178302 Self management factors that influence health outcome among individuals with type 2 diabetes in the U.S. Virgin Islands

Tuesday, October 28, 2008: 2:50 PM

Maxine A. Nunez, DrPH, MSN, RN , Division of Nursing Education, University of the Virgin Islands, St. Thomas, US Virgin Islands
Hossein N. Yarandi, PhD , Center for Health Research, Wayne State University, Detroit, MI
Marcella Nunez-Smith, MD, MHS , Department of Medicine, Yale University School of Medicine, New Haven, CT
Racial and ethnic health disparities in diabetes diagnosis, management, and outcomes have been demonstrated in the United States. Diabetes is also a major public health problem in the U.S. Virgin Islands (U.S.V.I.), and is the fifth leading cause of death in the territory. Prior research has demonstrated the important role of patient self-management in improving outcomes in patients diagnosed with diabetes. Although previous studies have focused on how race and ethnicity influence self-management, less is known about how this translates to a U.S. territory with a culturally distinct population that is predominantly of African descent.

Therefore, this research study aimed to answer the following questions: 1) How do patient factors, i.e. level of education, diabetes baseline knowledge, and income, influence self-management in a U.S.V.I. patient population ; 2) How do social contextual factors influence self-management? and 3) What experiences have encouraged or discouraged study participants to assume greater control of their diabetes management?

A mixed methods research design utilizing descriptive statistics, correlations and in-depth, structured qualitative interviews was employed. Data were collected from 53 Virgin Islanders diagnosed with type 2 diabetes within the prior 10 years. Qualitative transcripts were independently analyzed and Atlas ti 5.2 software was used to facilitate qualitative data organization and retrieval. SPSS 14 for Windows was used to analyze the unadjusted and adjusted relationships between patient characteristics, scores on multiple instruments, and HbA1C values.

Several recurrent themes are emerging from preliminary qualitative analysis such as the importance of fear in motivating behaviors and loose interpretations of advised medication regimens. Preliminary statistical analysis demonstrates low knowledge level scores across the sample. HbA1C values range from 5.0% to 13.0% with a mean of 7.36%. Further analysis will examine the association between HbA1C values and diabetes knowledge, social support, and several other measures.

There is very little research conducted on self management of chronic conditions in this population. Therefore, our findings will have several implications. This study willprovide the necessary insight to help clients and health care providers identify strategies

Learning Objectives:
1. Identify those patient factors and socio-cultural factors that significantly influence the self-management behaviors of Virgin Islanders with type 2 diabetes. 2. Distinguish between experiences that either encourage or discourage greater self control of a diabetic care regimen

Keywords: Diabetes, Self-Management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the primary researcher and investigator of the study that will be presented.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.