title: Effect of neighborhood factors on diabetes self-care behaviors in adults with type 2 diabetes.
abstract: OBJECTIVE
  The objective of this study was to identify latent variables for neighborhood factors and diabetes self-care and examine the effect of neighborhood factors on diabetes self-care in adults with type 2 diabetes.
  
  
  METHODS
  615 subjects were recruited from an academic medical center and a Veterans affairs medical center in the southeastern United States. Validated scales were used to assess neighborhood factors and diabetes-related self-care. Confirmatory factor analysis (CFA) was used to determine the latent constructs. Structural equation modeling (SEM) was then used to assess the relationship between neighborhood factors and diabetes self-care.
  
  
  RESULTS
  Based on a theoretical framework, CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood esthetics) and one latent variable diabetes self-care (including diet, exercise, foot care, blood sugar testing and medication adherence). SEM showed that social support (r=0.28, p<0.001) and access to healthy foods (r=-0.16, p=0.003) were significantly associated with self-care behaviors, while neighborhood violence (r=-0.06, p<0.001) and esthetics (r=-0.07, p=0.278) were not χ(2) (180, N=611)=192, p=0.26, RMSEA=0.01, CFI=0.999). In the final trimmed model, social support (r=0.31, p<0.001) and access to healthy foods (r=-0.20, p<0.001) remained significantly associated with self-care behaviors χ(2) (76, N=611)=60, p=0.91, RMSEA=0.00, CFI=1.0).
  
  
  CONCLUSIONS
  This study developed latent factors for neighborhood characteristics and diabetes self-care and found that social support and access to healthy foods were significantly associated with diabetes self-care and should be considered as targets for future interventions.
authors.affiliation: Center for Health Organization and Implementation Research (CHOIR), eHealth Quality Enhancement Research Initiative (QUERI), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.
authors.forename: Brittany L
authors.initials: BL
authors.lastname: Smalls
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Gregory
authors.affiliation: Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States.
authors.forename: James S
authors.initials: JS
authors.lastname: Zoller
authors.affiliation: Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, United States; Division of General Internal Medicine and Geriatrics, Department of Medicien, Medical University of South Carolina, Charleston, SC, United States; Health Equity and Rural Research Innovation Center (HEROIC), Charleston VA HSR&D COIN, Charleston, SC, United States. 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 / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000523:psychology; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D012111:Residence Characteristics; D012648:Self Care / Q000379:methods*; D012944:Social Support; D014481:United States; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D007004:Hypoglycemic Agents
keywords: Diabetes; Diabetes outcomes; Neighborhood/community; Self-care behaviors; Social determinants