The relationship of family environment and other social cognitive variables on diet and exercise in older adults with type 2 diabetes

The role of the family environment and other social cognitive factors in the management of type 2 diabetes is poorly understood in older adults. With a better understanding of the social cognitive factors that contribute to diabetes selfcare behaviors, interventions can be designed to improve these outcomes. The Social Cognitive Theory was employed to derive a model that depicts the complex and multidimensional aspects of the diabetes self-care regimen. The main objective of the study was to analyze the relationships among the family environment and other psychosocial variables on levels of diet and exercise selfcare activities. A non-experimental, descriptive study design was utilized to meet the objectives of the study. Data were collected from a convenience sample of older patients (55 years or older) who were receiving care from a university medical center outpatient facility. The researcher or trained Spanish-speaking interviewer administered the survey to the patients while they were in the clinic. The majority of the items on the survey were chosen from existing instruments. A model for family environment and social cognitive variables was supported empirically in predicting diet and exercise self-care behaviors. High levels of perceived family support specific to the diabetic regimen were directly associated with levels of exercise and diet self-care behaviors. Additionally, high levels of self-efficacy were associated with higher levels of diet and exercise selfcare. Perceived barriers to self-care were associated with the levels of exercise and self-care behavior. Self-efficacy had both a direct and indirect effect on the levels of exercise and diet self-care. Knowledge about diabetes and its management had a direct effect (although weak) on levels of exercise self-care but not on diet self-care. The results suggest that interventions that address family support specific to diabetes, self-efficacy, general knowledge about diabetes, and barriers to self-care may be important components for diabetes management. The results of the study have implications on how pharmacists and other health care providers can have a greater impact on their patients by having a better understanding of the family systems on diabetes management.