Objectives: To assess associations between perceptions of the patient–provider relationship (PPR), BMI, 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 (β = 0.23; p <0.05), exercise="" (β="0.13;">p <0.05) and="" diabetes="" management="" attitudes="" (β="0.33;">p <0.05). the="" direct="" path="" from="" management="" attitudes="" to="" exercise="" was="" also="" significant="" (β="0.12;">p <0.05). direct="" predictors="" of="" hrql="" included="" management="" attitudes="" (β="0.16;">p <0.05), exercise="" adherence="" (β="0.14,">p <0.05) and="" bmi="" (β="−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="">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.
Keywords Diabetes mellitus - Health related quality of life - BMI - Diet - Exercise