Understanding the influence of psychological and socioeconomic factors on diabetes self-care using structured equation modeling

Abstract

ObjectiveTo develop and test latent variables of the social determinants of health that influence diabetes self-care. Methods615 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. ResultsLatent 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. ConclusionBased 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 implicationsThis suggests that social determinants should be taken into account when developing patient self-care goals.