Self-Management among a Population of Patients with Adult-Onset Diabetes Mellitus in the U.S. Virgin Islands

Tuesday, 8 July 2008: 3:55 PM
Maxine A. Nunez, DrPH, MSN, RN , Nursing Education, University of the Virgin Islands, St. Thomas, US Virgin Islands
Hossein N. Yarandi, PhD , Center for Health Research, Wayne State University, Detroit, MI
Marcella Nunez-Smith, MD, MHS , Internal Medicine/Robert Wood Johnson Clinical Scholars Program, Yale University, New Haven, CT

Learning Objective 1: Describe self-management attitudes and behaviors of Virgin Islanders with adult onset diabetes mellitus

Learning Objective 2: Identify the unique patient and socio-cultural factors that substantially influence self-management attitudes and behaviors of Virgin Islanders with type 2 diabetes.

Diabetes is a major public health problem in the United States and in the U.S. Virgin Islands (USVI). When compared with whites and Hispanics, blacks continue to have the highest incidence of the disease at 10.5 per 1000 population. Although patient self-management is widely viewed as essential to hyperglycemic control, little is known about the facilitators and barriers to successful self-management in the culturally distinct USVI.

Our research objectives were: 1) To characterize how patients in this population define self-management and 2) To examine the association between patient factors (e.g. level of education, diabetes baseline knowledge), socio-cultural factors (e.g. social support and network structures) and self-management.

A mixed methods research design was utilized. Data were collected from 53 Virgin Islanders diagnosed with adult-onset diabetes within the prior 10 years. In-depth, structured qualitative interviews were conducted using a standard discussion guide to characterize patient experiences.. Qualitative transcripts were independently analyzed by two members of the research team using a developed code structure and discrepancies were resolved by negotiated consensus. Atlas ti 5.2 software was used to facilitate qualitative data organization and retrieval. SPSS 14 for Windows was used to analyze the unadjusted and adjusted relationships between patient characteristics (including HbA1C values), and scores on several relevant instruments.

Several recurrent themes are emerging from preliminary qualitative analysis such as the importance of fear in motivating behaviors and loose interpretations of advised medication regimens. Preliminary statistical analyses demonstrate low knowledge level scores across the sample. Mean HbA1C value was 7.4% ( range 5.0% - 13.0% ). Further analysis will examine the association between HbA1C values and diabetes knowledge, social support, and several other measures.

This study will provide the necessary insight to help clients and health care providers identify strategies and interventions that promote effective self-management in a unique population.