Examining the Support Peer Supporters Provide Using Structural Equation Modeling: Nondirective and Directive Support in
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ORIGINAL ARTICLE
Examining the Support Peer Supporters Provide Using Structural Equation Modeling: Nondirective and Directive Support in Diabetes Management Sarah D. Kowitt, MPH 1 & Guadalupe X. Ayala, PHD, MPH 2 & Andrea L. Cherrington, MPH, MD 3 & Lucy A. Horton, MS, MPH 4 & Monika M. Safford, MD 5 & Sandra Soto, MPH 6 & Tricia S. Tang, PHD 7 & Edwin B. Fisher, PHD 1
# The Society of Behavioral Medicine 2017
Abstract Background Little research has examined the characteristics of peer support. Pertinent to such examination may be characteristics such as the distinction between nondirective support (accepting recipients’ feelings and cooperative with their plans) and directive (prescribing “correct” choices and feelings). Purpose In a peer support program for individuals with diabetes, this study examined (a) whether the distinction between nondirective and directive support was reflected in participants’ ratings of support provided by peer supporters and (b) how nondirective and directive support were related to depressive symptoms, diabetes distress, and Hemoglobin A1c (HbA1c). Methods Three hundred fourteen participants with type 2 diabetes provided data on depressive symptoms, diabetes distress, and HbA1c before and after a diabetes management intervention delivered by peer supporters. At post-intervention, participants reported how the support provided by peer
supporters was nondirective or directive. Confirmatory factor analysis (CFA), correlation analyses, and structural equation modeling examined the relationships among reports of nondirective and directive support, depressive symptoms, diabetes distress, and measured HbA1c. Results CFA confirmed the factor structure distinguishing between nondirective and directive support in participants’ reports of support delivered by peer supporters. Controlling for demographic factors, baseline clinical values, and site, structural equation models indicated that at post-intervention, participants’ reports of nondirective support were significantly associated with lower, while reports of directive support were significantly associated with greater depressive symptoms, altogether (with control variables) accounting for 51% of the variance in depressive symptoms. Conclusions Peer supporters’ nondirective support was associated with lower, but directive support was associated with greater depressive symptoms.
Electronic supplementary material The online version of this article (doi:10.1007/s12160-017-9904-2) contains supplementary material, which is available to authorized users. * Sarah D. Kowitt [email protected]
Monika M. Safford [email protected]
Guadalupe X. Ayala [email protected]
Sandra Soto [email protected]
Andrea L. Cherrington [email protected]
Tricia S. Tang [email protected]
Lucy A. Horton [email protected]
Edwin B. Fisher [email protected]
ann. behav. med.
Keywords Social support . Diabetes . Chronic disease management
Introduction Research has consistently documented the beneficial effects of social support and
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