar and timely use of medication and regular physical activity, which was consistent with the present study.
According to this study's results, the average score of self-care in men, although higher than women, but this difference is not significant. In the study of Vaezi et al. , the results showed that self-care was more increased in men than women, which was consistent with the present study. While in the study of Shabibi et al.  and Farmer et al. , the self-care scores in female diabetic patients were significantly higher than in male patients, which was not consistent with the present study [32, 38].
According to Farmer et al. , female diabetic patients had significantly more self-care than diabetic men. However, men were expected to have lower self-care status due to less time devoted to self-care due to work, poor adherence to treatment, and more risky behaviors. In the study of Bai et al. , the self-care score in men was significantly higher than in women. The effect of gender difference on self-care ability can be affected by other variables such as knowledge level, physical-psychological, and behavioral status.
The age factor did not show a significant relationship with self-care behaviors. These findings were reported by Bukhsh et al. , Babazadeh et al. , Vaezi et al. , Hu et al.  were not aligned. It can be argued that aging reduces self-care for forgetfulness, inability, and further complications, thereby increasing the disease's severity.
In the present study, the mean scores of self-care behaviors in married patients were higher than in single patients. Still, this means the difference was significant, which may be due to the higher number of married people than a single in our study, which is consistent with Bukhsh et al.  Anbari et al.  in Iran. However, in the study of Vaezi et al. , Davari et al. , and Tal et al., it has been argued that married people face more self-care than single people because they have more social support and more knowledge.
There was no significant relationship between the levels of education of the subjects with self-care behaviors. However, people with higher levels of education had more self-care than other patients. This finding was not in line with the results of the study by Bukhsh et al. , Vaezi et al. , Hu et al. , Cassimatis et al. . Studies show that higher education patients have better judgment and decision-making ability to perform self-care behaviors . It can also be inferred that increasing education level by expanding the knowledge and knowledge of research units about their illness and self-care facilitates self-care . In other words, with increasing education and awareness of the complications of diabetes and understanding the severity of the problem, their attitude changed, and people became more concerned about self-care, which in turn will lead to the behavior in question . Thus, a high level of education facilitates the disease's self-care, while a low education level makes this process difficult.
In terms of job status, there was a significant difference between the mean score of self-care behaviors with the job so that the average self-care score of retirees was higher than others. This finding was constant with the results of the study of Babazadeh et al. , Bukhsh et al. , and Vaezi et al. . It can be argued that retirees enjoy economic support, including pensions, so they are more self-reliant.
In this study, monthly household income was not significant with self-care behaviors, which was not consistent with the study of Babazadeh et al. , Vaezi et al. , Hu et al. , and Davari et al. . The findings of Aghamalai et al.'s study  show that the most important reasons for not performing blood tests at home are the cost of blood sugar test kits and the patient's family's inability to provide the equipment. It can be debated that the high cost of treatment, testing, and drug shortages in society's current economic conditions causes many problems that prevent self-care behaviors.
The patients' scores were different from self-care behaviors according to location, and self-care scores of urban residents were significantly higher than rural residents, which is consistent with the findings of Anbari et al. The reason is probably the better and easier access of patients living in rural areas to medical care centers.
Self-care varied significantly depending on the type of treatment. The mean score of self-care in patients taking pills and insulin was higher than those treated with diet. In the study of Davari et al.  and Huisman et al. , self-care behaviors varied according to the type of treatment. This is the present study can be interpreted as that person taking pills or insulin, aware of the importance of taking medications or insulin to treat disease and lowering blood sugar, so for fear of chronic complications of diabetes to take pills or injections required insulin.
The duration of diabetes was significantly associated with patients' self-care behaviors. In other words, having diabetes for a long time, a person faces more obstacles, which can be due to old age, more complications, and other chronic diseases . The study by Bukhsh et al. , Vaezi et al. , and Babazadeh et al.  showed that with increasing duration of diabetes, patients gain more knowledge and skills in the field of self-care, and this leads to the promotion of these behaviors. However, in the study of Mohammadzadeh et al.  and Anbari et al. , there was no significant relationship between diabetes and self-care duration. Perhaps this discrepancy is the difference in the sex distribution of the present study groups with the before mentioned studies or researching different populations. There was no significant relationship between family history of diabetes and self-care behaviors, which is consistent with the study of Bukhsh et al..
In the present study, the status of diabetes did not show a significant relationship with self-care behaviors, which was in line with the study of Bigdeli et al. . In the present study, abdominal obesity did not show a significant relationship with self-care behaviors. On the other hand, 60% of patients had abdominal obesity, which may affect the self-care status of diabetic patients. It is usual for obese people because they do not follow their diet and do not have much physical activity; they are expected to have more inadequate self-care. These results were consistent with the study of Bigdeli et al. .
In this study, smoking was significant with self-care behaviors. This finding was not consistent with the study of Bukhsh et al. . Smoking is a risk factor for developing diabetes, and people with diabetes who smoke are at greater risk for kidney damage, cardiovascular disease, and other diabetes-related problems. These results indicate the need for further study and more appropriate education on smoking's side effects in diabetic patients.
In the present study, the findings showed that the type of treatment, smoking status, complications of diabetes, educational level, and place of residence predict 515% of the variance of self-care behaviors in patients with Type II diabetes. The strongest predictor of self-care behaviors is the variable type of treatment.
Patients seem to be looking for cost-effective and affordable treatments because of their experience with diabetes. Nouhjah  findings showed that the variables of how to see a doctor, level of education, life network, and duration of diabetes predict 23% of the variance in self-care behaviors of type II diabetic patients. In the present study, education was one of the predictors of self-care behaviors with which the results of several studies were consistent [39, 52, 53]. It can be argued that the best self-care practice in diabetic patients occurs when the patient has a high level of knowledge and awareness, and it is at this time that diabetes control improves. It seems that education in groups with lower literacy levels should be emphasized.