title: Understanding the complex associations between patient-provider relationships, self-care behaviours, and health-related quality of life in type 2 diabetes: a structural equation modeling approach.
abstract: OBJECTIVE
  To assess associations between perceptions of the patient-provider relationship (PPR), BMI, and adherence to diet and exercise in a rural population with type 2 diabetes and determine how these variables relate to HRQL.
  
  
  METHODS
  A model of the hypothesized relationships between the constructs was proposed and tested using structural equation modeling (SEM) and data collected as part of a controlled study to improve care for individuals with type 2 diabetes in rural health regions.
  
  
  RESULTS
  In the final model, positive perceptions of the PPR had a direct impact on adherence to diet (beta = 0.23; p < 0.05), exercise (beta = 0.13; p < 0.05) and diabetes management attitudes (beta = 0.33; p < 0.05). The direct path from management attitudes to exercise was also significant (beta = 0.12; p < 0.05). Direct predictors of HRQL included management attitudes (beta = 0.16; p < 0.05), exercise adherence (beta = 0.14, p < 0.05) and BMI (beta = -0.23; p < 0.05). Exercise adherence predicted BMI, whereas adherence to diet did not. The final model had an acceptable fit with the measured data (chi2 = 30.6 (26, N = 372), p = 0.25; RMSEA = 0.02; TLI = 0.98; SRMR = 0.02).
  
  
  CONCLUSIONS
  Patient-provider relationship and exercise adherence appeared to be key constructs in the model. HRQL in people with type 2 diabetes was positively associated with exercise adherence, which was related to a positive PPR. Adherence to diet was also related to a positive PPR, but diet adherence had no association with HRQL.
authors.affiliation: Department of Public Health Sciences, University of Alberta, Edmonton, Canada.
authors.forename: Sheri L
authors.initials: SL
authors.lastname: Maddigan
authors.forename: Sumit R
authors.initials: SR
authors.lastname: Majumdar
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
mesh_terms: D000368:Aged; D000416:Alberta; D001294:Attitude to Health; D003710:Demography; D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy / Q000517:prevention & control / Q000523:psychology*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010349:Patient Compliance / Q000523:psychology*; D010817:Physician-Patient Relations; D011788:Quality of Life; D012424:Rural Population; D012648:Self Care / Q000523:psychology*; D012720:Severity of Illness Index; D018434:Sickness Impact Profile