title: Understanding the influence of psychological and socioeconomic factors on diabetes self-care using structured equation modeling.
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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  This suggests that social determinants should be taken into account when developing patient self-care goals.
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA; Department of Health Science and Research, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: Walker
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Division of Public Health Sciences, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Gebregziabher
authors.affiliation: Department of Health Science and Research, Medical University of South Carolina, Charleston, SC, USA; Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Martin-Harris
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: egedel@musc.edu.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D015444:Exercise / Q000523:psychology; D005163:Factor Analysis, Statistical; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D012648:Self Care / Q000523:psychology*; D020377:Self Efficacy; D064890:Social Determinants of Health; D012931:Social Environment; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D014481:United States; D055815:Young Adult
keywords: Diabetes; Psychosocial factors; Self-care; Social determinants; Socioeconomic