A study was conducted to determine if an intervention could change social support and social-ecological resources of post-menopausal women diagnosed with type 2 diabetes, and if those changes mediated the intervention’s effects on health behaviors and outcomes. Women (N = 279) were randomly assigned to receive a comprehensive 6-month Mediterranean Lifestyle Program (MLP) or usual care from their physicians (UC). MLP was successful in changing social embeddedness and social-ecological resources, but not a measure of perceived support. Changes in social-ecological resources mediated intervention effects on fat consumption, exercise and glycemic control. The experimental manipulation of mediators and the demonstrated mediation effects support the conclusion that social-ecological resources can contribute to improvements in healthful lifestyles for women with type 2 diabetes.
Baron, R. M. , & Kenny, D. A. (1986). The moderator-mediator distinction in social psychological research: Conceptual, strategic, and statistical considerations . Journal of Personality and Social Psychology, 51, 1173-1182 .
2.
Barrera, M., Jr. (1986). Distinctions between social support concepts, measures, and models . American Journal of Community Psychology, 14, 413-445 .
3.
Barrera, M., Jr , Glasgow, R. E. , McKay, H. G. , Boles, S. M. , & Feil, E. G. (2002). Do Internet-based support interventions change perceptions of social support? An experimental trial of approaches for supporting diabetes self-management . American Journal of Community Psychology, 30, 637-654 .
4.
Barrera, M., Jr , & Prelow, H. (2000). Interventions to promote social support in children and adolescents. In D. Cicchetti , J. Rappaport , I. N. Sandler , & R. Weissberg (Eds.), The promotion of wellness in children and adolescents (pp. 309-339). Washington, DC: CWLA Press .
5.
Bogat, G. A. , Sullivan, L. A. , & Grober, J. (1993). Applications of social support to preventive interventions. In D. S. Glenwick & L. A. Jason (Eds.), Promoting health and mental health in children, youth, and families (pp. 205-232). New York: Springer .
6.
Chen, H.-T. (1990). Theory-driven evaluations. Newbury Park, CA: Sage .
7.
Cohen, S. (1988). Psychosocial models of the role of social support in the etiology of physical disease . Health Psychology, 7, 269-297 .
8.
Cohen, S. , Doyle, W. J. , Skoner, D. P. , Rabin, B. S. , & Gwaltney, J. M., Jr. (1997). Social ties and susceptibility to the common cold . Journal of the American Medical Association, 277, 1940-1944 .
9.
Cohen, S. , & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis . Psychological Bulletin, 98, 310-357 .
10.
De Lorgeril, M. , Renaud, S. , Mamelle, N. , Salen, P. , Martin, J. L. , Monjaud, I. , Guidollet, J. , Touboul, P. , & Delaye, J. (1994). Mediterranean alpha-linolenic acid-rich diet in secondary prevention of coronary heart disease . Lancet, 343, 1454-1459 .
11.
DiMatteo, M. R. (2004). Social support and patient adherence to medical treatment: A meta-analysis . Health Psychology, 23, 207-218 .
12.
Fitzgibbon, M. L. , Stolley, M. R. , Avellone, M. E. , Sugerman, S. , & Chavez, N. (1996). Involving parents in cancer risk reduction: A program for Hispanic American families . Health Psychology, 15, 413-422 .
13.
Glasgow, R. E. , Strycker, L. A. , Toobert, D. J. , & Eakin, E. A. (2000). Social-ecologic approach to assessing support for disease self-management: The Chronic Illness Resource Survey . Journal of Behavioral Medicine, 23, 559-583 .
14.
Glasgow, R. E. , & Toobert, D. J. (1988). Social environment and regimen adherence among type II diabetic patients . Diabetes Care, 11, 377-386 .
15.
Glasgow, R. E. , Toobert, D. J. , Barrera, M., Jr , & Strycker, L. (2005). The Chronic Illness Resources Survey: Cross-validation and sensitivity to intervention . Health Education Research, 20, 402-409 .
16.
Hamrick, N. , Cohen, S. , & Rodriguez, M. S. (2002). Being popular can be healthy or unhealthy: Stress, social network diversity, and incidence of upper respiratory infection . Health Psychology, 21, 294-298 .
17.
Harada, N. V. , Chiu, V. , King, A. , & Stewart, A. (2001). An evaluation of three self-report physical activity instruments for older adults . Medicine and Science in Sports and Exercise, 35, 1279-1286 .
18.
Helgeson, V. S. , Cohen, S. , Schulz, R. , & Yasko, J. (2000). Group support interventions for women with breast cancer: Who benefits from what?Health Psychology, 19, 107-114 .
19.
Helgeson, V. S. , & Gottlieb, B. H. (2000). Support groups. In S. Cohen , L. G. Underwood , & B. H. Gottlileb (Eds.), Social support measurement and intervention: A guide for health and social scientists (pp. 221-245). New York: Oxford University Press .
20.
Hogan, B. E. , Linden, W. , & Najarian, B. (2002). Social support interventions: Do they work?Clinical Psychology Review, 22, 381-440 .
21.
Holland, P. W. (1988). Causal inference, path analysis, and recursive structural equation models . Sociological Methodology, 18, 449-484 .
22.
Kristal, A. R. , Curry, S. J. , Shattuck, A. L. , Feng, Z. , & Li, S. A. (2000). Randomized trial of a tailored, self-help dietary intervention: The Puget Sound Eating Patterns Study . Preventive Medicine, 31, 380-389 .
23.
Kristal, A. R. , Shattuck, A. L. , & Henry, H. J. (1990). Patterns of dietary behavior associated with selecting diets low in fat: Reliability and validity of a behavioral approach to dietary assessment . Journal of the American Dietetic Association, 90, 214-220 .
24.
Lord, F. M. (1956). The measurement of growth . Educational and Psychological Measurement, 16, 421-437 .
25.
MacKinnon, D. P. , & Dwyer, J. H. (1993). Estimating mediated effects in prevention studies . Evaluation Review, 17, 144-158 .
26.
MacKinnon, D. P. , Taborga, M. P. , & Morgan-Lopez, A. A. (2002). Mediation designs for tobacco prevention research . Drug and Alcohol Dependence, 68, S69-S83 .
27.
Miller, Y. D. , Trost, S. G. , & Brown, W. J. (2002). Mediators of physical activity behavior change among women with young children . American Journal of Preventive Medicine, 23(2S), 98-103 .
28.
Ornish, D. (1990). Dr. Dean Ornish’s program for reversing heart disease. New York: Ballantine .
29.
Patterson, R. E. , Kristal, A. , Tinker, L. F. , Carter, R. A. , Bolton, M. P. , & Agurs-Collins, T. (1999). Measurement characteristics of the Women’s Health Initiative Food Frequency Questionnaire . Annals of Epidemiology, 9, 178-187 .
30.
Pham, D. , Fortin, E. , & Thibaudeau, M. E. (1996). The role of the health belief model in amputees’ self-evaluation of adherence to diabetes self-care behaviors . The Diabetes Educator, 22, 126-132 .
31.
Preacher, K. J. , & Leonardelli, G. J. (2001). Calculation for the Sobel test: An interactive calculation tool for mediation tests [computer software], March. Available at http://www.unc.edu/%7Epreacher/sobel/sobel.htm
32.
Rogosa, D. (1988). Myths about longitudinal research. In K. W. Schaie , R. T. Campbell , W. Meredith , & S. C. Rawlings (Eds.), Methodological issues in aging research (pp. 171-209). New York: Springer .
33.
Rogosa, D. , & Willett, J. B. (1983). Demonstrating the reliability of the difference score in the measurement of change . Journal of Educational Measurement, 20, 335-343 .
34.
Sallis, J. F. , & Nader, P. R. (1988). Family determinants of health behaviors. In D. S. Gochman (Ed.), Health behavior: Emerging research perspectives (pp. 107-124). New York: Plenum .
35.
Sherbourne, C. D. , & Stewart, A. L. (1991). The MOS social support survey . Social Science and Medicine, 32, 705-714 .
36.
Spiegel, D. , & Classen, C. (2000). Group therapy for cancer patients: A research-based handbook of psychosocial care. New York: Basic Books .
37.
Stewart, A. L. , Mills, K. M. , King, A. C. , Haskell, W. L. , Gillis, D. , & Ritter, P. L. (2001). CHAMPS Physical Activity Questionnaire for older adults: Outcomes for interventions . Medicine and Science in Sports and Exercise, 33, 1126-1141 .
38.
Toobert, D. , Glasgow, R. E. , Strycker, L. A. , Barrera, M., Jr , Radcliffe, J. L. , & Wander, R. C. (2003). Physiologic and quality of life outcomes from the Mediterranean Lifestyle Program: A randomized clinical trial . Diabetes Care, 26, 2288-2293 .
39.
Toobert, D. J. , Strycker, L. A. , & Glasgow, R. E. (1998). Lifestyle change in women with coronary heart disease: What do we know?Journal of Women’s Health, 7, 685-699 .
40.
Toobert, D. J. , Strycker, L. A. , Glasgow, R. E. , & Bagdade, J. D. (2002). If you build it, will they come? Reach and adoption associated with a comprehensive lifestyle management program for women with type 2 diabetes . Patient Education and Counseling, 48, 99-105 .
41.
Toobert, D. J. , Strycker, L. A. , Glasgow, R. E. , Barrera, M., Jr , & Angell, K. L. (2005). Behavioral and psychosocial effects of the Mediterranean Lifestyle Trial among women at risk for heart disease . Annals of Behavioral Medicine, 29, 128-137 .
42.
Uchino, B. T. (2004). Social support and physical health: Understanding the health consequences of relationships. New Haven, CT: Yale University Press .
43.
Wills, T. A. , & Shinar, O. (2000). Measuring perceived and received social support. In S. Cohen , L. G. Underwood , & B. H. Gottlieb (Eds.), Social support measurement and intervention: A guide for health and social scientists (pp. 86-135). New York: Oxford University Press .
