The mediating/moderating role of cultural context factors on self-care practices among those living with diabetes in rural Appalachia

BMC Public Health

Lovoria B. Williams¹  Nancy E. Schoenberg²  Matthew Rutledge³  Philip M. Westgate⁴  Md. Tofial Azam⁴  Ellen Combs⁵  Brittany L. Smalls⁶  Adebola Adegboyega⁷  Felipe De La Barra⁸ 

[1] Center for Health Equity Transformation, College of Medicine, University of Kentucky, 372 Healthy Kentucky Building, 40536, Lexington, KY, USA;College of Nursing, University of Kentucky, 751 Rose Street, 539 CON, 40536, Lexington, KY, USA;Center for Health Equity Transformation, College of Medicine, University of Kentucky, 372 Healthy Kentucky Building, 40536, Lexington, KY, USA;Department of Behavioral Science, College of Medicine, University of Kentucky, Medical Center, MN 150, 40536, Lexington, KY, USA;Center for Health Equity Transformation, College of Medicine, University of Kentucky, 372 Healthy Kentucky Building, 40536, Lexington, KY, USA;Department of Statistics, College of Arts and Science, University of Kentucky, 725 Rose Street, Multidisciplinary Science Building 0082, Room 303, 40536, Lexington, KY, USA;Department of Biostatistics, College of Public Health, University of Kentucky, 725 Rose Street, MDS 205, 40536, Lexington, KY, USA;Department of Family and Community Medicine, College of Medicine, University of Kentucky, 2195 Harrodsburg Road, Suite 125, 40504, Lexington, KY, USA;Department of Family and Community Medicine, College of Medicine, University of Kentucky, 2195 Harrodsburg Road, Suite 125, 40504, Lexington, KY, USA;Center for Health Equity Transformation, College of Medicine, University of Kentucky, 372 Healthy Kentucky Building, 40536, Lexington, KY, USA;Department of Statistics, College of Arts and Science, University of Kentucky, 725 Rose Street, Multidisciplinary Science Building 0082, Room 303, 40536, Lexington, KY, USA;University of Kentucky College of Medicine, William R. Willard Education Building, MN 150, 40536, Lexington, KY, USA;

关键词: Social support;    Religiosity;    Self-care;    Rural Appalachia;   

DOI  :  10.1186/s12889-021-11777-7

来源: Springer

【 摘 要 】

BackgroundThe aim of this study was to examine whether cultural factors, such as religiosity and social support, mediate/moderate the relationship between personal/psychosocial factors and T2DM self-care in a rural Appalachian community.MethodsRegression models were utilized to assess for mediation and moderation. Multilevel linear mixed effects models and GEE-type logistic regression models were fit for continuous (social support, self-care) and binary (religiosity) outcomes, respectively.ResultsThe results indicated that cultural context factors (religiosity and social support) can mediate/moderate the relationship between psychosocial factors and T2DM self-care. Specifically, after adjusting for demographic variables, the findings suggested that social support may moderate the effect of depressive symptoms and stress on self-care. Religiosity may moderate the effect of distress on self-care, and empowerment was a predictor of self-care but was not mediated/moderated by the assessed cultural context factors. When considering health status, religiosity was a moderately significant predictor of self-care and may mediate the relationship between perceived health status and T2DM self-care.ConclusionsThis study represents the first known research to examine cultural assets and diabetes self-care practices among a community-based sample of Appalachian adults. We echo calls to increase the evidence on social support and religiosity and other contextual factors among this highly affected population.Trial registrationUS National Library of Science identifier NCT03474731. Registered March 23, 2018, www.clinicaltrials.gov.

【 授权许可】

CC BY