Influence of Social Support, Diabetes Related Distress and Self-Care Behaviors on Quality of Life and Glycemic Control in Patients with Type 2Diabetes: A Longitudinal Study

• Main Authors: Hui-Chun Hsu, 徐慧君
• Other Authors: Ruey-Hsia Wang
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/eh4tt4

博士 === 高雄醫學大學 === 護理學系博士班 === 104 === Type 2 diabetes mellitus (T2DM) is a public health issue worldwide. Simultaneous achievement of the targets of both a good level of HbA1C and quality of life is key to diabetes care. Although there are complex inter-relationships between the psychosocial factors that affect diabetes care, few studies have employed longitudinal design to delineate the pathways between psychosocial factors, HbA1C and quality of life. The purpose of this study was to develop a pathway model to investigate the effects of personal demographic characteristics, social support, diabetes-related distress and self-care behaviors on quality of life and HbA1C in patients with T2DM using a structural equation modeling (SEM) procedure. In this longitudinal study, a total of 576 adults with T2DM were recruited from four endocrinology clinics and an outpatient clinic of a medical center in Southern Taiwan. The criteria for selecting the participants were those aged 20-80 years with an adequate level of literacy who had been diagnosed with T2DM for more than one year, and who had no communication problems. Patients with gestational diabetes mellitus, those with cognitive disorders, those with language barriers, illiterate subjects and those suffering mental illness, all of which may result in patients being unable to complete the questionnaire by themselves, were excluded from this study. Self -reported questionnaires were used to collect related to personal demographic characteristics, diabetes-related distress and social support at baseline. Self -care behaviors was collected at 6 months later. Quality of life and HbA1C were collected at 1 year later. Data are presented using descriptive statistics, including frequencies, percentages, and means. All scales were assessed in terms of their content validity and test-retest reliability. Confirmatory factor analysis was used to test the validity of each scale. The hypothesis of the model was tested by SEM using Amos 18.0 software. After a series of SEM analyses, a parsimonious and best-fit model was identified. The fit indices were χ2 = 142.606, df ＝ 51, p < .001, goodness of fit index = 939, adjusted goodness of fit Index = .907, incremental fit index = .911, non-normed fit index = .883, comparative fit index = .910, root mean square error of approximation = .069. The model indicated: 1.Duration of disease (β = .214, t = 3.787, p < .001) has a significant direct positive effect on self-care behaviors 6 months later. 2.Baseline social support has a significant direct positive effect (β =.292, t = 5.059, p < .001) on self-care behaviors 6 months later, and through self-care behaviors 6 months later has a significant negative indirect effect on quality of life one year later (β = .176, t = 2.049, p = .040). 3.Baseline social support has a significant direct negative effect (ß = −.259, t = −5.234, p < .001) on baseline diabetes-related distress, and through diabetes-related distress has a significant positive indirect effect on quality of life one year later (ß = .176, t = 11.889, p < .001). 4.Baseline diabetes-related distress has a significant direct negative effect (ß = −.447, t = −7.939, p < .001) on quality of life one year later, and through quality of life one year later has a significant negative indirect effect on HbA1C one year later (β = .093, t = 7.911, p < .001). 5.Self-care behaviors at 6 months later have a significant direct positive effect (β = .205, t = 3.366, p =.001) on quality of life one year later, and through quality of life one year later have a significant negative indirect effect on HbA1C one year later (ß = .043, t = −1.986, p = .046). These results delineated the pathways between social support, diabetes-related distress, self-care behaviors, HbA1C and quality of life in patients with T2DM. The model proposed in this study should be tested further in different populations in the future. The findings could be utilized to design intervention programs to improve HbA1C control and quality of life.