Family History of Diabetes: Implications for Illness Beliefs and Self-Care
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Introduction: Type 2 diabetes (T2DM) is a major public health problem and family history of diabetes (FHD) is a risk factor for developing diabetes, poorer self-care, and worse diabetes outcomes. However, the implications of a FHD for patients living with T2DM have been understudied. This study examined: 1) the relationship between a FHD, illness beliefs, and diabetes self-care, 2) the implications of specific characteristics of a FHD for illness beliefs and self-care behaviors among those participants with a FHD, and 3) the experience of FHD among adults in the Bronx with T2DM, via an exploratory pilot qualitative study.;Methods: Participants with T2DM (n = 120) completed self-report measures including the Illness Perception Questionnaire-Revised (IPQ-R), the Self-Care Inventory-Revised (SCI-R), and a FHD questionnaire, with 13 completing qualitative interviews. Quantitative data were analyzed cross-sectionally utilizing Spearman's correlations, Mann Whitney U-tests, independent samples t-tests, and chi-squares. The qualitative data were analyzed using Auerbach and Silverstein's method, based in grounded theory.;Results: Participants with a FHD had significantly higher IPQ-R negative emotional representations, M= .59, 95% CI [.2, .98], t(118) = 3.03,p = .003, and negative consequences subscale scores M= .36, 95% CI [.05, .68], t(118) = 2.314,p = .022 compared to those without. No significant difference between FHD groups was found on IPQ-R personal or treatment control or SCI-R scores. Among participants who endorsed a FHD (n = 90), descriptive correlational analyses found that IPQ-R treatment control subscale scores were positively correlated with timeline (acute/chronic) and personal treatment control. IPQR negative consequences subscale scores were correlated with both more negative emotional representations and higher SCI-R scores; negative emotional representations were also correlated with higher SCI-R scores. Number of very close family members who died of diabetes-related causes was significantly correlated with number of very close family members who had diabetes complications and number of family members who had very good control of their diabetes. Number of family members for whom diabetes had an effect on their day-to-day life was positively correlated with number of family members who had very good control of their diabetes, who had diabetes complications, and higher IPQ-R negative consequences subscale scores. Agreement that heredity is a likely cause of one's diabetes was correlated with lower IPQ-R personal control subscale scores, p= -0.21. IPQ-R timeline (acute/chronic) subscale scores were also positively correlated with number of very close family members who died from diabetes-related causes, p= .27. Number of very close relationships with family members who died from diabetes-related causes was associated with higher IPQ-R negative consequences subscale scores, M= .49, 95% CI [0.1, .88], t(44) = 2.55, p = 0.014. Participants who had close relationships with family members who died from diabetes-related causes also endorsed higher IPQ-R timeline (acute/chronic) subscale scores, U = 345.5, z = 1.99, p = .046. Three Theoretical Constructs: The Trauma of Diabetes in the Family, Silences Surrounding Diabetes and other Illnesses, and Belief in a Different Personal Legacy of Diabetes, comprised of eight Themes and 14 Repeating Ideas, were derived from the exploratory qualitative interviews. Participants described the devastating impact of a loved one's sudden diagnosis with diabetes, especially when accompanied by complications, patterns of family communication about illness, generational differences in the diabetes experience of their loved ones compared to themselves, and their own attempts at somatic-meaning making and greater agency regarding their T2DM.;Conclusions: The results of this study suggest that a FHD is associated with illness beliefs regarding greater consequences and more emotional representations of diabetes within our population of urban, socioeconomically marginalized adults with relatively poor diabetes self-management. Other differences between people with and without a FHD on illness beliefs and self-management behaviors were not found. Among participants with a FHD, specific attributes of one's FHD were associated with a chronic illness timeline and greater emotional representations and negative consequences. Qualitative findings suggest that FHD has informed how participants understanding of their loved ones' diabetes and their approach to their own diabetes when they were later diagnosed. The implications of these findings, limitations of the current study, and future research directions are also addressed.
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