Four broad groups of factors have been linked with self-management behavior in type 2 diabetes over time: (1) characteristics of patients, (2) amount and management of stress, (3) characteristics of providers and provider-patient relationships, and (4) characteristics of the social network/context in which disease management takes place. Of these four, social network/context has received the least amount of study and has been described in terms not easily applicable to intervention. In this paper, we identified the social network/context of diabetes management as residing within the family. We defined the family for clinical purposes, reviewed the literature concerning what is known about the link between properties of the family context of care and outcomes in type 2 diabetes and other chronic diseases, and identified areas of family life that are relevant to diabetes management. This information was then used to demonstrate how a family context of care can serve as a clinical framework for integrating all four groups of factors that affect disease management. Implications of this approach for practice and research are described.

R E S U LT S -Both sex and the three domains of family life were related to disease management, but the results varied by ethnic group. For EA patients, sex, family world view, and family emotion management were related to disease management (scores for Family Cohere n c e w e re negatively associated with HbA 1 c level and depression, and poor scores for Conflict Resolution were linked with high depression); for Hispanic patients, sex and family s t ru c t u re / o rganization were related to disease management (high scores for Organized Cohesiveness were associated with good diet and exercise, and high scores for Family Sex-Role Tr aditionalism were related to high quality of life). No significant interactions with sex occurre d . C O N C L U S I O N S -Characteristics of the family setting in which disease management takes place are significantly linked to patient self-care behavior, and these linkages vary by patient e t h n i c i t y. A family' s multiple independent dimensions provide multiple targets for interv e n t i o n , and diff e rences in family norms, stru c t u res, and emotion management should be considere d to ensure that interventions are compatible with the setting of disease management.

OBJECTIVE -To describe and contrast the personal models of type 2 diabetes in European Americans (EAs) and Latinos and to highlight differences that require a reorientation of clinical care. RESEARCH DESIGN AND METHODS -A total of 116 EAs and 76Latino individuals with type 2 diabetes were interviewed about their personal model of diabetes. Responses to open-ended questions about the perceived cause, nature, seriousness, course, and future course of diabetes and its impact on everyday life were analyzed using an iterative process, and categories of response were established. Responses were examined within ethnic group, and comparisons across ethnic groups were made for clinically significant differences.RESULTS -Disease descriptions about the nature of the disease were categorized as experiential, biomedical, or psychosocial. Disease descriptions varied significantly by ethnicity ( 2 = 35.92, 2 df, P Ͻ 0.001), with more Latinos using an experiential model and more EAs using a biomedical model. Significant differences in life changes caused by the disease were found, with EAs reporting changes in exercise and spontaneity and Latinos in fatigue and mood. Individuals with diabetes from both ethnic groups gave comparable assessments about the cause, seriousness, and effectiveness of treatments for the disease.CONCLUSIONS -Clinical practice that attends to the concerns and experiences of individuals with diabetes from diverse ethnic groups is warranted. Broad assessment of personal models in diverse ethnic groups is recommended.

The number of indicators of chronic disease management is large and no practical framework is available to guide selection for use in intervention programs. In addition, it is often difficult to integrate multiple disease management indicators into a comprehensive picture of patient functioning. The authors present a heuristic framework for creating a profile of disease management and an empirically based descriptive typology of disease management behavior. From the literature, they identified 5 domains of disease management indicators: biologic, general health and functional status, emotional tone, quality of life, and behavioral. They selected 11 scales and assessed 187 patients with type 2 diabetes. Five statistically replicable patient disease management types were derived from exploratory and confirmatory cluster analyses and a descriptive narrative was created for each: balanced (33%), problematic (6%), coasters (34%), discouraged (16%), and distressed (11%). The typology describes different presentations of disease management that can be linked with patient-tailored interventions for patients with type 2 diabetes.

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