African American Women with Type 2 Diabetes : A Biopsychosocial-Spiritual Approach

Abstract

This dissertation consists of two articles written to address the context of type 2 diabetes care in African American women. In addition, the proposal and required Institutional Review Board (IRB) documentation are included as Appendices. The first article is a review of the existing literature regarding the psychosocial and spiritual aspects of type 2 diabetes management and outcomes in African American women. The aim of conducting this review of extant literature was to identify what further research was needed specifically in African American women with type 2 diabetes as there is very little to date. The second article was written to identify and explore several demographic and biopsychosocial-spiritual variables associated with type 2 diabetes control in African American women. A set of variables were found to predict diabetes control over time (hemoglobin A1c (HbA1c)), body mass index (BMI), and depression severity. The focus of type 2 diabetes management has been predominantly biomedical. With major disparities in morbidity and mortality and a growing disease burden, the psychosocial-spiritual context of diabetes is important to consider. For this non-systematic review, articles were found in Google Scholar, EBSCO, and reference sections of resultant articles. Search terms included "type 2 diabetes management," "family," and "African American" and were set as follows: "type 2 diabetes management and family" and "type 2 diabetes management and African American." A total of 41 articles met inclusion criteria. Several factors associated with type 2 diabetes management in African American women were identified including: psychosocial support, socioeconomic status, culture, gender and sex, mental health, and spirituality. African American women's health appeared particularly sensitive to family context and spiritual wellbeing. Culture, socioeconomic status, and mental health were also associated with their diabetes-related health outcomes. Future researchers should address the multiplicative influence of these factors specifically in relation to African American women and their diabetes management and outcomes. The second article was written to report the biopsychosocial-spiritual variables related to type 2 diabetes management in African American women. A cross-sectional survey of African American women with type 2 diabetes (n=58) was utilized to explore demographic and biopsychosocial-spiritual variables related to diabetes control (HbA1c). Associations between BMI and depression severity (PHQ-9) and demographic and biopsychosocial-spiritual variables were explored. Participants were surveyed with the following scales: Diabetes Care Profile, Patient Health Questionnaire-9 (PHQ-9), Family Crisis Orientation Personal Evaluation, Illness Cognition, Health Distress, and Basic Adlerian Scales for Interpersonal Success. BMI and current HbA1c were extracted from participants' medical records. According to hierarchical regression analyses, the biopsychosocial model trended toward significant prediction of the variance in HbA1c; the demographic and biopsychological model explained 27% (p<0.001) of the variance in BMI; and the demographic and biopsychosocial-spiritual model explained 52% (p<0.001) of the variance in depression. Disability status was a significant individual predictor of BMI. Health distress and social/personal factors were individually significant predictors of PHQ-9. A revised framework of biopsychosocial-spiritual factors may be more predictive of HbA1c and diabetes risk factors in this population. This warrants further investigation in efforts to improve type 2 diabetes management and outcomes.