Satisfaction with Life and Biopsychosocial-Spiritual Health among Underserved Patients with Diabetes

Abstract

The prevalence of type 2 diabetes continues to escalate, especially among vulnerable and underserved populations (CDC, 2008); however, the current landscape of literature has not kept pace with the trends of those most affected. Available data have often pertained to nonunderserved groups and only address part of patients' physical, mental, social, or spiritual lives. The literature review and research articles included in this dissertation integrate available knowledge pertaining to the comprehensive experiences of underserved groups with type 2 diabetes and specifically the understudied concept of satisfaction with life (SWL) among African American and Hispanic minority groups. The first article presented is a literature review written to synthesize studies of underserved populations with type 2 diabetes, including individuals who were of a minority ethnic group, socioeconomically disadvantaged, elderly, uninsured, and/or of lower educational level. The objective of this review was to amalgamate current evidence for underserved groups using a biopsychosocial-spiritual framework (Engel, 1977; Hodgson, Lamson, & Reese, 2007; Wright, Watson, & Bell, 1996). Themes and gaps in knowledge from approximately 1995 to the present were identified. Fifty-one studies were reviewed and grouped into three themes pertaining to overall health and disease management, including: psychological influences; marital, familial, and environmental influences; and spiritual influences. Researchers documented a number of psychological, social, and spiritual variables influencing glycemic control. In particular, depression and relational conflict adversely influenced glycemic control in some cases, whereas availability of social support or spiritual resources frequently assisted in better disease management. Lack of demographic data and attention to diverse groups, as well as, incomplete empirical knowledge prompt the need for further research of the influences of disease management among underserved groups. Three recommendations are suggested: 1) further exploration of the relationship between psychosocial-spiritual influences on diabetes management for uniquely underserved groups; 2) investigation of demographic differences or similarities; and 3) development and use of clinical models incorporating a multidisciplinary, collaborative stance in addressing diabetes for vulnerable populations. The second article extends current literature and aims to meet a number of the above mentioned recommendations. This article is focused on two groups with noted health disparities, African American and Hispanic minorities with type 2 diabetes. It was written to examine associations found between biomedical markers of disease management and psychosocial constructs and assess the correlates and predictors of variability for SWL. Data were collected from 142 minority patients (65 African American and 77 Hispanic) during their first visit within a collaborative care program. Pearson product moment correlations, multiple linear regressions, and one-way analysis of variance were used to examine research questions in this descriptive, quantitative study. Only one weak, significant relationship was noted for BMI and somatization; otherwise, no noteworthy relationships were documented between psychosocial or spiritual constructs and biomedical markers of disease management (HbA1c and body mass index). Psychological distress, social support, and spirituality accounted for 63% of the variance in SWL for African American participants and 29% of the variance in SWL for Hispanic participants. Social support was the strongest predictor of SWL for African American participants, while psychological distress was the strongest predictor of SWL for Hispanic participants. Social support moderated the relationship between psychological distress and SWL for Hispanic participants, while social support did not moderate this relationship for African American participants. Spirituality did not moderate the relationship between psychological distress and SWL for either ethnic group. Clinicians and researchers who work with and study minority patients with uncontrolled type 2 diabetes may see improvement in patients' SWL when screening for and treating psychopathology, interpersonal strain, and existential struggles. Attention to ethnic variation in research and clinical practice is important since dissimilarity existed in the determinants of SWL and moderators of psychological distress and SWL.