使用结构方程模型理解心理和社会经济因素对糖尿病自我护理的影响。
Understanding the influence of psychological and socioeconomic factors on diabetes self-care using structured equation modeling.
作者信息
Walker Rebekah J, Gebregziabher Mulugeta, Martin-Harris Bonnie, Egede Leonard E
机构信息
Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA; Department of Health Science and Research, Medical University of South Carolina, Charleston, SC, USA.
Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Division of Public Health Sciences, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
出版信息
Patient Educ Couns. 2015 Jan;98(1):34-40. doi: 10.1016/j.pec.2014.10.002. Epub 2014 Oct 22.
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.
目的
开发并测试影响糖尿病自我管理的健康社会决定因素的潜在变量。
方法
从美国东南部的两家成人初级保健诊所招募了615名2型糖尿病成人患者。验证性因素分析（CFA）确定了社会经济决定因素、心理社会决定因素和自我管理（饮食、运动、足部护理、血糖检测和药物依从性）背后的潜在因素。结构方程模型（SEM）研究了决定因素与自我管理之间的关系。
结果
创建了糖尿病自我管理、心理困扰、自我效能感、社会支持和社会地位的潜在变量。初始模型（卡方(254) = 388.04，p < 0.001，RMSEA = 0.03，CFI = 0.98）显示，较低的心理困扰（r = -0.13，p = 0.019）、较高的社会支持（r = 0.15，p = 0.008）和较高的自我效能感（r = 0.47，p < 0.001）与糖尿病自我管理显著相关。社会地位与自我管理无显著相关性（r = 0.003，p = 0.952）。在修正模型（卡方(189) = 211.40，p = 0.126，RMSEA = 0.01，CFI = 0.99）中，较低的心理困扰（r = -0.13，p = 0.016）、较高的社会支持（r = 0.15，p = 0.007）和较高的自我效能感（r = 0.47，p < 0.001）仍与糖尿病自我管理显著相关。
结论
基于理论关系，衡量健康社会决定因素的三个潜在因素（心理困扰、社会支持和自我效能感）与糖尿病自我管理密切相关。
实践意义
这表明在制定患者自我管理目标时应考虑社会决定因素。
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