The purpose of this proposed phenomenological study is to describe the experiences of uninsured men and women in Southern Appalachia with type 2 diabetes during the first year of diagnosis. Diabetes is a progressive chronic disease with multiple complications and a higher incidence and prevalence among people in rural regions. Diabetes has been linked with lower socioeconomic status, obesity, poor nutrition, membership in certain racial and/or ethnic groups, and a family history of diabetes - factors often present among people living in rural regions. Intensifying the effect of these risk factors are barriers to effective diabetes self-management that include depression and certain cultural beliefs/norms. In addition, residents of rural regions contend with disparities caused by geographical isolation, lack of access to primary and specialty healthcare, fewer healthcare providers, mistrust of outsiders, and excessive self-reliance. Diabetes self- management is essential for all people with diabetes to monitor the disease process, prevent complications, improve glycemic control, and improve quality of life. Successful self-management training enhances knowledge and skill, and facilitates ongoing support. There are many approaches to diabetes self-management training, but to be successful, the perspective of individuals diagnosed with diabetes must be understood by healthcare providers. This proposed study supports core NINR strategic objectives to eliminate disparities in health, to improve quality of life, and to enhance self-management for persons with chronic illness. Results of qualitative studies have revealed some culturally-based perspectives and attitudes towards type 2 diabetes among residents of Appalachia;however, past studies have not focused on the experience of rural southern Appalachian residents within the first year of diagnosis - a crucial time for initiating self- management. Numerous studies have focused on Hispanic and African American populations in rural and urban settings;however, uninsured rural residents of southern Appalachia have not been studied. There are several studies about the meaning of self-management of type 1 diabetes in adolescents and elderly populations, but no studies were found with uninsured adults with type 2 diabetes. Knowledge about the experience of self-management of diabetes, from the perspective of adults diagnosed with type 2 diabetes within the first year may bridge the gap between patients and healthcare providers, thus enhancing culturally- tailored care. This proposed phenomenological study will inform providers and thus allow for future research to develop and test diabetes self-management programs tailored for uninsured rural Appalachian adults with type 2 diabetes.

Public Health Relevance

The primary purpose of this phenomenological descriptive study is to describe the experience of uninsured rural adults within the first year after diagnosis with diabetes in Southern Appalachia. Diabetes is a public health concern in the United States both in urban and rural settings;however, there are unique barriers to care in rural settings, especially those settings classified as medically underserved areas. Barriers include geographical topography, lack of healthcare providers and facilities, cultural norms/beliefs, increased unemployment, lower education achievement, and lack of health insurance coverage. According to health economists, the national annual cost to the healthcare system and the individual from resultant complications of type 2 diabetes is greater than 150 billion dollars. Effective diabetes self- management has been described as critical in reducing burden to the individual with diabetes. A goal of Healthy People 2010 is to increase the proportion of persons with diabetes who receive formal diabetes education. Therefore, research is needed to describe the experience among adults living in rural Appalachia during the first year after diagnosis with type 2 diabetes - a crucial time for establishing self-management. Promoting effective diabetes self-management will result in fewer complications, reduced costs of care, and improved quality of life among adults living with diabetes.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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University of Virginia
Schools of Nursing
United States
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