A Structural Equation Modeling Analysis to Explore Diabetes Self-Care Factors in a Rural Sample

Abstract

Diabetes is a public health problem that requires management to avoid health sequelae. Little is known about the determinants that influence diabetes self-care activities among rural populations. The purpose of this analysis was to explore the relationships among diabetes self-care activities, diabetes knowledge, perceived diabetes self-management, diabetes fatalism, and social support among an underserved rural group in the southern United States. A diabetes health promotion program was tested during a cluster randomized trial that tested a disease risk reduction program among adults living with prediabetes and diabetes. A structural equation model was fit to test psychosocial factors that influence diabetes self-care activities using the Information-Motivation-Behavioral Skills Model of Diabetes Self-Care (IMB-DSC) to guide the study. Perceived diabetes self-management significantly predicted self-care behaviors, and there was also a correlation between perceived diabetes self-management and diabetes fatalism. Perceived diabetes self-management influenced diabetes self-care activities in this rural sample and had an association with diabetes fatalism. The findings of this study can facilitate clinical care and community programs targeting diabetes and advance health equity among underserved rural groups.

Keywords: diabetes; diabetes self-management; disease risk; health promotion; rural.

Figure 1

Confirmatory factor analysis (CFA) model. Standardized CFA solution; *** p < 0.001.

Figure 2

Structural model with parameter estimates for each path. Standardized solution: ** p < 0.01, *** p < 0.001, p indicates a p-value equal to 0.085. Only one correlation among exogenous variables is presented, although all were fit. See Table 1 for correlations.