Understanding the Influence of Psychological and Socioeconomic Factors on Diabetes Self-care Using Structured Equation Modeling

Overview

Journal Patient Educ Couns

Publisher Elsevier

Specialties Health Services
Nursing

Date 2014 Dec 3

PMID 25455793

Citations 26

Authors

Rebekah J Walker

Mulugeta Gebregziabher

Bonnie Martin-Harris

Leonard E Egede

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Investigation of geographic disparities and temporal changes of non-gestational diabetes-related emergency department visits in Florida: a retrospective ecological study.

Khan M, Odoi A PeerJ. 2025; 13:e18897.

PMID: 39902319 PMC: 11789650. DOI: 10.7717/peerj.18897.

Association between major depressive disorder or depressive symptoms and the risk of vascular complications among patients with type 2 diabetes, and the mediating role of metabolic biomarkers: an analysis of the UK Biobank cohort.

Li G, Yu Y, Lin C, Zheng S, Tu H, Xu W EClinicalMedicine. 2024; 79:102982.

PMID: 39720611 PMC: 11665660. DOI: 10.1016/j.eclinm.2024.102982.

The Diabetes Remission in India (DiRemI) study: Protocol for a prospective matched-control trial.

Tripathi P, Kadam N, Tiwari D, Kathrikolly T, Vyawahare A, Sharma B PLoS One. 2024; 19(6):e0306394.

PMID: 38941311 PMC: 11213318. DOI: 10.1371/journal.pone.0306394.

The effect of socioeconomic status, depression, and diabetes symptoms severity on diabetes patient's life satisfaction in India.

Ranjan S, Thakur R Sci Rep. 2024; 14(1):12210.

PMID: 38806560 PMC: 11133318. DOI: 10.1038/s41598-024-62814-5.

Burden of type 2 diabetes mellitus and its risk factors in North Africa and the Middle East, 1990-2019: findings from the Global Burden of Disease study 2019.

Namazi N, Moghaddam S, Esmaeili S, Peimani M, Tehrani Y, Bandarian F BMC Public Health. 2024; 24(1):98.

PMID: 38183083 PMC: 10768242. DOI: 10.1186/s12889-023-16540-8.

References

Egede L, Ellis C . Development and psychometric properties of the 12-item diabetes fatalism scale. J Gen Intern Med. 2009; 25(1):61-6. PMC: 2811603. DOI: 10.1007/s11606-009-1168-5. View

Alam R, Sturt J, Lall R, Winkley K . An updated meta-analysis to assess the effectiveness of psychological interventions delivered by psychological specialists and generalist clinicians on glycaemic control and on psychological status. Patient Educ Couns. 2008; 75(1):25-36. DOI: 10.1016/j.pec.2008.08.026. View

Schreiber J . Core reporting practices in structural equation modeling. Res Social Adm Pharm. 2008; 4(2):83-97. DOI: 10.1016/j.sapharm.2007.04.003. View

Fisher L, Glasgow R, Mullan J, Skaff M, Polonsky W . Development of a brief diabetes distress screening instrument. Ann Fam Med. 2008; 6(3):246-52. PMC: 2384991. DOI: 10.1370/afm.842. View

Gilbody S, Richards D, Brealey S, Hewitt C . Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007; 22(11):1596-602. PMC: 2219806. DOI: 10.1007/s11606-007-0333-y. View

Wallston K, Rothman R, Cherrington A . Psychometric properties of the Perceived Diabetes Self-Management Scale (PDSMS). J Behav Med. 2007; 30(5):395-401. DOI: 10.1007/s10865-007-9110-y. View

Byrne B . Factor analytic models: viewing the structure of an assessment instrument from three perspectives. J Pers Assess. 2005; 85(1):17-32. DOI: 10.1207/s15327752jpa8501_02. View

Sigurdardottir A . Self-care in diabetes: model of factors affecting self-care. J Clin Nurs. 2005; 14(3):301-14. DOI: 10.1111/j.1365-2702.2004.01043.x. View

Sherbourne C, Stewart A . The MOS social support survey. Soc Sci Med. 1991; 32(6):705-14. DOI: 10.1016/0277-9536(91)90150-b. View

10.

Morisky D, Green L, Levine D . Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986; 24(1):67-74. DOI: 10.1097/00005650-198601000-00007. View

11.

Brown A, Ettner S, Piette J, Weinberger M, Gregg E, Shapiro M . Socioeconomic position and health among persons with diabetes mellitus: a conceptual framework and review of the literature. Epidemiol Rev. 2004; 26:63-77. DOI: 10.1093/epirev/mxh002. View

12.

Ismail K, Winkley K, Rabe-Hesketh S . Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. Lancet. 2004; 363(9421):1589-97. DOI: 10.1016/S0140-6736(04)16202-8. View

13.

Kessler R, Andrews G, Colpe L, Hiripi E, Mroczek D, Normand S . Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002; 32(6):959-76. DOI: 10.1017/s0033291702006074. View

14.

Bollen K . Latent variables in psychology and the social sciences. Annu Rev Psychol. 2001; 53:605-34. DOI: 10.1146/annurev.psych.53.100901.135239. View

15.

Kroenke K, Spitzer R, Williams J . The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9):606-13. PMC: 1495268. DOI: 10.1046/j.1525-1497.2001.016009606.x. View

16.

Delamater A, Jacobson A, Anderson B, Cox D, Fisher L, Lustman P . Psychosocial therapies in diabetes: report of the Psychosocial Therapies Working Group. Diabetes Care. 2001; 24(7):1286-92. DOI: 10.2337/diacare.24.7.1286. View

17.

Toobert D, Hampson S, Glasgow R . The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000; 23(7):943-50. DOI: 10.2337/diacare.23.7.943. View

18.

Egede L, Ellis C . Diabetes and depression: global perspectives. Diabetes Res Clin Pract. 2010; 87(3):302-12. DOI: 10.1016/j.diabres.2010.01.024. View

19.

Tahmasebi R, Noroozi A, Tavafian S . Determinants of self-management among diabetic patients: a path analysis. Asia Pac J Public Health. 2013; 27(2):NP524-34. DOI: 10.1177/1010539513475652. View

20.

Walker R, Smalls B, Campbell J, Williams J, Egede L . Impact of social determinants of health on outcomes for type 2 diabetes: a systematic review. Endocrine. 2014; 47(1):29-48. PMC: 7029167. DOI: 10.1007/s12020-014-0195-0. View