Relationships between psychosocial factors and adherence to diet and exercise in adults with type 2 diabetes: A test of a theoretical model



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Introduction: Cardiovascular disease (CVD) is the leading cause of premature death among people with diabetes. Diet and exercise adherence are\r\nimportant diabetes self management behaviors that can reduce CVD risk; unfortunately, adherence rates are low among diabetics. Improved understanding of psychosocial factors related to diet and exercise adherence among adults with\r\ntype 2 diabetes can improve strategies to reduce CVD morbidity and mortality in this population.\r\n Purpose: 1) Evaluate psychometrics of the Health Beliefs related to Cardiovascular Disease scale (HBCVD) which measures perceived susceptibility to and severity of heart attack or stroke and perceived benefits of and barriers to\r\ndiet and exercise; 2) Explore relationships between selected bio-psychosocial factors and diet and exercise adherence; and 3) Evaluate the ability of a theoretical model integrating the Health Belief Model (HBM) and Stages of Change Model (SOC) to explain diet and exercise adherence.\r\n Methods: The study design was a descriptive correlational cross section using a convenience sample of 212 adults with type 2 diabetes who completed a series of questionnaires measuring study variables. Outcome variables measured were diet and exercise adherence scores. Predictor/independent variables included knowledge related to CVD risk, cues to action, health beliefs, stage of change, social support, depression, comorbidity, diabetes duration, and\r\nsocioeconomic status. Relationships among model variables were explored using analysis of variance and simple and multiple regression techniques.\r\n Results: The HBCVD demonstrated evidence of validity and reliability, although an improved barriers subscale is recommended. The theoretical model was not supported, although significant paths between model variables were identified. The best model to predict diet included diet stage, susceptibility, self efficacy, social support, and age. The best model to predict exercise included\r\nexercise stage, self efficacy, and social support. Models including HBM and SOC provided greater explanatory power for diet and exercise adherence than either model alone. Susceptibility, barriers, and self efficacy varied significantly across\r\nstages of change. Significant group differences were found among model variables. Participants with depressive symptoms and the least education had lower diet and exercise adherence scores. Younger age and unemployment were also associated with lower diet adherence.\r\n



stages of change, health belief model, exercise, diet, diabetes, cardiovascular disease, adherence