TY - JOUR
T1 - Understanding the influence of psychological and socioeconomic factors on diabetes self-care using structured equation modeling
AU - Walker, Rebekah J.
AU - Gebregziabher, Mulugeta
AU - Martin-Harris, Bonnie
AU - Egede, Leonard E.
N1 - Funding Information:
This study was supported by Grant K24DK093699-01 from The National Institute of Diabetes and Digestive and Kidney Disease (PI: Leonard Egede).
Publisher Copyright:
© 2014 Elsevier Ireland Ltd.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Objective: To develop and test latent variables of the social determinants of health that influence diabetes self-care. Methods: 615 adults with type 2 diabetes were recruited from two adult primary care clinics in the southeastern United States. Confirmatory factor analyses (CFA) identified the latent factors underlying socioeconomic determinants, psychosocial determinants, and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling (SEM) investigated the relationship between determinants and self-care. Results: Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support and social status. The initial model (chi2(254). (388.04, p<. 0.001, RMSEA. (0.03, CFI. (0.98) showed that lower psychological distress (r (-0.13, p (0.019), higher social support (r (0.15, p (0.008), and higher self-efficacy (r (0.47, p<. 0.001) were significantly related to diabetes self-care. Social status was not significantly related to self-care (r (0.003, p (0.952). In the trimmed model (chi2(189). (211.40, p (0.126, RMSEA. (0.01, CFI. (0.99) lower psychological distress (r (-0.13, p (0.016), higher social support (r (0.15, p (0.007), and higher self-efficacy (r (0.47, p<. 0.001) remained significantly related to diabetes self-care. Conclusion: Based on theoretical relationships, three latent factors that measure social determinants of health (psychological distress, social support and self-efficacy) are strongly associated with diabetes self-care. Practice implications: This suggests that social determinants should be taken into account when developing patient self-care goals.
AB - Objective: To develop and test latent variables of the social determinants of health that influence diabetes self-care. Methods: 615 adults with type 2 diabetes were recruited from two adult primary care clinics in the southeastern United States. Confirmatory factor analyses (CFA) identified the latent factors underlying socioeconomic determinants, psychosocial determinants, and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling (SEM) investigated the relationship between determinants and self-care. Results: Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support and social status. The initial model (chi2(254). (388.04, p<. 0.001, RMSEA. (0.03, CFI. (0.98) showed that lower psychological distress (r (-0.13, p (0.019), higher social support (r (0.15, p (0.008), and higher self-efficacy (r (0.47, p<. 0.001) were significantly related to diabetes self-care. Social status was not significantly related to self-care (r (0.003, p (0.952). In the trimmed model (chi2(189). (211.40, p (0.126, RMSEA. (0.01, CFI. (0.99) lower psychological distress (r (-0.13, p (0.016), higher social support (r (0.15, p (0.007), and higher self-efficacy (r (0.47, p<. 0.001) remained significantly related to diabetes self-care. Conclusion: Based on theoretical relationships, three latent factors that measure social determinants of health (psychological distress, social support and self-efficacy) are strongly associated with diabetes self-care. Practice implications: This suggests that social determinants should be taken into account when developing patient self-care goals.
KW - Diabetes
KW - Psychosocial factors
KW - Self-care
KW - Social determinants
KW - Socioeconomic
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U2 - 10.1016/j.pec.2014.10.002
DO - 10.1016/j.pec.2014.10.002
M3 - Article
C2 - 25455793
AN - SCOPUS:84920031425
VL - 98
SP - 34
EP - 40
JO - Patient Education and Counseling
JF - Patient Education and Counseling
SN - 0738-3991
IS - 1
ER -
