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

  • Ann-Marie RoslandEmail author
  • Edith Kieffer
  • Barbara Israel
  • Marvis Cofield
  • Gloria Palmisano
  • Brandy Sinco
  • Michael Spencer
  • Michele Heisler
Original Article



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.


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.


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


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


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.


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.


diabetes self-management social support community based participatory research Hispanic Americans African Americans 




We thank the CHASS/REACH Detroit Partnership staff, the REACH Detroit Partnership Steering Committee (, 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 (


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.


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.


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Ann-Marie Rosland
    • 1
    Email author
  • Edith Kieffer
    • 2
  • Barbara Israel
    • 3
  • Marvis Cofield
    • 5
    • 6
  • Gloria Palmisano
    • 6
  • Brandy Sinco
    • 2
  • Michael Spencer
    • 2
  • Michele Heisler
    • 1
    • 4
  1. 1.Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  2. 2.School of Social WorkUniversity of MichiganAnn ArborUSA
  3. 3.School of Public HealthUniversity of MichiganAnn ArborUSA
  4. 4.Ann Arbor VAAnn ArborUSA
  5. 5.DetroitUSA
  6. 6.REACH Detroit PartnershipDetroitUSA

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