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

• Structured equation modeling evaluated role of social determinants on diabetes self-care (n = 615).
• Social determinants latent factors included distress, self-efficacy, and social support.
• Psychological distress, social support, and self-efficacy were significantly related to self-care.
• Study shows that social determinants of health are associated with diabetes self-care.
• Thus, social determinants should be taken into account when developing self-care intervention.

ObjectiveTo develop and test latent variables of the social determinants of health that influence diabetes self-care.Methods615 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.ResultsLatent 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.ConclusionBased 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 implicationsThis suggests that social determinants should be taken into account when developing patient self-care goals.