TY - JOUR
T1 - Quantifying direct effects of social determinants of health on glycemic control in adults with type 2 diabetes
AU - Walker, Rebekah J.
AU - Gebregziabher, Mulugeta
AU - Martin-Harris, Bonnie
AU - Egede, Leonard E.
N1 - Publisher Copyright:
© Copyright 2015, Mary Ann Liebert, Inc. 2015.
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Background: The aim of this study was to investigate if self-care is the pathway through which social determinants of health impact diabetes outcomes by analyzing the direct and indirect effects of socioeconomic and psychosocial factors on self-care and glycemic control. Subjects and Methods: Six hundred fifteen adults were recruited from two primary care clinics in the southeastern United States. A series of confirmatory factor analyses identified the latent factors underlying social status, psychosocial determinants (psychological distress, self-efficacy, and social support), and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling investigated the relationship among social determinants, self-care and glycemic control. Results: Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support, and social status. The final model [χ2(275)=450.07, P<0.001, R2=99, root mean square error of approximation=0.03, comparative fit index=0.98] showed lower psychological distress (r=-0.13, P=0.012), higher social support (r=0.14, P=0.01), and higher self-efficacy (r=0.47, P<0.001) were significantly related to diabetes self-care. Lower psychological distress (r=0.10, P=0.03), lower social support (r=0.10, P=0.02), and higher self-efficacy (r=-0.37, P<0.001) were significantly related to lower glycemic control. When social determinants of health variables were included in the model, self-care was no longer significantly associated with glycemic control (r=0.01, P=0.83). Conclusions: This study suggests a direct relationship between psychosocial determinants of health and glycemic control. Although associated with self-care, the relationship between social determinants of health and glycemic control is not mediated by self-care. Development of interventions should take psychosocial factors into account as independent influences on diabetes outcomes, rather than as indirect influences via self-care behavior.
AB - Background: The aim of this study was to investigate if self-care is the pathway through which social determinants of health impact diabetes outcomes by analyzing the direct and indirect effects of socioeconomic and psychosocial factors on self-care and glycemic control. Subjects and Methods: Six hundred fifteen adults were recruited from two primary care clinics in the southeastern United States. A series of confirmatory factor analyses identified the latent factors underlying social status, psychosocial determinants (psychological distress, self-efficacy, and social support), and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling investigated the relationship among social determinants, self-care and glycemic control. Results: Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support, and social status. The final model [χ2(275)=450.07, P<0.001, R2=99, root mean square error of approximation=0.03, comparative fit index=0.98] showed lower psychological distress (r=-0.13, P=0.012), higher social support (r=0.14, P=0.01), and higher self-efficacy (r=0.47, P<0.001) were significantly related to diabetes self-care. Lower psychological distress (r=0.10, P=0.03), lower social support (r=0.10, P=0.02), and higher self-efficacy (r=-0.37, P<0.001) were significantly related to lower glycemic control. When social determinants of health variables were included in the model, self-care was no longer significantly associated with glycemic control (r=0.01, P=0.83). Conclusions: This study suggests a direct relationship between psychosocial determinants of health and glycemic control. Although associated with self-care, the relationship between social determinants of health and glycemic control is not mediated by self-care. Development of interventions should take psychosocial factors into account as independent influences on diabetes outcomes, rather than as indirect influences via self-care behavior.
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U2 - 10.1089/dia.2014.0166
DO - 10.1089/dia.2014.0166
M3 - Article
C2 - 25361382
AN - SCOPUS:84922453988
SN - 1520-9156
VL - 17
SP - 80
EP - 87
JO - Diabetes Technology and Therapeutics
JF - Diabetes Technology and Therapeutics
IS - 2
ER -