The Role of Social Relationships and Self-Efficacy in Diabetes Management

描述(由申请人提供)：这份R21申请寻求支持一项关于婚姻状况、社会支持和自我效能在美国不同人群的中老年人糖尿病管理有效性中的作用的调查。拟议的研究将使用结构方程模型来分析2002年和2004年从具有全国代表性的健康和退休研究(HRS)的核心访谈中收集的数据，以及2003年针对糖尿病的补充邮件调查的数据，以按性别、年龄组和主要种族-民族类别检查这些关系。这项拟议的研究的意义在于，在过去的几十年里，美国所有人群中2型糖尿病的发病率都在飙升，但主要是在中老年人中。对肥胖和缺乏体力活动及其与糖尿病发病、并发症和社会成本的联系的担忧导致了国家一级的公共卫生任务--例如2010年《健康人》中包括的公共卫生任务--旨在扭转这些趋势。虽然预防糖尿病当然是一个重要的目标，但对已被诊断为糖尿病的患者进行更有效的治疗对于降低未来并发症的风险也至关重要。目前，只有不到八分之一的糖尿病成年人遵循良好管理指南；老年人遵循这些指南的比率甚至更低。许多过去的研究表明，自我效能和社会关系是糖尿病相关行为和健康结果的关键因素，但它们的使用受到非代表性数据集的使用、横断面分析以及对其他可能也需要考虑的重要因素的不充分控制。该应用程序的目标是研究社会关系(尤其是婚姻)和自我效能如何影响对糖尿病相关生活方式行为和健康结果的遵守，以便开发和测试为成年糖尿病患者提供更有效支持的干预措施。特别是，我们将：(1)检查婚姻状况作为预测患有糖尿病的中老年人的行为(饮食和锻炼)和健康结果(血糖控制和与糖尿病相关的生活质量)的指标；(2)调查自我效能和糖尿病支持是否在婚姻状况和糖尿病的行为和健康结果之间起中介作用；以及(3)辨别婚姻状况、糖尿病支持、自我效能和行为和健康结果之间的关系是否受到性别、年龄组或种族的调节。更清楚地了解婚姻和自我效能的作用，特别是中年和老年已婚和未婚成年人对糖尿病的管理是否以及如何不同，可能有助于为成人糖尿病患者开发更有效的干预措施。考虑到最近的研究表明，由于婚姻环境和共同的环境，配偶本身患糖尿病的风险可能会增加，这一知识可能更加重要。与公共健康相关的对肥胖和缺乏运动及其与糖尿病的联系的担忧导致了旨在扭转这些趋势的公共卫生任务--例如包括在2010年《健康人》中的那些任务。尽管预防糖尿病是一个重要的目标，但对已被诊断为糖尿病的患者进行更有效的治疗对于降低未来并发症的风险也至关重要。目前，只有不到八分之一的糖尿病成年人遵循良好管理指南；老年人遵循这些指南的比率甚至更低。了解社会关系(尤其是婚姻)和自我效能如何影响患有糖尿病的中老年人的良好糖尿病管理，可能是开发和测试提供更有效支持的干预措施的关键，对已婚夫妇来说更重要，因为如果配偶患有糖尿病，他们自己患糖尿病的风险可能会更高。

DESCRIPTION (provided by applicant):This R21 application seeks support for an investigation of the roles of marital status, social support, and self- efficacy in the effectiveness of diabetes management in a diverse population of middle-aged and older adults in the U.S. The proposed research will use structural equation modeling to analyze data collected in 2002 and 2004 from core interviews of the nationally representative Health and Retirement Study (HRS), plus data from the 2003 supplemental diabetes-specific mail survey to examine these relationships by gender, age group, and major race-ethnicity categories. The significance of the proposed research lies in the skyrocketing rates of type 2 diabetes in the U.S. over the past few decades in all segments of the population, but primarily in middle aged and older adults. Concerns about obesity and physical inactivity and their links to the onset, complications, and societal costs of diabetes have led to public health mandates at the national level-such as those included in Healthy People 2010-aimed at reversing those trends. Although prevention of diabetes is certainly an important goal, more effective management for individuals already diagnosed with diabetes is also critical for reducing the risks of future complications. Currently, less than one in eight of all adults with diabetes follow the guidelines for good management; and older adults follow them at even lower rates. Many past studies showing that self-efficacy and social relationships are key factors in diabetes-related behavioral and health outcomes are limited by their use of non-representative data sets, cross-sectional analyses, and inadequate controls on other factors that may also be important to consider. This application's goal is to examine how social relationships (and particularly marriage) and self-efficacy influence adherence to diabetes-related lifestyle behaviors and health outcomes in order to develop and test interventions that provide more effective supports for adults living with diabetes. In particular, we will: (1) examine marital status as a predictor of behavioral (diet and exercise) and health outcomes (glycemic control and diabetes-related quality of life) in middle-aged and older adults living with diabetes; (2) investigate whether self-efficacy and diabetes support mediate the link between marital status and behavioral and health outcomes of diabetes; and (3) discern whether associations among marital status, diabetes support, self-efficacy, and behavioral and health outcomes are moderated by gender, age group, or race-ethnicity. Understanding more clearly the role of marriage and self-efficacy, and particularly if and how diabetes management differs between middle-aged and older married and unmarried adults, may inform the development of more effective interventions for adults living with diabetes. This knowledge may also be all the more important given recent studies showing spouses may be at increased risk for developing diabetes themselves because of the marital context and shared environment. PUBLIC HEALTH RELEVANCE Concerns about obesity and physical inactivity and their links to diabetes have led to public health mandates- such as those included in Healthy People 2010-aimed at reversing those trends. Although prevention of diabetes is an important goal, more effective management for individuals already diagnosed with diabetes is also critical for reducing the risks of future complications. Currently, less than one in eight adults with diabetes follow the guidelines for good management; and older adults follow them at even lower rates. Understanding how social relationships (and particularly marriage) and self-efficacy influence good diabetes management in middle-aged and older adults living with diabetes may be key to developing and testing interventions that provide more effective supports, and all the more important to married couples because spouses may be at higher risk for developing diabetes themselves if their partner has diabetes.