Exploring socioeconomic variations in diabetes control strategies: impact of outcome expectations

J Natl Med Assoc. 2009 Jan;101(1):18-23. doi: 10.1016/s0027-9684(15)30806-3.

Abstract

Objective: Prior studies have suggested socioeconomic differences in outcome expectations for diabetes. This paper explores outcome expectations of adults of varied socioeconomic status with type 2 diabetes, examining differences between African Americans and whites.

Design: A qualitative study using focus groups of individuals with type 2 diabetes. Interviews were tape recorded and transcribed verbatim. Data analysis was based on the constant comparative method, assisted by qualitative analysis software. Research was done in outpatient clinics in both a community health center and tertiary care center.

Participants: Seventy-one participants, 46% African American, 54% with household income less than or equal to $40,000, diagnosed with type 2 diabetes for at least 1 year.

Interventions: Subjects discussed coping mechanisms, including self-control, compliance discipline, and denial regarding diabetes.

Results: Behavior control was typified as (1) beliefs about controlling diabetes and (2) beliefs about controlling one's behavior aside from diabetes control. Patients described a range of strategies, including beliefs as self-efficacy, confidence and willingness to take on self-management, and. positive and negative outcome expectations about ability to modify the natural course of the disease.

Conclusions: Those of higher socioeconomic status espoused more positive outcome expectations and self-efficacy, while poorer subjects reported more negative outcome expectations. Factors such as perception of control may contribute to root causes of socioeconomic disparities seen in diabetes outcomes. INTERVENTIONS to increase compliance should address class-specific disease perceptions. Practical support that builds on patients' preferred strategies could help improve diabetes disparities.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Americans / psychology*
  • Diabetes Mellitus, Type 2 / ethnology*
  • Diabetes Mellitus, Type 2 / prevention & control
  • Diabetes Mellitus, Type 2 / psychology*
  • European Continental Ancestry Group / psychology*
  • Female
  • Focus Groups
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Middle Aged
  • Motivation
  • Socioeconomic Factors
  • Treatment Outcome