title: Validation of theoretical pathway between discrimination, diabetes self-care and glycemic control.
abstract: This study examined the mechanisms through which discrimination influences diabetes self-care and glycemic control in patients with diabetes by using structured equation modeling.
  
  
  
  615 patients were recruited from two adult primary care clinics in the southeastern United States. Measures were based on a theoretical model and included perceived discrimination, social support, social cohesion, and perceived stress. Structured equation modeling examined the relationship with diabetes self-care and glycemic control.
  
  
  
  The final model (chi2(211)=328.82, p<0.0001, R(2)=0.99, RMSEA=0.03 and CFI=0.98) shows that higher stress is directly significantly related to a decreased self-care (r=-0.59, p <0.001) and increased HbA1c (r=0.27, p<0.05). There was no significant direct association between discrimination, social support or social cohesion, and glycemic control or self-care. There was, however, a direct significant association between increased discrimination (r=0.46, p<0.001), decreased social support (r=-0.34, p<0.001), increased social cohesion (r=0.14, p<0.05) and increased stress.
  
  
  
  These results support the hypothesized pathway of discrimination on health outcomes, showing both a direct and indirect influence through stress on HbA1c in adults with diabetes. Understanding the pathways through which discrimination influences diabetes outcomes is important for providing more comprehensive and effective care. These results suggest future interventions targeting patients with diabetes should take discrimination-induced stress into account.
authors.affiliation: Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA. Electronic address: dawson@musc.edu.
authors.forename: Aprill Z
authors.initials: AZ
authors.lastname: Dawson
authors.affiliation: Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC, USA. Electronic address: walkerrj@musc.edu.
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: Walker
authors.affiliation: Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA. Electronic address: campbja@musc.edu.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Campbell
authors.affiliation: Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, 109 Bee Street, Charleston, SC, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, USA. Electronic address: egedel@musc.edu.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000523:psychology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology / Q000628:therapy*; D004192:Discrimination, Psychological; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010349:Patient Compliance / Q000523:psychology; D011320:Primary Health Care; D012648:Self Care / Q000523:psychology; D057566:Self Report; D012944:Social Support; D013022:South Carolina; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control / Q000523:psychology
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Discrimination; Glycemic control; Pathways; Self-care; Stress