Health-related quality of life, disease severity, and anticipated trajectory of diabetes

PURPOSE

Adults hospitalized with diabetes are likely to have multiple comorbid conditions contributing to suboptimal health-related quality of life. The purpose of this study was to survey urban, very low-income, hospitalized adults with diabetes about disease severity, anticipated disease trajectory, and self-rated health-related quality of life.

METHODS

Data were collected using the Brief Illness Perception Questionnaire, the 36-item Short Form Health Survey (SF-36), the comparative risk perception questionnaire, and glycosylated hemoglobin. Severity was defined by glycosylated hemoglobin level and current microvascular complications from diabetes.

FINDINGS

Those with more severe disease who also anticipated the development of additional diabetes-related complications were likely to have suboptimal physical and mental functioning. The perception of diabetes as a health threat concurrent with having non-diabetes-related comorbid chronic conditions contributed uniquely to explaining scores in health-related quality of life.

CONCLUSION

Hospitalized adults with diabetes represent a population affected by chronic disease demands that contribute to suboptimal physical and mental functioning. Suboptimal quality of life may contribute to severity of diabetes and to a perception of having a threatening disease trajectory. Hospitalization provides an opportunity for clinicians to intervene in mental and physical functioning by assessing for threatening illness perceptions and employing interventions to promote acceptance of functional limitations.

Afrocentric cultural values and beliefs: movement beyond the race and ethnicity proxy to understand views of diabetes

PURPOSE

The purpose of this study was to estimate the benefit of using a cultural characteristics scale to help diabetes educators understand how African Americans cope with diabetes. Illness representations are influenced by culture. Race and ethnicity as a proxy for culture provides an incomplete understanding of the mechanism by which cultural values influence representations of diabetes.

METHODS

A descriptive correlational design was employed by recruiting hospitalized adults with type 2 diabetes at 3 metropolitan northeast coast sites. The TRIOS Afrocentric cultural characteristics measure and the Illness perception Questionnaire were administered by paper-and-pencil to a diverse sample. Black race and African American ethnicity was used as a proxy for culture and compared to levels of agreement on an Afrocentric cultural scale to determine the relative ability to explain variance in illness representations of diabetes.

CONCLUSION

The TRIOS measure adapted to diabetes care explained variance in illness representations of diabetes, while African American ethnicity/black race was not able to explain variance in illness representations. Clinicians would benefit from considering the degree to which a patient identifies with particular cultural characteristics when tailoring interventions to manipulate illness representations that are not concordant with biomedical representations.

Self-regulation theory and the multigenerational legacy of diabetes

The purpose of this study was to lend further support to the practice-based theory multigenerational legacies of diabetes (MGLDM). The hypothesis that perceptions of diabetes differ depending upon self-reported family history of diabetes was tested. Surveys assessing illness representation were administered by mail to adults with type 2 diabetes who attended diabetes education programs in a Northern Metropolitan East Coast location. Perceptions of diabetes were significantly different between those who remember a family member having diabetes and those who do not. Components of the commonsense model that differ in this sample were personal control, treatment control, emotional representations, and illness coherence (understanding), which were associated with dietary and monitoring adherence. Exploring commonsense models of diabetes during education sessions may help identify perceptions that may be shaped by the experiences of family members.