Older adults with diabetes who properly self-manage this disease can decrease their risk of severe complications and age more successfully. Diabetes and diabetic complications are major causes of mortality and morbidity; they are often devastating for patients and extremely costly to the health care system. Diabetes disproportionately affects minority populations, making it a major source of health disparity. While specific self-management intervention programs exist, members of rural and ethnic minority populations have little access to such programs and programs may not be culturally appropriate. Few programs are designed to meet the special needs of elderly populations. Little research has considered diabetes self-management strategies used by older adults, particularly older rural and minority adults. This project focuses on the self-management strategies used by rural older adults of different ethnicities (African American, Native American, European American) to manage Type 2 diabetes. The research combines survey and qualitative methods to produce an in-depth understanding of self-management.
The specific aims are to: (1) document the diabetes self- management strategies of community-dwelling rural older adults with Type 2 diabetes; (2) compare and contrast the diabetes self-management strategies of older adults by ethnic group; (3) identify cultural, social, economic, and life course predictors of and barriers to diabetes self-management; and (4) evaluate diabetes self-management strategies of older adults using a series of psychosocial and functional measures. This study will be guided by a conceptual framework of health self-management based on the investigators' ongoing work, and it will be conducted in 2 rural counties where the investigators have established a successful presence. The study has 2 components. Component 1 is a survey of 482 adults, aged 65 and older with diagnosed Type 2 diabetes. This sample will be equally divided among the 6 gender- ethnic groups, and it will be drawn using HCFA files. A computer assisted personal interview will be used to collect background characteristics, personality, self-management resources, self-management activities and outcome measures (e.g., Hemoglobin A1C, depression, quality of life). Component 2 includes in-depth interviews with 15 experts who provide diabetes services, and 48 older adults with diabetes. Expert selection will be based on the investigators' knowledge of the counties; older adults will be selected from the survey sample and include equal numbers by gender, ethnicity and glucose control. In-depth interview data will be used to explore the community context for diabetes self- management, as well as the processes by which older adults develop and maintain a self-management strategy. Multivariate techniques will be used in the analysis of the survey data. A systematic approach will be used to analyze the qualitative data.
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