title: Direct and indirect effects of neighborhood factors and self-care on glycemic control in adults with type 2 diabetes.
abstract: OBJECTIVE
  To determine whether neighborhood factors have direct or indirect effects, via self-care behaviors on glycemic control.
  
  
  METHODS
  Adult patients with type 2 diabetes were recruited from an academic medical center and Veterans Affairs Medical Center in the southeastern United States. Confirmatory factor analysis was used to create latent variables for neighborhood factors and diabetes self-care behavior. Structural equation modeling was used to test direct and indirect effects between neighborhood factors and glycemic control as assessed by HbA1c levels.
  
  
  RESULTS
  CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood aesthetics) and one latent variable diabetes self-care. We found that social support (β=0.28, z=4.86, p<0.001) and access to healthy foods (β=-0.17, z=-2.95, p=0.003) had direct effects on self-care; self-care (β=-0.15, z=-2.48, p=0.013) and neighborhood aesthetics (β=0.12, z=2.19, p=0.03) had direct effects on glycemic control; while social support (β=-0.04, z=-2.26, p=0.02) had an indirect effect on glycemic control via self-care.
  
  
  CONCLUSIONS
  This study showed that self-care behaviors and neighborhood aesthetics have direct effects on glycemic control, social support and access to health foods had direct effects on self-care, and social support had an indirect effect on glycemic control via self-care.
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 151-A Rutledge Ave., Charleston, SC, 29425, US; Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Ave, Room 280, MSC 593, Charleston, SC, 29425, US. Electronic address: Brittany.smalls@va.gov.
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, 151-A Rutledge Ave., Charleston, SC, 29425, US. Electronic address: gregoryc@musc.edu.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Gregory
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 151-A Rutledge Ave., Charleston, SC, 29425, US; Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Ave., MSC 960, Charleston, SC 29425, US. Electronic address: zollerjs@musc.edu.
authors.forename: James S
authors.initials: JS
authors.lastname: Zoller
authors.affiliation: Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Ave., MSC 960, Charleston, SC 29425, US; Division of General Internal Medicine Geriatrics, Department of Medicine, Medical University of South Carolina, 135 Rutledge Ave, RT 12th Floor, P.O. Box 250591 Charleston, SC 29425, US; Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, 109 Bee Street, Charleston, SC 29401, US. 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; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy / Q000523:psychology / Q000628:therapy*; D003927:Diet, Diabetic; D015444:Exercise; D005163:Factor Analysis, Statistical; D005523:Food Supply; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D008875:Middle Aged; D008960:Models, Psychological; D012111:Residence Characteristics; D012648:Self Care; D057566:Self Report; D012944:Social Support; D013022:South Carolina; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Community characteristics; Diabetes; Neighborhood factors; Self-care; Social determinants