Understanding the complex associations between patient-provider relationships, self-care behaviours, and health-related quality of life in type 2 diabetes: A structural equation modeling approach

Objectives: To assess associations between perceptions of the patient-provider relationship (PPR), BMI, and adherence to diet and exercise in a rural population with type 2 diabetes and determine how these variables relate to HRQL. Methods: A model of the hypothesized relationships between the constructs was proposed and tested using structural equation modeling (SEM) and data collected as part of a controlled study to improve care for individuals with type 2 diabetes in rural health regions. Results: In the final model, positive perceptions of the PPR had a direct impact on adherence to diet (beta = 0.23; p < 0.05), exercise (beta = 0.13; p < 0.05) and diabetes management attitudes (beta = 0.33; p < 0.05). The direct path from management attitudes to exercise was also significant (beta = 0.12; p < 0.05). Direct predictors of HRQL included management attitudes (beta = 0.16; p < 0.05), exercise adherence (beta = 0. 14, p < 0.05) and BMI (beta = -0.23; p < 0.05). Exercise adherence predicted BMI, whereas adherence to diet did not. The final model had an acceptable fit with the measured data (chi(2) = 30.6 (26, N = 372), p = 0.25; RMSEA = 0.02; TLI = 0.98; SRMR = 0.02). Conclusion: Patient-provider relationship and exercise adherence appeared to be key constructs in the model. HRQL in people with type 2 diabetes was positively associated with exercise adherence, which was related to a positive PPR. Adherence to diet was also related to a positive PPR, but diet adherence had no association with HRQL.