Social Determinants of Health Predict Self-Care Maintenance in Adults with T1D

Austin Matus, RN

Credit: Penn Nursing

Adults with type 1 diabetes (T1D) showing job and material insecurity were less likely to engage in behavior to promote and preserve their health, according to new research.¹

The findings, presented at the 83rd Scientific Sessions of the American Diabetes Association (ADA 2023), suggest healthcare providers could influence self-care of patients by offering self-care guidance after assessment of social determinants of health risk.

“Social determinants of health were significant determinants of self-care maintenance in adults with T1D,” wrote the investigative team, led by Austin Matus, RN, a PhD candidate from the University of Pennsylvania School of Nursing.

Inequities in health care access and outcomes among adults with T1D are strongly influenced by social determinants of health, consisting of the conditions in which people live, learn, work, play, and age.² For those with T1D, management of the disease centers around diabetes self-care, or daily behaviors performed to maintain health (maintenance), monitor changes (monitoring), and manage illness (management). However, these behaviors could be impacted by a patient’s social determinants of health.

The current analysis aimed to determine if social determinants of health predicted self-care maintenance, monitoring, and management.¹ If this was the case, the investigative team aimed to identify which social determinants of health items were the principal factors. The analysis included a diverse sample of adults with T1D (n = 200; 27% Black; 61% female; median age, 35 years; disease duration,19 years) who completed a social determinants of health risk assessment and a self-care assessment (Self-Care of Diabetes Inventory [SCODI]; 3 self-care [maintenance, monitoring, and management] and 1 confidence scale).

The analysis built a multivariable linear regression model of self-care maintenance, monitoring, and management, including social determinants of health risk and confidence as independent variables in the models. Additionally, post-hoc exploratory models were build using backwards stepwise regression to determine which of the 14 social determinants of health domains were the most noteworthy predictors.

Upon analysis, investigators found social determinants of health risk was a significant predictor of self-care maintenance. Every 1 unit increase in social determinants of health risk was associated with a 1.14 unit decrease in maintenance (P <.01). Moreover, the exploratory multivariable analysis showed employment insecurity and material insecurity were the primary social determinants of health risk predictor of maintenance.

Results showed participants who were not employed full-time were estimated to have maintenance scores of 5.15 ± 2.27 units less (P <.05). Meanwhile, every 1 unit increase in material insecurity (score range, 0 - 7), estimated maintenance decreased by 2.6 ± .89 units (P <.01). The investigative team noted patients with higher social determinants of health risks are less likely to perform behaviors to maintain health.

“Material security and employment status were the most salient determinants of self-care maintenance amongst the measured social determinants of health domains,” Matus and colleagues wrote. “Individuals with job and material insecurity may be foregoing activities to promote and preserve physical health and mental well-being.”

References

Matus A, Riegel B, Rickels MR. Social Determinants of Health Predict Self-Care in Type 1 Diabetes. Poster presentation at the 83rd Scientific Sessions of the American Diabetes Association. June 23 – 26, 2023

Hill-Briggs F, Adler NE, Berkowitz SA, et al. Social Determinants of Health and Diabetes: A Scientific Review [published online ahead of print, 2020 Nov 2]. Diabetes Care. 2020;44(1):258-279. doi:10.2337/dci20-0053