Browsing by Author "Harvey, Natasha R."

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    Self-management activities in type 2 diabetes: a structural equation modeling analysis
    (2006) Harvey, Natasha R.; Dobson, Keith S.
    Background: A plethora of psychosocial predictors of Type 2 diabetes self-management adherence have been identified, yet these variables generally fail to account for more than about 25% of the variance in measures of diabetes adherence. The predominance of the Type 2 diabetes adherence literature represents behaviour change (intrapersonal) and social support (interpersonal) models. Few studies have examined the roles of empirically supported diabetes adherence predictors within a social-ecological model framework. Purpose: To use structural equation modeling to increase our understanding of the associations among social-ecological support resources, perceived locus of control of diabetes, negative affect (anxiety, depression, and alexithymia), and Type 2 diabetes self-care activities. Methods: This cross-sectional study utilized a convenience sample of 235 participants (54% male, 46% female) aged 25 to 87 (Mage= 56, SD = 11) with Type 2 diabetes from Calgary's Regional Diabetes Education Centre. Self-report measures were distributed for home completion and returned by post. Primary measures included (1) Chronic Illness Resources Survey, (2) Perceived Control of Diabetes Scales, (3) Twenty-Item Toronto Alexithymia Que tionnaire, (4) Well-Being Questionnaire anxiety and depression subscales, and (5) ummary of Diabetes Self-Care Activities Questionnaire, with an appended foot-care measure. Structural equation modeling was used to assess measurement and structural models. Results: Social-ecological support resources emerged as the sole direct predictor of diabetes self-care activity, accounting for 45% of the variance in diabetes self-care activity. Intraindividual variables ( decreased emotional well-being, perceived personal and situational control) had indirect effects on diabetes self-care activity primarily through their direct influence on social- 111 ecological support resources. Conclusions: The present study suggests that previous emphasis on the direct influence of intrapersonal variables measured in this study is likely an oversimplification of the complex interaction among variables influencing Type 2 diabetes self-care activities. Further, the results support a strong positive direct influence of utilization of social-ecological support resources on diabetes self-care activity, while the measured intrapersonal variables had only a very modest indirect relationship with diabetes self-care activity. Results point to the importance of considering social-ecological models of Type 2 diabetes adherence and ensuring sufficient availability and personal utilization of social-ecological support resources in clinical practice.