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

2014; Elsevier BV; Volume: 36; Issue: 6 Linguagem: Inglês

10.1016/j.genhosppsych.2014.06.011

1873-7714

Rebekah J. Walker, Mulugeta Gebregziabher, Bonnie Martin‐Harris, Leonard E. Egede,

Primary Care and Health Outcomes

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. 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. 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). 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.