Smalls Brittany L, Gregory Chris M, Zoller James S, Egede Leonard E
Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 151-A Rutledge Ave., Charleston, SC, 29425, US; Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Ave, Room 280, MSC 593, Charleston, SC, 29425, US.
Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 151-A Rutledge Ave., Charleston, SC, 29425, US.
J Diabetes Complications. 2015 Mar;29(2):186-91. doi: 10.1016/j.jdiacomp.2014.10.008. Epub 2014 Oct 22.
To determine whether neighborhood factors have direct or indirect effects, via self-care behaviors on glycemic control.
Adult patients with type 2 diabetes were recruited from an academic medical center and Veterans Affairs Medical Center in the southeastern United States. Confirmatory factor analysis was used to create latent variables for neighborhood factors and diabetes self-care behavior. Structural equation modeling was used to test direct and indirect effects between neighborhood factors and glycemic control as assessed by HbA1c levels.
CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood aesthetics) and one latent variable diabetes self-care. We found that social support (β=0.28, z=4.86, p<0.001) and access to healthy foods (β=-0.17, z=-2.95, p=0.003) had direct effects on self-care; self-care (β=-0.15, z=-2.48, p=0.013) and neighborhood aesthetics (β=0.12, z=2.19, p=0.03) had direct effects on glycemic control; while social support (β=-0.04, z=-2.26, p=0.02) had an indirect effect on glycemic control via self-care.
This study showed that self-care behaviors and neighborhood aesthetics have direct effects on glycemic control, social support and access to health foods had direct effects on self-care, and social support had an indirect effect on glycemic control via self-care.
确定社区因素是否通过自我护理行为对血糖控制产生直接或间接影响。
从美国东南部的一家学术医疗中心和退伍军人事务医疗中心招募成年2型糖尿病患者。采用验证性因素分析来创建社区因素和糖尿病自我护理行为的潜在变量。使用结构方程模型来测试社区因素与通过糖化血红蛋白水平评估的血糖控制之间的直接和间接影响。
验证性因素分析产生了四个社区因素的潜在变量（社区暴力、获得健康食品的机会、社会支持和社区美观度）和一个糖尿病自我护理的潜在变量。我们发现社会支持（β=0.28，z=4.86，p<0.001）和获得健康食品的机会（β=-0.17，z=-2.95，p=0.003）对自我护理有直接影响；自我护理（β=-0.15，z=-2.48，p=0.013）和社区美观度（β=0.12，z=2.19，p=0.03）对血糖控制有直接影响；而社会支持（β=-0.04，z=-2.26，p=0.02）通过自我护理对血糖控制有间接影响。
本研究表明，自我护理行为和社区美观度对血糖控制有直接影响，社会支持和获得健康食品的机会对自我护理有直接影响，社会支持通过自我护理对血糖控制有间接影响。
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