Worry, Psychological Well-Being, and Health Behaviors in Asian and Pacific Islanders with Diabetes

Background: Self-management of diabetes mellitus (DM) involves complex modifications of daily life. Patient education that can increase knowledge of the disease and disease management skills may or may not lead to transformative health behavior changes. One of the barriers to behavior change is patients’ worries. People with diabetes have worries about their disease and these are related to worries about being able to carry out family responsibilities in the future, worries about their financial future, worries about weight, and worries about risk for hypoglycemia (Peyrot, Rubin, Lauritzen, Snoek, Matthews, & Skovlund, 2005). Asian Americans tend to score higher on social and diabetes-specific worries; however, investigation into the effects of worry on health has focused primarily on worry's motivational properties and little is known about how worry affects self-management adherence and psychological well-being in various ethnic groups of people with diabetes.

Objectives: The purpose of this secondary data analyses was to investigate the relationship between worry, psychological well-being, and health behaviors in Asian and Pacific Islanders (API) with diabetes, and to compare subgroups (i.e., clusters) of patients based on their levels of and types of worry in terms of psychological well-being and health behaviors.

Method: The study sample included 197 patients with diabetes, who were enrolled in the ENHANCE project. Baseline data of this two arm randomized controlled intervention trial were used for the current analyses. All patients were Asian American (72%) and Pacific Islanders (28%). Participants ranged in age from 18 and 76 years (M=57.3 years, SD=10.9 years). The majority of the participants were female (54%), married (67%), and had at least some college education (79%). Participants self-reported their worries on two subscales of the Diabetes Quality of Life Scale (DQOL), diabetes specific worries (DW) and social/vocational worries (SW) (higher adjusted subscale scores indicate highest levels of worry on a scale of 0 to 100), as well as Item 16 of the Multidimensional Diabetes Questionnaire (MDQ), which asked to what extent the patient "worry about your diabetes?" (0 = low, 6 = high).

Results: Independent t-tests on worry variables by ethnicity indicated that the Hawaiian and Pacific Islanders in the current study experienced significantly higher level of worries than the Asian participants (DW group means were 34.89 vs. 23.82, p < .05; SW group means were 20.76 vs. 11.99, p < .05; MDQ16 group means were 4.68 vs. 3.88, p < .01 for HPI and Asian patients, respectively). K-means and two-step cluster analyses using DW, SW, and MDQ16 revealed three clusters: 1) Cluster1 (n = 30) consisted of patients who scored high on social and diabetes related worries, 2) Cluster 2 (n = 88) scored low social worries, but high diabetes related worries, 3) Cluster 3 (n = 79) included patients scoring low on social and diabetes related worries. A chi-square test showed significant (p < .01) association between cluster membership and ethnicity: a higher percentage of HPI participants (26.4%) were in Cluster 1 compared to Asian (10.9%), whereas a lower percentage of HPI participant (20.8%) were in Cluster 3 compared to Asian (48.2%). Chi-square tests results further indicated that  patients in Clusters 1 are more likely to be a) depressed (p < .05), b) so depressed that they “couldn’t function well” (p < .01), and c) current smokers, compared to Clusters 2 and 3.

Conclusion and Discussion: Findings of this study suggest that levels and types of worry have an effect on psychological well-being (i.e. depression) and self-management adherence (i.e., smoking) among Asian and Pacific Islander patients with DM. In addition, this study supported the understanding that worry perception and impact may differ among ethnic groups (Awang-Hashim, O'Neil, & Hocevar, 2002; Huang, et al., 2009). Future research is needed to examine the effects of worry perception on other psychological well-being and physiological outcomes.