The Influence of the Social Determinants of Health on Diabetes Self-Management in Rural Appalachia

Purpose: Diabetes, a worldwide public health concern, has been linked with lower socioeconomic status, obesity, poor nutrition, membership in certain racial and / or ethnic groups, and family history of diabetes – factors often present in both urban and rural regions. Researchers are finding that greater knowledge of the relationship between social determinants of health and diabetes may provide insight into individuals’ health outcomes related to diabetes. The purpose of this descriptive phenomenological study was to explore the social determinants of health as they relate to diabetes self-management in a rural United States population.

Methods: This qualitative analysis is part of a study to gain insight into the individual’s perspective on living with diabetes given the social determinants of her/his situation. Recruitment of 10 adults was accomplished through key community contacts, local physicians, and posted flyers. Participants were both male (n=6) and female (n=4), on average 46.5 years of age, and had been diagnosed with diabetes for about 11 months (range 2-18 months). For purposes of this study, qualitative data were collected from digitally-recorded sessions and then analyzed using constant comparison and procedures to avoid bias. Identified themes were extracted to provide insight into individuals’ perspectives of living with diabetes.

Results: Data analysis revealed three major themes related to the influence of the social determinants of health on the individual’s perspective on living with diabetes: (1) importance of work; 2) importance of social connectivity/support; and (3) importance of family and sense of place in self-definition.

Conclusion: Diabetes is a nationwide public health concern in the United States; however, individuals in rural communities often face unique barriers or challenges. Results of this qualitative study offer healthcare providers helpful insight about facilitators and barriers to living with diabetes among a sample of rural residents from Southern Appalachia, United States. Findings illustrate the influence of external or upstream social determinants on the individual’s health. Further research to determine the influence of social determinants on diabetes self-management will help to improve individuals’ health outcomes.