Sociostructural determinants of diabetes self-management: test of a self-efficacy model.

Abstract

Diabetes self-management has clear benefits in reducing diabetes symptoms and complications and improving the health, wellbeing and quality of life of people with diabetes. Successful intervention programs focus on the development of diabetes self-efficacy, which promotes the capacity of people with diabetes to perform diabetes self-management even in the face of difficulty. Diabetes self-management, however, presents considerable challenges for health systems that have been structured to provide acute, rather than chronic care, and health professionals who have been trained to cure illness, rather than manage behaviour. It presents further challenges for people with diabetes who live in socioeconomically disadvantaged circumstances and have limited financial resources for diabetes care and therapies, and poor access to resources for diabetes self-management, such as clean, safe exercise areas and healthy foods at low-cost. These sociostructural determinants of diabetes self-management, defined here as GP care and socioeconomic resources, have the potential to impede the uptake and effective dissemination of diabetes self-management policy and intervention. This research thesis investigated the impact of sociostructural determinants on diabetes self-management using a model developed from self-efficacy theory. The model was empirically examined using a mixed quantitative and qualitative methodology, where qualitative data were used to illuminate the findings of quantitative data. The quantitative component comprised a random cross-sectional survey of 105 people with diabetes subjected to hierarchical multiple regression with tests for moderator effects. The qualitative component comprised three group interviews of 27 English-speaking, Vietnamese-speaking and Arabic-speaking people with diabetes, analysed using the phenomenological method. Findings provided partial support for the model. Relationships between sociostructural determinants and diabetes self-management were complex. While good quality GP care facilitated diabetes self-management, it also acted as a barrier to self-monitoring of blood glucose for people with low levels of diabetes self-efficacy. Having limited access to socioeconomic resources did not impede diabetes self-management, even for people with low levels of diabetes self-efficacy, although this may have been masked by access to public health schemes and welfare support. The findings from this small-scale exploratory study suggest that self-efficacy may exert an impact on diabetes self-management, even in the face of sociostructural determinants.