Effect of neighborhood factors on diabetes self-care behaviors in adults with type 2 diabetes

Objective: The objective of this study was to identify latent variables for neighborhood factors and diabetes self-care and examine the effect of neighborhood factors on diabetes self-care in adults with type 2 diabetes. Research design and methods: 615 subjects were recruited from an academic medical center and a Veterans affairs medical center in the southeastern United States. Validated scales were used to assess neighborhood factors and diabetes-related self-care. Confirmatory factor analysis (CFA) was used to determine the latent constructs. Structural equation modeling (SEM) was then used to assess the relationship between neighborhood factors and diabetes self-care. Results: Based on a theoretical framework, CFA yielded four latent variables for neighborhood factors (neighborhood violence, access to healthy food, social support, and neighborhood esthetics) and one latent variable diabetes self-care (including diet, exercise, foot care, blood sugar testing and medication adherence). SEM showed that social support (r = 0.28, p < 0.001) and access to healthy foods (r = -0.16, p = 0.003) were significantly associated with self-care behaviors, while neighborhood violence (r = -0.06, p < 0.001) and esthetics (r = -0.07, p = 0.278) were not x(2) (180, N = 611) = 192, p = 0.26, RMSEA = 0.01, CFI = 0.999). In the final trimmed model, social support (r = 0.31, p < 0.001) and access to healthy foods (r = -0.20, p < 0.001) remained significantly associated with self-care behaviors x(2) (76, N = 611) = 60, p = 0.91, RMSEA = 0.00, CFI = 1.0). Conclusion: This study developed latent factors for neighborhood characteristics and diabetes self-care and found that social support and access to healthy foods were significantly associated with diabetes self-care and should be considered as targets for future interventions. (C) 2014 Elsevier Ireland Ltd. All rights reserved.