Rebekah J. Walker|Mulugeta Gebregziabher|Bonnie Martin?Harris|Leonard E. Egede
Relationship between social determinants of health and processes and outcomes in adults with type 2 diabetes: validation of a conceptual framework
Ralph H. Johnson VA Medical Center|Ralph H. Johnson VA Medical Center|Medical University of South Carolina|Medical University of South Carolina
aim study empirically validate conceptual framework elucidate pathways linking social determinants health outcomes individuals type 2 diabetes615 adults recruited adult primary care clinics southeastern united states model estimated using path analysis determine socioeconomic education employment income psychosocial fatalism selfefficacy depression diabetes distress serious psychological distress social support perceived stress factors would independently predict glycemic control associated mediatormoderators selfcare access care processes care covariates gender age race health literacythe final model chi2 15 1768 p 028 rmsea 002 cfi 099 showed lower glycemic control directly associated less hours worked r 013 p 0002 fatalistic attitudes r 009 p 003 selfefficacy r 030 p 0001 less diabetes distress r 012 p 003 majority total effects direct significant paths associated selfcare diabetes distress r 014 p 001 perceived stress r 015 p 001 access care income r 008 p 003 diabetes distress r 021 p 0001 social support r 008 p 003 processes care income r 011 p 003 social support r 010 p 004 perceived stress r 010 p 004 paths explained 76 variance modelconsistent conceptual framework social determinants associated glycemic control direct association mediatorsmoderators selfcare access care processes care study provides first validation conceptual framework relationship socioeconomic psychological components social determinants health diabetes outcomes