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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

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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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Authors and Affiliations

  1. Department of Public Health Sciences, University of Alberta, Edmonton, Canada

    Sheri L. Maddigan, Sumit R. Majumdar & Jeffrey A. Johnson

  2. Institute of Health Economics, #1200-10405 Jasper Avenue, Edmonton, Alberta, Canada, T5J 3N4

    Sheri L. Maddigan & Jeffrey A. Johnson

  3. Department of Medicine, University of Alberta, Canada

    Sumit R. Majumdar

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  1. Sheri L. Maddigan
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Correspondence to Jeffrey A. Johnson.

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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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