Fatalism, Social Support and Self-Management Perceptions among Rural African Americans Living with Diabetes and Pre-Diabetes

Abstract

Diabetes is a public health problem and a major risk factor for cardiovascular disease, the leading cause of death in the United States. Diabetes is prevalent among underserved rural populations. The purposes of this study were to perform secondary analyses of existing clinical trial data to determine whether a diabetes health promotion and disease risk reduction intervention had an effect on diabetes fatalism, social support, and perceived diabetes self-management and to provide precise estimates of the mean levels of these variables in an understudied population. Data were collected during a cluster randomized trial implemented among African American participants (n = 146) in a rural, southern area and analyzed using a linear mixed model. The results indicated that the intervention had no significant effect on perceived diabetes management (p = 0.8), diabetes fatalism (p = 0.3), or social support (p = 0.4). However, the estimates showed that, in the population, diabetes fatalism levels were moderate (95% CI = (27.6, 31.3)), and levels of social support (CI = (4.0, 4.4)) and perceived diabetes self-management (CI = (27.7, 29.3)) were high. These findings suggest that diabetes fatalism, social support, and self-management perceptions influence diabetes self-care and rural health outcomes and should be addressed in diabetes interventions.

A Structural Equation Modeling Analysis to Explore Diabetes Self-Care Factors in a Rural Sample

“…Little is known about factors that influence diabetes self-care outcomes, and the findings of this study contribute to the literature about diabetes outcomes among underserved rural groups. In this sample, the intervention had no statistically significant impact on perceived diabetes self-management, and a possible rationale could be that the levels were already high at baseline and left little room for improvement at post-test [ 47 ]. However, in this analysis, perceived diabetes self-management had the largest impact on self-care behaviors, as greater self-efficacy in performing self-care activities was associated with the actual performance of those behaviors.…”

“…This result makes clinical sense since, with an increase in the perception of diabetes self-management, it would seem likely that people would have greater feelings of self-efficacy and fewer fatalistic beliefs about living with and managing diabetes. However, even though the perceived diabetes self-management score was reported as high in this population, diabetes fatalism was moderate, which suggests that interventions should include efforts to reduce fatalism by directly impacting psychological and behavioral factors [ 47 , 53 ]. This has clinical importance because other studies found that higher diabetes fatalism was directly linked to poor glycemic control, poor medication adherence, and decreased self-care [ 53 , 54 , 55 ].…”

Mediation by Fatalism of the Association Between Symptom Burden and Self-care Management in Patients With Heart Failure

“…20 For example, fatalistic individuals with diabetes have poor medication adherence and self-care behaviors compared with those who are not fatalistic. 21,22 Fatalistic individuals more commonly have major misperceptions about the risks they face for heart disease and cancer. 23 Several investigators have shown that higher levels of fatalism are associated with worse patient outcomes.…”

“…As a result, fatalistic individuals are more likely to accept what happens in their lives without attempting to change it or engaging in behaviors that could prevent or manage an illness 20 . For example, fatalistic individuals with diabetes have poor medication adherence and self-care behaviors compared with those who are not fatalistic 21,22 . Fatalistic individuals more commonly have major misperceptions about the risks they face for heart disease and cancer 23 .…”

“…Fatalism is an appropriate candidate for this mediator 21 . Investigators indicate that increased fatalism can detrimentally affect self-care and lead to adverse health outcomes 22,31 . Thus, our aim was to determine whether fatalism mediates an association between symptom burden and SCM.…”