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Understanding the influence of psychological and socioeconomic factors on diabetes self-care using structured equation modeling. Patient Educ Couns 2015 Jan;98(1):34-40



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Scopus ID

2-s2.0-84920031425 (requires institutional sign-in at Scopus site)   40 Citations


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.

Author List

Walker RJ, Gebregziabher M, Martin-Harris B, Egede LE


Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin
Rebekah Walker PhD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Blood Glucose Self-Monitoring
Diabetes Mellitus, Type 2
Factor Analysis, Statistical
Health Knowledge, Attitudes, Practice
Medication Adherence
Middle Aged
Self Care
Self Efficacy
Social Determinants of Health
Social Environment
Social Support
Socioeconomic Factors
Stress, Psychological
United States
Young Adult