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

社会关系和自我效能在糖尿病管理中的作用

基本信息

批准号：
7689938
负责人：
Linda Ann Wray
金额：
$ 19.68万
依托单位：
PENNSYLVANIA STATE UNIVERSITY, THE
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-20 至 2012-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7689938
关键词：
Address Adherence Adult Aging Area Attenuated Behavior Behavioral Birth Categories Characteristics Couples Cross-Sectional Studies Data Data Analyses Data Set Development Diabetes Mellitus Diabetes prevention Diagnosis Divorce Effectiveness Elderly Environment Environmental Risk Factor Equation Ethnic Origin Fostering Future Gender Goals Guidelines Health Health Personnel Health behavior Health behavior outcomes Healthy People 2010 Individual Intervention Interview Investigation Knowledge Life Life Style Link Literature Mails Marital Status Marriage Mediating Modeling Nature Never Married Non-Insulin-Dependent Diabetes Mellitus Obesity Outcome Pattern Play Population Population Heterogeneity Practice Guidelines Prevalence Process Psychosocial Factor Psychosocial Influences Public Health Quality of life Race Research Retirement Risk Role Sampling Self Efficacy Social Environment Social status Social support Spouses Surveys Testing Translating Unmarried Vacuum Woman age group base behavioral health cohort cost design diabetes management diet and exercise effective intervention glycemic control high risk men middle age person centered public health relevance social trend

项目摘要

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.

描述（由申请人提供）：本 R21 申请寻求支持对美国中老年人群的婚姻状况、社会支持和自我效能在糖尿病管理有效性中的作用进行调查。拟议的研究将使用结构方程模型来分析 2002 年和 2004 年从全国代表性健康与退休研究 (HRS) 的核心访谈中收集的数据，以及 2003 年补充报告中的数据。针对糖尿病的邮件调查，按性别、年龄组和主要种族类别检查这些关系。这项研究的意义在于，过去几十年来，美国各阶层人群的 2 型糖尿病发病率急剧上升，但主要是中老年人。对肥胖和缺乏身体活动及其与糖尿病的发病、并发症和社会成本的联系的担忧导致了国家层面的公共卫生指令（例如《2010 年健康人民》中所包含的指令）旨在扭转这些趋势。尽管预防糖尿病无疑是一个重要目标，但对已诊断出糖尿病的个体进行更有效的管理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成人糖尿病患者遵循良好管理指南；老年人的追随率甚至更低。过去的许多研究表明，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，但由于使用非代表性数据集、横断面分析以及对其他可能也很重要的考虑因素的控制不足而受到限制。该应用程序的目标是检查社会关系（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坚持，以便开发和测试为成人糖尿病患者提供更有效支持的干预措施。具体来说，我们将：（1）检查婚姻状况作为中老年糖尿病患者行为（饮食和运动）和健康结果（血糖控制和糖尿病相关生活质量）的预测因素； (2) 调查自我效能和糖尿病支持是否介导婚姻状况与糖尿病行为和健康结果之间的联系； (3) 辨别婚姻状况、糖尿病支持、自我效能以及行为和健康结果之间的关联是否受到性别、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之间的糖尿病管理是否存在差异以及如何差异，可能有助于为成人糖尿病患者制定更有效的干预措施。鉴于最近的研究表明，由于婚姻背景和共同环境，配偶本身患糖尿病的风险可能会增加，因此这一知识可能也更加重要。公共卫生相关性对肥胖和缺乏身体活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指令（例如《2010 年健康人口》中包含的指令）。尽管预防糖尿病是一个重要目标，但对已诊断出糖尿病的个体进行更有效的管理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成人糖尿病患者遵循良好管理指南；老年人的追随率甚至更低。了解社会关系（尤其是婚姻）和自我效能如何影响中老年糖尿病患者的良好糖尿病管理可能是制定和测试提供更有效支持的干预措施的关键，对于已婚夫妇来说更重要，因为如果伴侣患有糖尿病，配偶自己患糖尿病的风险可能更高。