The mediating/moderating role of cultural context factors on self-care practices among those living with diabetes in rural Appalachia

Nancy E. Schoenberg,Brittany L. Smalls,Ellen Combs,Adebola Adegboyega,Lovoria B. Williams,Md. Tofial Azam,Matthew Rutledge,Felipe De La Barra,Philip M. Westgate

doi:10.1186/s12889-021-11777-7

Abstract

BackgroundThe aim of this study was to examine whether cultural factors, such as religiosity and social support, mediate/moderate the relationship between personal/psychosocial factors and T2DM self-care in a rural Appalachian community.MethodsRegression models were utilized to assess for mediation and moderation. Multilevel linear mixed effects models and GEE-type logistic regression models were fit for continuous (social support, self-care) and binary (religiosity) outcomes, respectively.ResultsThe results indicated that cultural context factors (religiosity and social support) can mediate/moderate the relationship between psychosocial factors and T2DM self-care. Specifically, after adjusting for demographic variables, the findings suggested that social support may moderate the effect of depressive symptoms and stress on self-care. Religiosity may moderate the effect of distress on self-care, and empowerment was a predictor of self-care but was not mediated/moderated by the assessed cultural context factors. When considering health status, religiosity was a moderately significant predictor of self-care and may mediate the relationship between perceived health status and T2DM self-care.ConclusionsThis study represents the first known research to examine cultural assets and diabetes self-care practices among a community-based sample of Appalachian adults. We echo calls to increase the evidence on social support and religiosity and other contextual factors among this highly affected population.Trial registrationUS National Library of Science identifier NCT03474731. Registered March 23, 2018, www.clinicaltrials.gov.

Highlights

The aim of this study was to examine whether cultural factors, such as religiosity and social support, mediate/moderate the relationship between personal/psychosocial factors and Type 2 diabetes mellitus (T2DM) self-care in a rural Appalachian community
Conceptual model In this paper, we present an analysis to determine if cultural context factors mediate/ moderate the relationship between psychosocial factors and T2DM self-care practices
Summary of key findings In summary, the results indicated that cultural context factors can mediate/moderate the relationship between psychosocial factors and T2DM self-care

Summary

Introduction

The aim of this study was to examine whether cultural factors, such as religiosity and social support, mediate/moderate the relationship between personal/psychosocial factors and T2DM self-care in a rural Appalachian community. Rural Appalachians are disproportionately likely to experience factors that predispose them to the development of T2DM, such as higher levels of stress, obesity, food insecurity, as well as low levels of health literacy and limited access to health services [3, 4]. In addition to these predisposing factors, rural dwellers are exposed to challenging socialenvironment factors, including high rates of poverty and sparse community and medical services, that may complicate the management of T2DM. To attain optimal health outcomes, persons with diabetes must attend multiple physician visits per year; adhere to several different types of medications; engage in many facets of self-care, including home glucose monitoring, healthy eating, and exercise; and negotiate barriers to management, such as cost of care while balancing work and life commitments [5]

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