Diagnosis of Diabetes and Health Behaviors in Middle-Aged and Older Adults: The Role of Self-Efficacy and Social Support

Focusing on middle-aged and older adults, the present study objectives are to investigate the effects of a diabetes diagnosis on the initiation and maintenance of healthy behaviors and whether self-efficacy and social support modify the relationships.
The study sample came from the Health and Retirement Study. The predictor variables were diabetes diagnosis, self-efficacy, and social support from family and friends. The outcome variables were three health behaviors (alcohol consumption, smoking status, and physical activity) and utilization of four preventive care services (blood test for cholesterol, influenza vaccination, prostate cancer exam, and mammography).
Study 1 utilized a matched case-control difference-in-differences approach to estimate the effect of a diabetes diagnosis on the likelihood of change in health behaviors and utilization of preventive care services. Study 2 applied mixed-effects regression models to analyze the longitudinal effects of diabetes diagnosis, self-efficacy, and social support on health behavior changes and to examine the moderating effects of self-efficacy and social support. Study 3 performed Cox proportional hazards regression models to examine the effects of a diabetes diagnosis, self-efficacy, and social support on the hazards of failure to maintain healthy behaviors and to examine the moderating effects of self-efficacy and social support.
Results from study 1 indicated that individuals reduced alcohol consumption and increased utilization of blood tests for cholesterol and influenza vaccination after a diagnosis of diabetes. Findings from study 2 showed that a diagnosis of diabetes was associated with reduced drinking. A significant interaction between social support from family and diabetes diagnosis was found in predicting drinking and smoking. Last, study 3 reported that a diagnosis of diabetes was associated with higher hazards of failure to maintain physical activity. A significant interaction between social support from family and diabetes diagnosis was found in predicting physical activity maintenance.
The collective findings of the three studies suggest that a diagnosis of diabetes can be both a teachable moment that motivates the initiation of reducing health-risking behaviors, and a stressful health event that hinders maintenance of health-promoting behaviors. Mobilizing social support from family may help individuals adopt and maintain healthy behaviors after a diabetes diagnosis.