Interplay of personal control and health-related social control on diabetic adjustment among Singaporean late-middle-aged and older adults with type 2 diabetes
Date of Issue2014
School of Humanities and Social Sciences
Chronic illness, like diabetes is an increasingly severe public health issue that merits more research in order to facilitate chronic illness adjustment and reduce the disease burden on the individual patients, their families and the health care system. While the majority of previous research examines personal characteristics and social environmental factors separately in the context of chronic illness, the current study aims to examine the interplay of a less studied social relationship mechanism—health-related social control from family members (both direct and indirect) and personal characteristics—patients’ diabetes-related self-efficacy and internal health locus of control on diabetic adjustment in a sample of Singaporean late-middle-aged and older adults with Type 2 diabetes (N=199). I conceptualized better diabetic adjustment outcomes as better adherence to self-care activities, lower diabetes-related emotional distress and fewer depressive symptoms, and optimal glycemic control. Health-related social control operates in direct and indirect ways, such that direct health-related social control refers to family members’ direct attempts to regulate, influence or constrain health behaviors, while indirect health-related social control refers to patients’ internalized sense of responsibility or obligation to family members to stay healthy, which in turn encourages patients to maintain healthy behaviors. Data were collected between February 2012 and July 2013 in Singapore. Participants answered a battery of scales, including direct and indirect health-related social control, self-efficacy and internal health locus of control, and diabetic adjustment outcomes. Results showed that both self-efficacy and internal health locus of control were beneficial to psychological diabetic adjustment, while self-efficacy had additional behavior-facilitating effect. Direct health-related social control was positively related to diabetes-related emotional distress and self-care activities; and indirect health-related social control was negatively related to depressive symptoms, but positively related to self-care activities (bivariate correlation). Results also showed that the interaction between direct health-related social control and patients’ self-efficacy was significant for diabetes-related emotional distress and depressive symptoms. Specifically, direct health-related social control demonstrated a positive association with diabetes-related emotional distress and depressive symptoms for those with higher self-efficacy, but a negative association with depressive symptoms for those with lower self-efficacy. The indirect effect of indirect health-related social control on diabetes-related emotional distress and depressive symptoms was significant via internal health locus of control, but not self-efficacy. This study highlights the importance of promoting patients’ self-efficacy and internal health locus of control in order to improve their diabetic adjustment. Moreover, the interaction results suggest that direct health-related social control may exert an interference effect for patients higher in self-efficacy, but a compensation effect for patients lower in self-efficacy. The mediation results elucidate the mechanism underlying indirect health-related social control and diabetic adjustment, and highlight the importance of fostering indirect health-related social control and internal health locus of control for better diabetic adjustment. Taken together, the present study represents a valuable attempt to integrate health-related social control received from family members with patients’ personal control belief (self-efficacy and internal health locus of control) for understanding the interplay of social environmental and personal variables on diabetic adjustment.
DRNTU::Social sciences::Psychology::Applied psychology