Perceived Stress as a Pathway for the Relationship Between Neighborhood Factors and Glycemic Control in Adults With Diabetes

Abstract

Purpose Neighborhood factors such as crime, discrimination, and violence are increasingly recognized as correlates of poor glycemic control. However, pathways for these relationships are unclear. This study examined stress and self-efficacy as potential pathways for the relationship between neighborhood factors and glycemic control in adults with type 2 diabetes. Design Cross-sectional study. Setting Two primary care clinics in southeastern US. Participants 615 adults aged 18 years and older. Measures Validated measures were used to capture neighborhood factors, stress, and self-efficacy, while hemoglobin A1c (HbA1c) was abstracted from the electronic health record. Analysis Path analysis was used to investigate direct and indirect relationships between neighborhood factors, stress, self-efficacy, and glycemic control. Results In the final model, violence (r = .17, P = .024), discrimination (r = .46, P < .001), and crime (r = .36, P = .046) were directly associated with higher perceived stress. Stress (r = −.5, P < .001) was directly associated with lower self-efficacy. Self-efficacy was directly associated with better general diet (r = .12, P < .001), better specific diet (r = .04, P < .001), more exercise (r = .08, P < .001), and lower HbA1c (r = −.11, P < .001). Stress (r = .05, P < .001), crime (r = .20, P < .001), and discrimination (r = .08, P < .001) were indirectly associated with higher HbA1c. Conclusion Stress and self-efficacy are potential pathways for the relationship between neighborhood factors like violence, discrimination, and crime and glycemic control. Interventions aimed at mitigating stress and improving self-efficacy may improve self-care behaviors and glycemic control.