Independent effects of socioeconomic and psychological social determinants of health on self-care and outcomes in Type 2 diabetes

Gen Hosp Psychiatry. 2014 Nov-Dec;36(6):662-8. doi: 10.1016/j.genhosppsych.2014.06.011. Epub 2014 Jul 9.

Abstract

Objective: The purpose of this study was to investigate the independent effects of socioeconomic and psychological social determinants of health on diabetes knowledge, self-care, diabetes outcomes and quality of life.

Research design and methods: Cross-sectional sample of 615 adults from two adult primary care clinics in the southeastern United States. Primary outcome variables were diabetes knowledge, self-care behaviors (diet, exercise, medication adherence, blood sugar testing, foot care) and diabetes outcomes (HbA1c, low-density lipoprotein, blood pressure, physical component summary score of SF12 quality of life, mental component summary score of SF12 quality of life). Covariates included age, sex, race/ethnicity, marital status, health literacy and comorbidity. Linear regression models were used to assess independent associations controlling for covariates.

Results: In final adjusted models, significant associations for HbA1c included education [β = -0.72, 95% confidence interval (CI): -1.36 to -0.08], income (β = -0.66, CI: -1.30 to -0.16), self-efficacy (β = -0.12, CI: -0.15 to -0.08) and diabetes distress (β = 0.43, CI: 0.14 to 0.72). Significant associations for self-care included medication adherence with diabetes distress (β = -0.58, CI: -0.91 to -0.25) and perceived stress (β = -0.12, CI: -0.18 to -0.05) and exercise with depression (β = -0.06, CI: -0.10 to -0.01) and self-efficacy (β = 0.06, CI: 0.01 to 0.10). Significant associations for quality of life included depression (β = -0.08, CI: -0.12 to -0.03), serious psychological distress (β = -0.09, CI: -0.12 to -0.05), social support (β = 0.01, CI: 0.001 to 0.02) and perceived stress (β = -0.12, CI: -0.19 to -0.06).

Conclusions: Social determinants of health were significantly associated with diabetes self-care and outcomes with socioeconomic factors being most often associated with diabetes outcomes and psychological factors, specifically self-efficacy and perceived stress being most often associated with self-care and quality of life.

Keywords: Diabetes; Psychological; Self-care; Social determinants; Socioeconomic.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood Glucose Self-Monitoring / psychology
  • Blood Glucose Self-Monitoring / statistics & numerical data*
  • Cross-Sectional Studies
  • Depression / epidemiology
  • Depression / psychology
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / psychology
  • Diabetes Mellitus, Type 2 / therapy*
  • Educational Status
  • Exercise / psychology
  • Female
  • Glycated Hemoglobin / metabolism
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Income / statistics & numerical data
  • Lipoproteins, LDL / blood
  • Male
  • Medication Adherence / psychology
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Self Care / psychology
  • Self Care / statistics & numerical data*
  • Self Efficacy
  • Social Class*
  • Social Determinants of Health*
  • Social Support
  • Stress, Psychological / epidemiology
  • Treatment Outcome
  • Young Adult

Substances

  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Lipoproteins, LDL
  • hemoglobin A1c protein, human