McClernon, Susan2015-09-082015-09-082013-11https://hdl.handle.net/11299/174217University of Minnesota Ph.D. dissertation. November 2013. Major: Health Services Research, Policy and Administration. Advisor: Bryan Dowd. 1 computer file (PDF); x, 341 pages.Objectives Only 20% of patients with type 2 diabetes implement recommended self-management behaviors (DAWN study) (Funnell, 2006). In this research, psychosocial factors significantly influenced self-management behaviors and A1c, having more influence than SES factors. The integrated conceptual model illuminated complex relationships between psychosocial factors, self-management(SM) and A1c levels. It posited self-efficacy (SE) as mediator between self-management and other psychosocial factors. Method This study explored direct and indirect relationships between diabetes social support (DSS), knowledge, affect, self-efficacy and dependent variables including diet, exercise, competency in adult patients with type 2 diabetes with suboptimal glycemic control (A1c <&ge> 7%) using cross sectional data from the IDEA study using structural equation modeling. Results The conceptual model fit test statistics are <&chi>;a1c2= 379 (df = 112; n=564, <&rho>-value = 000). The RSMEA estimate was .043 (.037 - .051 CI), SRMR was .045, and GFI was .94. The direct effects for knowledge (<&beta> = .647, <&rho> value &#8804; .001) influenced SE and SE indirectly influenced A1c (<&beta> = .253, <&rho> value &#8804; .001). DSS directly influenced knowledge (<&beta> = .579, <&rho> value &#8804; .001) and SE (<&beta> range = .482, <&rho> value &#8804; .001). Affect directly influenced knowledge (<&beta> range = .296, <&rho> value &#8804; .05) and indirectly influenced SE (<&beta> = .192, <&rho> value &#8804; .05). A second hypothesis found SE mediated SM and A1c only for knowledge, not for DSS or affect. DSS, knowledge, and affect indirectly influenced SM behaviors and A1c significantly (affect only for exercise and A1c). Knowledge was a mediator for DSS to SE. Conclusions The theoretically integrated conceptual model has merit. Affect and DSS (mediates) are directly influencing knowledge, with is significantly linked with SE. SE mediates SM and A1c. This new knowledge of relationships between psychosocial factors may assist caregivers in better engaging their patients with diabetes in improving SM behaviors and outcomes.enOutcomesPsychosocial FactorsSelf-efficacySelf-managementStructural equation modelingType 2 DiabetesThesis or Dissertation