The Social Ecological Model Of Self-management Activities In Type 2 Diabetes: A Structural Equation Modeling Analysis

Background. Type 2 diabetes mellitus is a typically progressive, chronic and lifelong disease. Treatments are aimed at managing and controlling the disease as opposed to curing it. Therefore, the self-management activities, such as diet control, regular exercise, blood glucose monitoring and foot care, are critical to improve diabetes-related health outcomes.The social ecological model, proposed by Glasgow and Eakin in 1996, used a sociological perspective that assesses the impact of the environment or society on the patients'self-management activities. These environmental/social factors were not only the context in which human interaction occurs, but also the social resources used by the patients to support their self-management behaviors. This model was supported by many empirically research. However there were few studies based on the social ecological model in China.Aims. The aims of this study were:(â…°) to get the psychometric indicators (i.e. reliability and validity) of the Chinese version of The Summary of Diabetes Self-care Activities Questionnaire (SDSCA); (â…±) to get the psychometric indicators (i.e. reliability and validity) of the Chinese version of The Chronic Illness Resources Survey (CIRS); (â…²) to determine whether the social ecological model could fit in the Chinese population.Methods. Four hundred and nineteen type 2 diabetes patients from Zhejiang Province (China) were participated in this study. Primary measures included:The Summary of Diabetes Self-care Activities Questionnaire (SDSCA); The Chronic Illness Resources Survey (CIRS); Multimentional Health Locus of Control Scales (MHLC); The Diabetes Empowerment Scale (DES). The main statistical method of data analysis was structural equation modeling.Results. The findings of this study were as follows:(â…°) The Summary of Diabetes Self-care Activities Questionnaire entailed good psychometric properties. The test-retest reliability coefficients of subscales were 0.425-0.774, the internal consistency coefficients were 0.829-0.913. The result of confirmatory factor analysis showed this questionnaire had good factorial validity. The tool also had good criterion-related validity (i.e. the scores of this questionnaire could predict the patients'diabetes control of blood glucose).(â…±) The Chronic Illness Resources Survey demonstrated good psychometric properties in Chinese population as well. The test-retest reliability coefficients of subscales were 0.585-0.724, the internal consistency coefficients were 0.738-0.929. The result of confirmatory factor analysis showed good factorial validity of the scale. The tool also exhibited good criterion-related validity (i.e. the scores of this scale could predict the patients'diabetes self-management activities).(â…²) The self-management behaviors of type 2 diabetes patients were not very considerably unwell, especially in the blood glucose monitoring and foot care related activities.(â…³) The factors influencing the diabetes self-management behaviors included: demographic variables, social resources, self-efficacy and locus of control.(â…´) The social ecological model of diabetes self-management activities was demonstrated in the Chinese type 2 diabetes population from Zhejiang Province. The diabetes self-management was the key factors of diabetes control in type 2 diabetes patients. Social resources provided significant positive influences on diabetes control (i.e. blood glucose control) through the absolute mediation of self-management.Conclusions. The results indicate that the patients'self-management activities should be paid more attention to and the diabetes education program can be designed based on the social ecological model in China.