| This dissertation investigated socioeconomic and psychological social determinants of health that influence outcomes in patients with type 2 diabetes. 615 adults were recruited from two primary care clinics in the southeastern United States. Validated instruments captured demographic, socioeconomic, and psychological constructs. HbA1c, blood pressure, and lipids were extracted from the medical record. Regression analysis, confirmatory factor analysis, path analysis and structured equation modeling was used. Socioeconomic and psychological social determinants were significantly associated with diabetes self-care, glycemic control, and quality of life. One socioeconomic and three psychological constructs (psychological distress, self-efficacy and social support) existed. Psychological constructs had a direct effect on self-care and glycemic control, however, self-care did not mediate the association with glycemic control. A conceptual framework was validated to elucidate pathways linking social determinants of health to diabetes outcomes, including both direct effects and indirect effect through self-care, access to care and processes of care. |
