Understanding the influence of psychological and socioeconomic factors on diabetes self-care using structured equation modeling

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. Conclusion: 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. Practice implications: This suggests that social determinants should be taken into account when developing patient self-care goals.