Date on Master's Thesis/Doctoral Dissertation

8-2012

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Health Promotion and Behavioral Sciences

Committee Chair

LaJoie, Andrew Scott

Author's Keywords

Diabetes; African American; Self-determination theory; Emotional distress; Self-management; Basic psychological needs

Subject

Diabetics--Mental health; Diabetics--Attitudes; Diabetes--Psychological aspects; African Americans--Health and hygiene; African Americans--Social conditions

Abstract

Introduction: African Americans are disproportionally diagnosed with Type-2 diabetes, and have been observed to have poor self-management, which increases risk of complications. Social influences are commonly associated with diabetes-related outcomes. Purpose: The purpose of the study was to assess whether and how socio-contextual factors influence self-management and emotional distress in urban African American adults living with type-2 diabetes, as well as to assess whether social support facilitate relatedness need fulfillment within this population. The study also sought to gain an understanding of the psychosocial support needs and preferences of urban African American adults living with type-2 diabetes. Methods: The descriptive study employed a mixed-methods research design. African American adults were recruited to take a one-time written survey. Hypotheses one and two were tested using hierarchical linear regression, hypothesis three was assessed using VI a simple linear model, and hypotheses four and five were evaluated using path analysis. Four gender-stratified follow-up focus groups were also conducted, to confirm quantitative findings and gain insight into the support needs and preferences of urban African American adults living with type-2 diabetes. Study Variables: Independent study variables included social support, autonomy support, basic psychological needs (autonomy, competence, relatedness), and autonomous regulation. Primary dependent variables were diabetes self-management and diabetes-related emotional distress. Results: 155 eligible individuals (67 male, 88 female) were included in the quantitative analytic sample. 23 individuals (10 male, 13 female) participated in follow-up focus groups, yielding a total of 6 hours of audio-recorded focus group data. Autonomy and competence significantly predicted self-management and emotional distress in hypotheses one and two, respectively. Competence was the strongest predictor of selfmanagement and emotional distress among sample participants, followed by autonomy, but relatedness was not observed to be a significant variable in the prediction of study outcomes. Social support was observed to significantly predict relatedness need fulfillment in a simple linear model for hypothesis three. Data did not support hypothesis four and five. Qualitative findings contextualized the quantitative study findings. Conclusions: Future support programs should facilitate basic need fulfillment in urban African American adults living with type-2 diabetes. Relatedness is especially important in this collectivistic cultural group.

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