The proposed research addresses the effects of a family- based model -- composed of family, personal and provider characteristics -- on the self-care behaviors, health-care utilization and quality of life of non- Hispanic white and Hispanic Type II diabetic patients and their spouses over time. There is wide variation in patient and family response to diabetes, with subsequent variation in disease progression, use of health care resources and costs over time. Characteristics of the family unit have been identified as a primary predictor of disease- related outcomes in Type I diabetes and other major chronic conditions, but few studies of the family have been undertaken in Type II diabetes. Using the family as an underlying framework, a longitudinal study is proposed: (1) to test and compare for non-Hispanic whites and Hispanics a comprehensive, integrated model of diabetes outcomes composed of the direct and interactive effects of three groups of variables -- patient beliefs, traits and reactivity to stress, provider beliefs and practice style, and family qualities and characteristics -- on indices of diabetes outcomes over time; (2) to use important summary composites from these groups of variables to establish an empirically-based typology of patient/family functioning in relation to diabetes management for non- Hispanic whites and Hispanics; and (3) to explain the links between the types of patient/family contexts and diabetes outcomes by ethnographic/interpretive methods for these two ethnic groups.
