Assessing the relationship between neighborhood factors and diabetes related health outcomes and self-care behaviors. BMC Health Serv Res 2015 Oct 01;15:445
Date
10/03/2015Pubmed ID
26428459Pubmed Central ID
PMC4589943DOI
10.1186/s12913-015-1086-7Scopus ID
2-s2.0-84942693580 (requires institutional sign-in at Scopus site) 59 CitationsAbstract
BACKGROUND: Studies have shown that community and neighborhood characteristics can impact health outcomes of those with chronic illness, including T2DM. Factors, such as crime, violence, and lack of resources have been shown to be barriers to optimal health outcomes in diabetes. Thus, the objective of this study is to assess the effects of neighborhood factors on diabetes-related health outcomes and self-care behaviors.
METHODS: Adult patients (N = 615) with type 2 diabetes mellitus (T2DM) were recruited from an academic medical center and a Veterans Affairs medical center in the southeastern United States. Validated scales and indices were used to assess neighborhood factors and diabetes-related self-care behaviors. The most recent HbA1c, blood pressure, and LDL cholesterol were abstracted from each patients' electronic medical record.
RESULTS: In the fully adjusted model, significant associations were between neighborhood aesthetics and diabetes knowledge (β = 0.141) and general diet (β = -0.093); neighborhood comparison and diabetes knowledge (β = 0.452); neighborhood activities and general diet (β = -0.072), exercise (β = -0.104), and foot care (β = -0.114); food insecurity and medication adherence (β = -0.147), general diet (β = -0.125), and blood sugar testing (β = -0.172); and social support and medication adherence (β = 0.009), foot care (β = 0.010), and general diet (β = 0.016). Significant associations were also found between neighborhood violence and LDL Cholesterol (β = 4.04), walking environment and exercise (β = -0.040), and social cohesion and HbA1c (β = -0.086).
DISCUSSION: We found that neighborhood violence, aesthetics, walking environment, activities, food insecurity, neighborhood comparison, social cohesion and social support have statistically significant associations with self-care behaviors and outcomes to varying degrees. However, the key neighborhood factors that had independent associations with multiple self-care behaviors and outcomes were food insecurity, neighborhood activities and social support.
CONCLUSION: This study suggests that food insecurity, neighborhood activities, aesthetics, and social support may be important targets for interventions in individuals with T2DM.
Author List
Smalls BL, Gregory CM, Zoller JS, Egede LEAuthor
Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Blood Pressure
Cholesterol, LDL
Diabetes Mellitus, Type 2
Exercise
Female
Food Supply
Humans
Male
Medication Adherence
Middle Aged
Quality of Life
Residence Characteristics
Self Care
Social Support
Young Adult
