Department of Family and Community Medicine, College of Medicine, University of Kentucky, 2195 Harrodsburg Road, Suite 125, Lexington, KY, 40504, USA.
Center for Health Equity Transformation, College of Medicine, University of Kentucky, 372 Healthy Kentucky Building, Lexington, KY, 40536, USA.
BMC Public Health. 2021 Oct 2;21(1):1784. doi: 10.1186/s12889-021-11777-7.
The aim of this study was to examine whether cultural factors, such as religiosity and social support, mediate/moderate the relationship between personal/psychosocial factors and T2DM self-care in a rural Appalachian community.
Regression models were utilized to assess for mediation and moderation. Multilevel linear mixed effects models and GEE-type logistic regression models were fit for continuous (social support, self-care) and binary (religiosity) outcomes, respectively.
The results indicated that cultural context factors (religiosity and social support) can mediate/moderate the relationship between psychosocial factors and T2DM self-care. Specifically, after adjusting for demographic variables, the findings suggested that social support may moderate the effect of depressive symptoms and stress on self-care. Religiosity may moderate the effect of distress on self-care, and empowerment was a predictor of self-care but was not mediated/moderated by the assessed cultural context factors. When considering health status, religiosity was a moderately significant predictor of self-care and may mediate the relationship between perceived health status and T2DM self-care.
This study represents the first known research to examine cultural assets and diabetes self-care practices among a community-based sample of Appalachian adults. We echo calls to increase the evidence on social support and religiosity and other contextual factors among this highly affected population.
US National Library of Science identifier NCT03474731. Registered March 23, 2018, www.clinicaltrials.gov .
本研究旨在探讨文化因素（如宗教信仰和社会支持）是否在个人/心理社会因素与农村阿巴拉契亚社区 2 型糖尿病自我护理之间的关系中起中介/调节作用。
回归模型用于评估中介和调节作用。多水平线性混合效应模型和 GEE 型逻辑回归模型分别适用于连续（社会支持、自我护理）和二项（宗教信仰）结果。
结果表明，文化背景因素（宗教信仰和社会支持）可以调节/中介心理社会因素与 2 型糖尿病自我护理之间的关系。具体来说，在调整人口统计学变量后，研究结果表明，社会支持可能调节抑郁症状和压力对自我护理的影响。宗教信仰可能调节痛苦对自我护理的影响，而赋权是自我护理的预测因素，但不受评估的文化背景因素的调节/中介。考虑到健康状况时，宗教信仰是自我护理的一个中等显著预测因素，可能调节感知健康状况与 2 型糖尿病自我护理之间的关系。
本研究代表了首次已知的研究，调查了基于社区的阿巴拉契亚成年人样本中的文化资产和糖尿病自我护理实践。我们回应了增加这一高度受影响人群中社会支持和宗教信仰及其他背景因素的证据的呼吁。
美国国家医学图书馆科学标识符 NCT03474731。2018 年 3 月 23 日注册，www.clinicaltrials.gov。
