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When Is Social Support Important? The Association of Family Support and Professional Support with Specific Diabetes Self-management Behaviors

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Abstract

BACKGROUND

Social support is associated with better diabetes self-management behavior (SMB), yet interventions to increase family and friend support (FF support) have had inconsistent effects on SMB.

OBJECTIVE

To test whether FF support differentially affects specific SMBs and compare the influence of support from health professionals and psychological factors on specific SMBs to that of FF support.

DESIGN

Cross-sectional survey of people with diabetes recruited for a self-management intervention

PARTICIPANTS AND SETTING

One hundred sixty-four African-American and Latino adults with diabetes living in inner-city Detroit

MEASUREMENTS AND MAIN RESULTS

For every unit increase in FF support for glucose monitoring, the adjusted odds ratio (AOR) of completing testing as recommended was 1.77 (95% CI 1.21–2.58). FF support was not associated with four other SMBs (taking medicines, following a meal plan, physical activity, checking feet). Support from non-physician health professionals was associated with checking feet [AOR 1.72 (1.07–2.78)] and meal plan adherence [AOR = 1.61 (1.11–2.34)]. Diabetes self-efficacy was associated with testing sugar, meal plan adherence, and checking feet. Additional analyses suggested that self-efficacy was mediating the effect of FF support on diet and checking feet, but not the FF support effect on glucose monitoring.

CONCLUSIONS

The association between FF support and SMB performance was stronger for glucose monitoring than for other SMBs. Professional support and diabetes self-efficacy were each independently associated with performance of different SMBs. SMB interventions may need to differentially emphasize FF support, self-efficacy, or professional support depending on the SMB targeted for improvement.

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Acknowledgements

Contributors

We thank the CHASS/REACH Detroit Partnership staff, the REACH Detroit Partnership Steering Committee (www.reachdetroit.org), and the REACH Detroit Partnership intervention participants for their involvement in this study. The REACH Detroit Partnership is affiliated with the Detroit Community-Academic Urban Research Center (www.sph.umich.edu/URC/).

Funding

Support for this study was provided by the Centers for Disease Control and Prevention Cooperative Agreement no. U50/CCU417409, the Michigan Diabetes Research and Training Center (NIDDK P60DK-20572). Michele Heisler is a VA HSR&D Career Development awardee. Ann-Marie Rosland is a Robert Wood Johnson Clinical Scholar.

Presentations

Results from this paper were presented at the Society of General Internal Medicine Midwest Region Annual Meeting on 29 September 2007.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Ann-Marie Rosland MD, MS & Michele Heisler MD, MPA

  2. School of Social Work, University of Michigan, Ann Arbor, MI, USA

    Edith Kieffer PhD, MPH, Brandy Sinco MS & Michael Spencer PhD, MSW

  3. School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Barbara Israel DrPH, MPH

  4. Ann Arbor VA, Ann Arbor, MI, USA

    Michele Heisler MD, MPA

  5. Detroit, MI, USA

    Marvis Cofield

  6. REACH Detroit Partnership, Detroit, MI, USA

    Marvis Cofield & Gloria Palmisano MA

Authors
  1. Ann-Marie Rosland MD, MS
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  2. Edith Kieffer PhD, MPH
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  3. Barbara Israel DrPH, MPH
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  8. Michele Heisler MD, MPA
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Corresponding author

Correspondence to Ann-Marie Rosland MD, MS.

Appendix

Appendix

Survey questions

Sociodemographics

Gender/sex

Male or female

Age

Calculated from date of birth (DOB)

Race/ethnicity

-White

What is the ethnic origin/race that you identify most with? Check only one

-Black

-Hispanic/Latino

-Native American

-Asian or Pacific Islander

-Arabic

-Other (please specify)

Education:

-Less than high school

What is the highest level of education you completed? Check only one answer

-High school graduate

-Technical school

-Some college

-Two-year college (Associate’s degree)

-Four-year college (Bachelor’s degree)

-Graduate school (Master’s or Doctorate)

-Other

Health status

Functional status:

Yes or no

Are you limited in any way in any activities because of physical, mental, or emotional problems?

Diabetes medication regimen:

Yes or no

 - Are you taking diabetes pills?

 - Are you taking insulin?

Self-management behavior (SMB):

Survey of Diabetes Self-Care activities31, 32

Days per week

On how many of the last 7 days did you:

 

 - Take your recommended insulin dose or number of diabetes pills?

 

 - Follow a healthful eating plan?

 

 - Test your blood sugar at least as often as your doctor has recommended?

 

 - Check your feet?

 

Physical Activity: Behavioral Risk Factor Surveillance Survey (BRFSS)

Whether meet CDC physical activity guidelines: moderate activity × 30 min at least 5 days/week OR vigorous activity × 20 min at least 3 days/week

Psychological factors

Diabetes self-efficacy: Perceived Competence for Diabetes Scale34:

Five-point agree-disagree

Total scaled to 0–10

 - You feel confident in your ability to manage your diabetes

Higher score = higher self-efficacy

 - You feel capable of handling your diabetes now

 

 - You are able to do your own routine diabetes care now

 

 - You are able to meet the challenge of controlling your diabetes

 

Depressive symptoms: Patient Health Questionnaire (PHQ-9)35:

0–27

Higher score = more depression symptoms

How often have you been bothered by each of the following symptoms during the past 2 weeks?

 

 - Feeling down, depressed, or hopeless?

 

 - Little interest or pleasure in doing things?

 

 - Trouble falling or staying asleep, or sleeping too much?

 

 - Feeling tired or having little energy?

 

 - Poor appetite or overeating?

 

 - Feeling bad about yourself - or that you are a failure or have let yourself or your family down?

 

 - Trouble concentrating on things, such as reading the newspaper or watching television?

 

 - Moving or speaking so slowly that other people noticed? Or the opposite – being so fidgety or restless that you moved around a lot more than usual?

 

 - Thoughts that you would be better off dead or of hurting yourself in some way?

 

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Rosland, AM., Kieffer, E., Israel, B. et al. When Is Social Support Important? The Association of Family Support and Professional Support with Specific Diabetes Self-management Behaviors. J GEN INTERN MED 23, 1992–1999 (2008). https://doi.org/10.1007/s11606-008-0814-7

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  • DOI: https://doi.org/10.1007/s11606-008-0814-7

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