Skip to main content

Advertisement

SpringerLink
Log in

Self-management and Self-rated Health Among Middle-aged and Older Adults with Type 2 Diabetes in China: A Structural Equation Model

  • Published:
Social Indicators Research Aims and scope Submit manuscript

Abstract

This study assesses the association between self-rated health (SRH) and diabetes self-management (DSM) factors (i.e., conventional self-care, holistic health practices, and insulin injection) among age 40 and older Chinese with type 2 diabetes in China. Three models are proposed and tested using structural equation model techniques analyzing the data from the Chinese Health and Nutrition Survey (1997–2006). All models have acceptable fit with the data. In all three models, insulin injection is negatively associated with SRH. Conventional self-care and holistic health practices predict impaired SRH only when examined separately. Whereas the connection between insulin injection and lower SRH is not surprising, the negative effect of holistic health practices and conventional self-care on SRH warrants further attention. The findings potentially suggest more complex theoretical or conceptual models should be developed to explain the relationship between DSM and SRH in a non-Western context. In addition, health care professionals might consider the benefits of DSM on health and wellness among middle-aged and older diabetics, and cogitate developing effective interventions and instructions for DSM in China that acknowledge the relationship between DSM and SRH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Aljasem, L. I., Peyrot, M., Wissow, L., & Rubin, R. R. (2001). The impact of barriers and self-efficacy on self-care behaviors in type 2 diabetes. Diabetes Educator, 27(3), 393–404.

    Article  Google Scholar 

  • Arcury, T. A., Bell, R. A., Snively, B. M., Smith, S. L., Skelly, A. H., Wetmore, L. K., et al. (2006). Complementary and alternative medicine use as health self-management: Rural older adults with diabetes. Journal of Gerontology Social Sciences, 61B(2), S62–S70.

    Article  Google Scholar 

  • Ayers, S. L., & Kronnenfeld, J. J. (2010). Using factor analysis to create complementary and alternative medicine domains: An examination of patterns of use. Health, 14(3), 234–252.

    Google Scholar 

  • Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman.

    Google Scholar 

  • Bjorner, J. B., Fayers, P., & Ldler, E. (2005). Self-rated health. In P. Fayers & R. Hays (Eds.), Assessing quality of life in clinical trials: Methods and Practice (2nd ed., pp. 309–323). USA: Oxford University Press.

    Google Scholar 

  • Byrne, B. M. (2011). Structural equation modeling with mplus: Basic concepts, applications and programming (multivariate application series). New York: Routledge Academic.

    Google Scholar 

  • Chan, Y. M., & Molassiotis, A. (1999). The relationship between diabetes knowledge and compliance among Chinese with non-insulin dependent type 2 diabetes mellitus in Hong Kong. Journal of Advanced Nursing, 30(2), 431–438.

    Article  Google Scholar 

  • Chang, H.-Y., Wallis, M., & Tiralongo, E. (2007). Use of complementary and alternative medicine among people living with diabetes: Literature review. Journal of Advanced Nursing, 58(4), 307–319.

    Article  Google Scholar 

  • Clark, N. M., Becker, M. H., Janz, N., Lorig, K., Rakowski, W., & Anderson, L. (1991). Self-management of chronic disease by older adults. Journal of Aging and Health, 3(1), 3–27.

    Article  Google Scholar 

  • Cott, C. A., Gignac, M. A. M., & Badley, E. M. (1999). Determinants of self-rated health for Canadians chronic disease and disability. Journal of Epidemiology Community Health, 53, 731–736.

    Article  Google Scholar 

  • Donnelly, R., Wang, B., & Qu, X. (2006). Type 2 diabetes in China: Partnerships in education and research to evaluate new antidiabetic treatments. British Journal of Clinical Pharmacology, 61(6), 702–705.

    Article  Google Scholar 

  • Fayers, P. M., & Sprangers, M. A. G. (2002). Understanding self-rated health. The Lancet, 359(9302), 187–188.

    Article  Google Scholar 

  • Feldman, D. E., Duffy, C., de Civita, M., Malleson, P., Philibert, L., Gibbon, M., et al. (2004). Factors associated with the use of complementary alternative medicine in juvenile idiopathic arthritis. Arthritis and Rheumatism (Arthritis Care and Research), 51(4), 527–532.

    Article  Google Scholar 

  • Franks, P., Gold, M. R., & Fiscella, K. (2003). Sociodemographics, self-rated health, and mortality in the US. Social Science and Medicine, 56, 2505–2514.

    Article  Google Scholar 

  • Gallant, M. P. (2003). The influence of social support on chronic illness self-management: A review and directions for research. Health Education and Behavior, 30(2), 170–195.

    Article  Google Scholar 

  • Glasgow, R. E., Ruggiero, L., Eakin, E. G., Dryfoos, J., & Chobanian, L. (1997). Quality of life and associated characteristics in a large national sample of adults with diabetes. Diabetes Care, 20, 562–567.

    Article  Google Scholar 

  • Gu, D., Reynolds, K., Duan, X., Xin, X., Chen, J., Wu, X., et al. (2003). Prevalence of diabetes and impaired fasting glucose in the Chinese adults population: International collaborative Study of Cardiovascular Disease in Asia (InterASIA). Diabetologia, 46, 1190–1198.

    Article  Google Scholar 

  • Helgeson, V. S. (1992). Moderators of the relation between perceived control and adjustment to chronic disease. Journal of Personality and Social Psychology, 63(4), 656–666.

    Article  Google Scholar 

  • Herman, W., Ilag, L. L., Johnson, S. L., Martin, C. L., Sinding, J., Al Harthi, A., et al. (2005). A clinical trial of continuous subcutaneous insulin infusion versus multiple daily injections in older adults with type 2 diabetes. Diabetes Care, 28(7), 1568–1573.

    Article  Google Scholar 

  • Hoeymans, N., Feskens, E. J. M., Kromhout, D., & van den Bos, G. A. M. (1999). The contribution of chronic conditions and disabilities to poor self-rated health in elderly men. Journal of Gerontology Medical Science, 54A(10), M501–M506.

    Article  Google Scholar 

  • Huang, C.-L., Tai, Y. K., Yang, Y. H., & Wang, R. H. (2012). Efficacy of five-element gymnastics in glucose and lipid control in Taiwanese patients with type 2 diabetes. Research in Nursing and Health, 35, 419–429.

    Article  Google Scholar 

  • Hunt, L. M., Valenzuela, M. A., & Pugh, J. A. (1997). NIDDM patients’ fears and hopes about insulin therapy. Diabetes Care, 20(3), 292–298.

    Article  Google Scholar 

  • Jia, W. P., Pang, C., Chen, L., Bao, Y. Q., Lu, J. X., Lu, H. J., et al. (2007). Epidemiological characteristics of type 2 diabetes mellitus and impaired glucose regulation in a Chinese adult population: The Shanghai diabetes studies, a cross-sectional 3-year follow-up study in Shanghai urban communities. Diabetoglogia, 50, 286–292.

    Article  Google Scholar 

  • Jylha, M. (2009). What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Science and Medicine, 69, 307–316.

    Article  Google Scholar 

  • Klein, B. E. K., Klein, R., & Moss, S. (1998). Self-rated health and diabetes of long duration: The Wisconsin Epidemiologic Study of Diabetic Retinopathy. Diabetes Care, 21(2), 236–240.

    Article  Google Scholar 

  • Li, W. L., Zheng, H. C., Bukuru, J., & De Kimpe, N. (2004). Natural medicines used in the traditional Chinese medicine system for therapy of type 2 diabetes mellitus. Journal of Ethnopharmocology, 92, 1–21.

    Article  Google Scholar 

  • Lieberman, L. S. (2003). Dietary, evolutionary, and modernizing influences on the prevalence of Type 2 diabetes. Annual Review of Nutrition, 23, 345–377.

    Article  Google Scholar 

  • Liu, G. P., & Zhang, Z. (2004). Sociodemographic differentials of the self-rated health of the oldest-old Chinese. Population Research and Policy Review, 23, 117–133.

    Article  Google Scholar 

  • Lorig, K. R., Ritter, P., Stewart, A. L., Sobel, D. S, Jr, Brown, B. W., Bandura, A., et al. (2001). Chronic disease self-management program: 2-year health status and health care utilization outcomes. Medical Care, 39(11), 1217–1223.

    Article  Google Scholar 

  • Maddigan, S. L., Majumdar, S. R., & Johnson, J. A. (2005). Understanding the complex associations between patient-provider relationships, self-care behaviors, and health-related quality of life in type 2 diabetes: A structural equation modeling approach. Quality of Life Research, 14, 1489–1500.

    Article  Google Scholar 

  • Malinauskiene, V., Leisyte, P., Malinauskas, R., & Kirtiklyte, K. (2011). Associations between self-rated health and psychological conditions, lifestyle factors and health resources among hospital nurses in Lithuania. Journal of Advanced Nursing, 67(11), 2383–2393.

    Article  Google Scholar 

  • Miilunpalo, S., Vuori, I., Oja, P., Pasanen, M., & Urponen, H. (1997). Self-rated health status as a health measure: The predictive value of self-reported health status on the use of physician services and on mortality in the working-age population. Journal of Clinical Epidemiology, 50(5), 517–528.

    Article  Google Scholar 

  • Molarius, A., & Janson, S. (2002). Self-rated health, chronic disease, and symptoms among middle-aged and elderly men and women. Journal of Clinical Epidemiology, 55, 364–370.

    Article  Google Scholar 

  • Mossey, J. M., & Shapiro, E. (1982). Self-rated health: A predictor of mortality among the elderly. American Journal of Public Health, 72(8), 800–808.

    Article  Google Scholar 

  • Muthen, B. O., du Toit, S. H. C., & Spisic, D. (1997). Robust inference using weighted least square and quadratic estimating equations in latent variable modeling with categorical and continuous outcomes. http://pages.gseis.ucla.edu/faculty/muthen/psychometrics.htm.

  • Ni, H., Simile, C., & Hardy, A. M. (2002). Utilization of complementary and alternative medicine by United States adults. Medical Care, 40(4), 353–358.

    Article  Google Scholar 

  • Norris, S. L., Engelgau, M. M., & Venkat Narayan, K. M. (2001). Effectiveness of self-mangement training in type 2 diabetes: A systematic review of randomized controlled trials. Diabetes Care, 24(3), 561–587.

    Article  Google Scholar 

  • Norris, S. L., Lau, J., Smith, S. J., Schmid, C. H., & Engelgau, M. M. (2002). Self-management education for adults with type 2 diabetes: A meta-analysis of the effect on glycemic control. Diabetes Care, 25, 1159–1171.

    Article  Google Scholar 

  • Redekop, W. K., Koopmanschap, M. A., Stolk, R. P., Rutten, G. E., Wolffenbuttel, B. H., & Niessen, L. W. (2002). Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes. Diabetes Care, 25(3), 458–463.

    Article  Google Scholar 

  • Reimann, J. O. F., Talavera, G. A., Salmon, M., Nunez, J. A., & Velasquez, R. J. (2004). Cultural competence among physicians treating Mexican Americans who have diabetes: A structural model. Social Science and Medicine, 59, 2195–2205.

    Article  Google Scholar 

  • Ren, X. S., & Chang, K. (1998). Evaluating health status of elderly Chinese in Boston. Journal of Clinical Epidemiology, 51(5), 429–435.

    Article  Google Scholar 

  • Rubin, R. R., & Peyrot, M. (1999). Quality of life and diabetes. Diabetes Metabolism Research Review, 15(3), 205–218.

    Article  Google Scholar 

  • Sousa, V. D., & Zauszniewski, J. A. (2005). Toward a theory of diabetes self-care management. The Journal of Theory Construction and Testing, 9(2), 61–67.

    Google Scholar 

  • Stewart, A. L., Greenfield, S., Hays, R. D., Wells, K., Rogers, W. H., Berry, S. D., et al. (1989). Functional status and well-being of patients with chronic conditions: Results from the medical outcomes study. The Journal of the American Medical Association, 262(7), 907–913.

    Article  Google Scholar 

  • Thorne, S., Paterson, B., Russell, C., & Schultz, A. (2002). Complementary/alternative medicine in chronic illness as informed self-care decision making. International Journal of Nursing Studies, 39, 671–683.

    Article  Google Scholar 

  • Unden, A.-L., Elofsson, S., Andreasson, A., Hillered, E., Eriksson, I., & Brismar, K. (2008). Gender differences in self-rated health, quality of life, quality of care, and metabolic control in patients with diabetes. Gender Medicine, 5(6), 162–180.

    Article  Google Scholar 

  • van der Bijl, J., van Poelgeest-Eeltink, A., & Shortridge-Baggett, L. (1999). The psychometric properties of the diabetes management self-efficacy scale for patients with type 2 type 2 diabetes mellitus. Journal of Advanced Nursing, 30(2), 352–359.

    Article  Google Scholar 

  • Van der Does, F. E., de Neeling, J. N., Snoek, F. J., Grootenhuis, P. A., Kostense, P. J., Bouter, L. M., et al. (1998). Randomized study of two different levels of glycemic control within the acceptable range in type 2 diabetes. Diabetes Care, 21, 2085–2093.

    Article  Google Scholar 

  • Vinik, A. I., & Zhang, Q. (2007). Adding insulin glargine versus rosiglitazone. Diabetes Care, 30(4), 795–800.

    Article  Google Scholar 

  • Xu, Y., Pan, W., & Liu, H. (2010). Self-management practices of Chinese Americans with type 2 diabetes. Nursing and Health Science, 12, 228–234.

    Article  Google Scholar 

  • Xu, Y., Toobert, D., Savage, C., Pan, W., & Whitmer, K. (2008a). Adaptation and testing of instruments to measure diabetes self-management in people with type 2 diabetes in Mainland, China. Journal of Transcultural Nursing, 19(3), 234–242.

    Article  Google Scholar 

  • Xu, Y., Toobert, D., Savage, C., Pan, W., & Whitmer, K. (2008b). Factors influencing diabetes self-management in Chinese people with type 2 diabetes. Research in Nursing and Health, 31, 613–625.

    Article  Google Scholar 

  • Yeh, G. Y., Eisenberg, D. M., Davis, R. B., & Phillips, R. S. (2002). Use of complementary and alternative medicine among persons with type 2 diabetes mellitus: Results of a national survey. American Journal of Public Health, 92(10), 1648–1652.

    Article  Google Scholar 

  • Yin, J., Zhang, H. J., & Ye, J. P. (2008). Traditional Chinese medicine in treatment metabolic syndrome. Endocrine, Metabolic and Immune Disorders Drug Targets, 8(2), 99–111.

    Article  Google Scholar 

Download references

Acknowledgments

We thank Suzanne R. Kunkel, Professor, and J. Scott Brown, Associate Professor, for all their energy put into this study and for assisting with the manuscript revision.

Author information

Authors and Affiliations

  1. Department of Sociology and Gerontology, Miami University, Oxford, OH, USA

    Xi Pan

  2. Department of Kinesiology and Health, Miami University, Oxford, OH, USA

    Rose Marie Ward

Authors
  1. Xi Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rose Marie Ward
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xi Pan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pan, X., Ward, R.M. Self-management and Self-rated Health Among Middle-aged and Older Adults with Type 2 Diabetes in China: A Structural Equation Model. Soc Indic Res 120, 247–260 (2015). https://doi.org/10.1007/s11205-014-0575-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11205-014-0575-0

Keywords

Search

Navigation