title: A latent structural equation model of protective behaviors and pressure ulcer outcomes among people living with spinal cord injury.
abstract: METHODS
  Cross-sectional.
  
  
  OBJECTIVE
  To develop a latent structural model to demonstrate the relationship between factor structures of protective health behaviors and pressure ulcer (PrU) outcomes among participants with spinal cord injury (SCI).
  
  
  METHODS
  Data were collected at a large specialty hospital and analyzed at a medical university in the Southeastern USA.
  
  
  METHODS
  A total of 1871 participants with traumatic SCI of at least 1 year duration were included. A latent PrU variable was measured by four observable PrU-related outcomes. Latent variable structural equation modeling was performed to assess the relationship between latent protective behavior (fitness and productive activities) and latent PrU outcome. Several exogenous variables were included: sex, age, race, marital status, injury severity and years since injury.
  
  
  RESULTS
  The protective behavior dimension had a significant direct effect on the latent PrU (direct effect=-0.275, P<0.01). All direct relationships between protective behavior dimension and healthy behaviors were also significant (rfit=0.899 and rproductive activity=0.568). Relationships between the latent PrU and fitness (indirect effect=-0.247) and productive activities (indirect effect=-0.156) were mediated through the protective behavior dimension. Participants who were African American, had higher injury levels, and had longer time since SCI were more likely to have worse PrU outcomes.
  
  
  CONCLUSIONS
  The overall findings of this study suggest the need to enhance healthy behaviors to prevent adverse PrU outcomes, especially among people who are African American, have longer time since SCI and have higher level of SCI.
authors.affiliation: Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: C
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: N D
authors.initials: ND
authors.lastname: DiPiro
authors.affiliation: Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: J
authors.initials: J
authors.lastname: Krause
mesh_terms: D000328:Adult; D000066949:Biobehavioral Sciences; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000517:prevention & control* / Q000523:psychology; D011446:Prospective Studies; D015144:Southeastern United States / Q000453:epidemiology; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome