Abstract
Objectives: To assess associations between perceptions of the patient–provider relationship (PPR), BMI, adherence to diet and exercise in a rural population with type 2 diabetes and determine how these variables relate to HRQL.
Methods: A model of the hypothesized relationships between the constructs was proposed and tested using structural equation modeling (SEM) and data collected as part of a controlled study to improve care for individuals with type 2 diabetes in rural health regions.
Results: In the final model, positive perceptions of the PPR had a direct impact on adherence to diet (β = 0.23; p <0.05), exercise (β = 0.13; p <0.05) and diabetes management attitudes (β = 0.33; p <0.05). The direct path from management attitudes to exercise was also significant (β = 0.12; p <0.05). Direct predictors of HRQL included management attitudes (β = 0.16; p <0.05), exercise adherence (β = 0.14, p <0.05) and BMI (β = −0.23; p <0.05). Exercise adherence predicted BMI, whereas adherence to diet did not. The final model had an acceptable fit with the measured data (χ2 = 30.6 (26, N = 372), p = 0.25; RMSEA = 0.02; TLI = 0.98; SRMR = 0.02).
Conclusion: Patient–provider relationship and exercise adherence appeared to be key constructs in the model. HRQL in people with type 2 diabetes was positively associated with exercise adherence, which was related to a positive PPR. Adherence to diet was also related to a positive PPR, but diet adherence had no association with HRQL.
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Abbreviations
- BMI:
-
body mass index
- HRQL:
-
health-related quality of life
- A1c:
-
glycosylated haemoglobin
- IQR:
-
inter-quartile Range
- DLF:
-
Diabetes Lifestyle Form
- TLI:
-
Tucker Lewis Index
- RMSEA:
-
root mean square error of approximation
- SRMR:
-
standardized root mean square residual
- SDSCA:
-
Summary of Diabetes Self-Care Activities
- HUI3:
-
Health Utilities Index mark 3
- PHC:
-
physical health composite
- MHC:
-
mental health composite
- SMC:
-
squared multiple correlation
- PPR:
-
patient provider relationship
- MA:
-
management attitudes
- EFA:
-
exploratory factor analysis
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Maddigan, S.L., Majumdar, S.R. & Johnson, J.A. Understanding the complex associations between patient–provider relationships, self-care behaviours, and health-related quality of life in type 2 diabetes: A structural equation modeling approach. Qual Life Res 14, 1489–1500 (2005). https://doi.org/10.1007/s11136-005-0586-z
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DOI: https://doi.org/10.1007/s11136-005-0586-z