Structural Equation Modeling on Self-Care Behavior and Quality of Life in Older Adults with Diabetes Using Citizen Health Promotion Centers

Songheun Lee; Hyunli Kim

doi:10.4040/jkan.2017.47.4.514

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Lee and Kim: Structural Equation Modeling on Self-Care Behavior and Quality of Life in Older Adults with Diabetes Using Citizen Health Promotion Centers

Original Article

J Korean Acad Nurs 2017;47(4):514-525.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.4.514

Structural Equation Modeling on Self-Care Behavior and Quality of Life in Older Adults with Diabetes Using Citizen Health Promotion Centers

Songheun Lee¹, Hyunli Kim^2,

¹Department of Nursing, Chodang University, Muan

²College of Nursing, Chungnam University, Daejeon, Korea

Address reprint requests to : Kim, Hyunli College of Nursing, Chungnam University, 266 Munhwa-ro, Jung-gu, Daejeon 35015, Korea Tel: +82-42-580-8330 Fax: +82-42-580-8309 E-mail: hlkim@cnu.ac.kr

Received 27 April 2017 Revised 21 July 2017 Accepted 21 July 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to construct and test a structural equation model for Diabetes self-management (DSM) behavior and Quality of life (QoL) in older adults with diabetes who use Citizen Health Promotion Centers. The theory used this study was a combination of the Information-Motivation-Behavioral Model (IMB) and Self-Determination Theory (SDT) to reflect autonomous characteristics of participants.

Methods

Data were collected from April 20 to August 31, 2015 using a self-report questionnaire. The sample was 205 patients with type 2 Diabetes who regularly visited a Citizen Health Promotion Center. SPSS 22.0 and AMOS 22.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factor affecting the participants’ DSM behavior and QoL.

Results

The supported hypotheses were as follows; 1) The variable that had a direct effect on QoL was health behavior adherence (γ=.55, p=.007). 2) The variables that had a direct effect on DSM behavior were DSM information (γ=.15, p=.023), DSM confidence (γ=.25, p<.001), and autonomous motivation (γ=.13, p=.048). 3) The variable that had a direct effect on DSM confidence was autonomy support (γ=.33, p<.001).

Conclusion

The major findings of this study are that supporting patient's autonomous motivation is an influential predictor for adherence to DSM behavior, and integrative intervention strategies which include knowledge, experience and psychosocial support are essential for older adults with diabetes to continue DSM behavior and improve QoL.

Keywords: Health behavior, Personal autonomy, Self care, Diabetes mellitus type 2, Quality of life

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Figure 1.

Hypothetical model.

Figure 2.

Path diagram for the hypothetical model.

Table 1.

General and Disease-Related Characteristics of the Participants (N=205)

Variable	Category	n (%)	Mean (SD) (range) Median (IQR)
Age (years)	60~69	84 (41.0)	71.28 (5.80)
	70~79	107 (52.2)	(60~86 years)
	≥ 80	14 (16.8)
Gender	Male	121 (59.0)
	Female	84 (41.0)
Education	None	35 (17.9)
	Elementary school graduation	55 (26.8)
	Middle school graduation	39 (19.0)
	High school graduation	39 (19.0)
	≥College	37 (18.0)
BMI (kg/m²)	Underweight (<18.5)	5 (2.4)	23.92 (2.96)
	Normal (18.5~24.9)	137 (66.8)	(15.62~27.87)
	Overweight (25.0~29.9)	58 (28.3)
	Obesity (≥30.0)	5 (2.5)
Perceived Health	Healthy	38 (17.5)
	Fair	90 (43.9)
	Poor	77 (37.6)
Average Number of Center Visits	1~2/month	160 (78.0)	2 (1)
	3~4/month	19 (9.3)
	≥5/month	26 (12.7)
Duration of DM Diagnosis (years)	<10	142 (69.3)	9.98 (8.30)
	≥10 and <20	44 (21.5)	(1~40 years)
	≥20	19 (9.2)
Classification of Comorbidity	Hypertension	88 (42.9)
	Eye Problem	33 (16.1)
	Foot Problem	9 (4.4)
	Kidney Problem	11 (5.4)
	Numbness	13 (6.2)

BMI=Body mass index.

Table 2.

Descriptive Statistics of the Observed Variable (N=205)

Variable	Mean±SD	Range	Skewness	Kurtosis
DSM Information	6.99±2.16	0~12	-0.51	-0.11
Autonomy Support	74.85±16.78	24~105	-0.09	-0.26
Autonomous Motivation	43.13±8.28	20~56	-0.24	-0.85
DSM Confidence	71.27±9.84	45~92	0.16	-0.51
DSM Behavior	62.78±18.48	19~105	0.08	-0.07
Quality of Life	0.86±0.11	0.4~1.0	-1.39	1.93
Multivariate				5.04

DSM=Diabetes self-management.

Table 3.

Correlation among the Observed Variable (N=205)

	DSM	Autonomy	Autonomous	DSM	DSM
	Information (p)	Support (p)	Motivation (p)	Confidence (p)	Behavior (p)
Autonomy Support	-.02 (.710)
Autonomous Motivation	.10 (.148)	.59 (<.001)
DSM Confidence	-.04 (.501)	.36 (<.001)	.23 (.001)
DSM Behavior	.15 (.029)	.12 (.067)	.21 (.002)	.29 (<.001)
Quality of Life	.12 (.072)	.13 (.053)	.13 (.051)	.17 (.011)	.18 (.008)
Tolerance	.95	.59	.61	.81	.86
VIF	1.04	1.68	1.61	1.23	1.16

DSM=Diabetes self-management; VIF=Variance inflation factor.

Table 4.

Standardized Estimate of the Hypothetical Model (N=205)

Endogenous variable	Exogenous variable	NSRW	Standardized	C.R (p)	Direct effect	Indirect effect	Total effect	SMC
		(S.E.)	estimate b			p
DSM Confidence	DSM Information (γ11)	0.20 (.30)	0.04	0.65 (.513)	.04 (.513)		.04 (.513)	.132
	Autonomy Support (γ12)	0.20 (.05)	0.33	4.07 (<.001)	.33 (.005)		.33 (<.001)
	Autonomous Motivation (γ13)	0.05 (.10)	0.05	0.55 (.583)	.05 (.583)		.05 (.583)
DSM Behavior	DSM Information (γ21)	1.29 (.57)	0.15	2.27 (.023)	.15 (.023)	.01 (.600)	.15 (.067)	.123
	DSM Confidence (b21)	0.47 (.13)	0.25	3.75 (<.001)	.25 (<.001)		.25 (<.001)
	Autonomous Motivation (γ23)	0.30 (.15)	0.14	1.98 (.048)	.14 (.048)	.01 (.595)	.15 (.050)
Quality of Life	DSM Behavior (b32)	<0.01 (<.01)	0.55	2.70 (.007)	.25 (.007)		.25 (.007)	.302

DSM=Diabetes self-management; NSRW=Non-standardized regression weight; S.E.=Standardized error; C.R.=Critical ratio; SMC=Squared multiple correlations.

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