Diabetes self-management in a low-income population: impacts of social support and relationships with the health care system

Abstract

Objectives This article reports on results of a qualitative study of social supports and institutional resources utilized by individuals living with diabetes in a high-poverty urban setting. The goal was to examine how access to social capital among low-income populations facilitates and impedes their self-efficacy in diabetes self-management. Methods Semi-structured interviews were conducted with 34 patients with diabetes from a safety net primary care practice in Buffalo, New York. Results Facilitators and barriers to successful self-management were identified in three broad areas: (1) the influence of social support networks; (2) the nature of the doctor-patient relationship; and (3) the nature of patient-health care system relationship. Patients' unmet needs were also highlighted across these three areas. Discussion Participants identified barriers to effective diabetes self-management directly related to their low-income status, such as inadequate insurance, and mistrust of the medical system. It may be necessary for patients to activate social capital from multiple social spheres to achieve the most effective diabetes management.

Self-management as a mediator of the relationship between social support and health outcomes of African American adults with type 2 diabetes.

“…The definitions of social support (Table 1) convey the need for a uniform description of the attributes that delineate the concept. In their concept analysis of social support, Langford et al (1997) Appraisal support is an intangible support that positively reinforces changes in patient behavior in following predetermined self-management guidelines (Vest et al, 2013).…”

“…In addition, personal variables such as gender, culture, and race of both the support person and the patient were important variables that strengthen or hinder social support (Cosansu & Erdogan, 2013;Hempler et al, 2013;Mathew et al, 2012;Strom & Egede, 2012;Venkatesh & Weatherspoon, 2013;Vest et al, 2013). For example, Strom and Egede (2012) found that racial differences had a great impact on the mode of delivery of social support.…”

“…An active reciprocal exchange of information is the core of informational support (Finfgeld-Connett, 2005). Appraisal support is the intangible (verbal and nonverbal) support that reinforces changes in patient behavior related to self-management (Vest et al, 2013). Emotional support occurs through the empathetic expression of feelings, which is mainly varied by the nature of the relationship between the patient and the caregiver (Furler et al, 2008).…”

“…Psychosocial variables (e.g., sex, culture, and race of both the support person and the patient are impacting the effectiveness of social support dimensions (Cosansu & Erdogan, 2013;Hempler, Ekholm, & Willaing, 2013;Mathew et al, 2012;Strom & Egede, 2012;Venkatesh & Weatherspoon, 2013;Vest et al, 2013).…”

“…These outcomes are classified into three categories: (-1) positive health behavior change (Strom & Egede, 2012); (2) improved self-management, adherence to regimen, and glycemic control (Cosansu & Erdogan, 2013;Nicklett & Liang, 2010;Strom & Egede, 2012;Vest et al, 2013), and (3) improved mental health and psychosocial outcomes (Finfgeld-Connett, 2005;Fortmann, Gallo, & PhilisTsimikas, 2011;Glasgow et al, 2012;Strom & Egede, 2012). Conversely, negative outcomes were observed.…”