Brittany L Smalls1, Chris M Gregory2, James S Zoller3, Leonard E Egede4. 1. Center for Health Organization and Implementation Research (CHOIR), eHealth Quality Enhancement Research Initiative (QUERI), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States. 2. Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States. 3. Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States. 4. Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, United States; Division of General Internal Medicine and Geriatrics, Department of Medicien, Medical University of South Carolina, Charleston, SC, United States; Health Equity and Rural Research Innovation Center (HEROIC), Charleston VA HSR&D COIN, Charleston, SC, United States. Electronic address: egedel@musc.edu.
Abstract
OBJECTIVE: The objective of this study was to identify latent variables for neighborhood factors and diabetes self-care and examine the effect of neighborhood factors on diabetes self-care in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS: 615 subjects were recruited from an academic medical center and a Veterans affairs medical center in the southeastern United States. Validated scales were used to assess neighborhood factors and diabetes-related self-care. Confirmatory factor analysis (CFA) was used to determine the latent constructs. Structural equation modeling (SEM) was then used to assess the relationship between neighborhood factors and diabetes self-care. RESULTS: Based on a theoretical framework, CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood esthetics) and one latent variable diabetes self-care (including diet, exercise, foot care, blood sugar testing and medication adherence). SEM showed that social support (r=0.28, p<0.001) and access to healthy foods (r=-0.16, p=0.003) were significantly associated with self-care behaviors, while neighborhood violence (r=-0.06, p<0.001) and esthetics (r=-0.07, p=0.278) were not χ(2) (180, N=611)=192, p=0.26, RMSEA=0.01, CFI=0.999). In the final trimmed model, social support (r=0.31, p<0.001) and access to healthy foods (r=-0.20, p<0.001) remained significantly associated with self-care behaviors χ(2) (76, N=611)=60, p=0.91, RMSEA=0.00, CFI=1.0). CONCLUSION: This study developed latent factors for neighborhood characteristics and diabetes self-care and found that social support and access to healthy foods were significantly associated with diabetes self-care and should be considered as targets for future interventions.
OBJECTIVE: The objective of this study was to identify latent variables for neighborhood factors and diabetes self-care and examine the effect of neighborhood factors on diabetes self-care in adults with type 2 diabetes. RESEARCH DESIGN AND METHODS: 615 subjects were recruited from an academic medical center and a Veterans affairs medical center in the southeastern United States. Validated scales were used to assess neighborhood factors and diabetes-related self-care. Confirmatory factor analysis (CFA) was used to determine the latent constructs. Structural equation modeling (SEM) was then used to assess the relationship between neighborhood factors and diabetes self-care. RESULTS: Based on a theoretical framework, CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood esthetics) and one latent variable diabetes self-care (including diet, exercise, foot care, blood sugar testing and medication adherence). SEM showed that social support (r=0.28, p<0.001) and access to healthy foods (r=-0.16, p=0.003) were significantly associated with self-care behaviors, while neighborhood violence (r=-0.06, p<0.001) and esthetics (r=-0.07, p=0.278) were not χ(2) (180, N=611)=192, p=0.26, RMSEA=0.01, CFI=0.999). In the final trimmed model, social support (r=0.31, p<0.001) and access to healthy foods (r=-0.20, p<0.001) remained significantly associated with self-care behaviors χ(2) (76, N=611)=60, p=0.91, RMSEA=0.00, CFI=1.0). CONCLUSION: This study developed latent factors for neighborhood characteristics and diabetes self-care and found that social support and access to healthy foods were significantly associated with diabetes self-care and should be considered as targets for future interventions.
Authors: David C Lee; Ta'Loria Young; Christian A Koziatek; Christopher J Shim; Marcela Osorio; Andrew J Vinson; Joseph E Ravenell; Stephen P Wall Journal: Prev Chronic Dis Date: 2019-08-01 Impact factor: 2.830