Date on Master's Thesis/Doctoral Dissertation

12-2017

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Nursing

Degree Program

Nursing, PhD

Committee Chair

Chlebowy, Diane Orr

Committee Co-Chair (if applicable)

Hall, Lynne A.

Committee Member

Hall, Lynne A.

Committee Member

Crawford, Timothy N.

Committee Member

Yankeelov, Pamela A.

Author's Keywords

type 2 diabetes; glycemic control; anxiety; depression; stress; demographics

Abstract

Type 2 diabetes (T2D) is often associated with serious complications. African American adults have higher rates of diabetes-related complications than other ethnicities. Diabetes self-management reduces the risk of developing biological and psychological symptoms. Social support promotes positive behavior change and self-management that leads to improved biobehavioral and psychosocial outcomes. Few studies explored the relationship between social support dimensions and self-management behaviors, diabetes biomarkers, and psychosocial outcomes of African American adults with T2D. The purpose of this dissertation was to examine the relationships of various dimensions of social support with self-management behaviors and diabetes biomarkers and psychosocial outcomes of African American adults with T2D. This dissertation consists of three manuscripts which include: (1) a state of the science systematic review of social support measurement in studies of persons with T2D; (2) a study of the relationships of sociodemographic characteristics with dietary adherence and glycemic control in persons diagnosed with T2D; and (3) a cross-sectional study in which the effects of self-management as a mediator in the relationship between social support and health outcomes in African American adults diagnosed with T2D was explored. The systematic review of the literature revealed that the existing definitions of social support convey the need for uniform descriptions of the attributes of the concept. A majority of the studies used measures that assess perceived support. The desired outcomes of social support included positive behavior change, improved self-management, and improved health outcomes. The use of a combination of social support measures was recommended to capture the multidimensionality of support necessary to improve outcomes. The second manuscript examined the relationships of sociodemographic characteristics with adherence to American Diabetes Association (ADA) dietary guidelines and glycated hemoglobin (A1C)in adults with T2D. The results of this study showed that females, non-Hispanic Blacks, widowers, and those with less than a high school education had higher A1Cs than their counterparts. Race/ethnicity and marital status were significantly related to adherence to ADA dietary guidelines. In addition, sex, race/ethnicity, and marital status were significantly related to A1C. Thus, it is important to control for these sociodemographic characteristics in studying the impact of self-management on health outcomes in persons with T2D. The third manuscript results revealed that functional support, the quality of the primary intimate relationship, and the number of support persons were negatively correlated with depression. Functional support and satisfaction with support explained a significant amount of the variance in self-management. However, self-management failed to mediate the relationship between social support dimensions and health outcomes.

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