Financial Insecurity and Attitudes Toward Self-Care Management in Adults With Diabetes

Purpose: People with diabetes often struggle with self-care. Financial insecurity may create added challenges. The purpose of this study was to examine the relationship of participant’s attitudes toward their self-care and their perceived ability to pay for basic needs.

Methods: A secondary analysis was done of baseline data (2009-2011) from a study of adults with type 2 diabetes and self-reported sleepiness (R21 HL 089522). Instruments included the Diabetes Care Profile subscales for Positive Attitudes and Negative Attitudes that measured psychological factors affecting self-care and the Profiles of Mood States that measured general mood disturbance. Clinical evaluations included height/weight to calculate BMI kg/m² and A1C level. Demographic information included age, gender, race, education, marital status, and the question “How difficult is it for you to meet your basic needs (i.e. food, housing, utilities, and health care?)” with possible responses dichotomized as “not at all difficult” and “somewhat or extremely difficult.” Data analysis with IBM SPSS 22 included descriptive statistics, Mann-Whitney U tests, Spearman correlations; and significance, p< .05.

Results: The sample (N=107) was middle-aged (Mean ± SD = 52.23 ± 9.28 years, range = 31-82 years), had suboptimal glucose control (Mean A1C =7.3% ± 1.5) and was well distributed by gender, race, education, and marital status (females 58%, non-Caucasian 53%, > high school education 63%; married/partnered 42%). Participants (n=88, 76%) who responded “somewhat or extremely difficult” paying for their basic needs were significantly more likely than participants reporting “not at all difficult” to experience worse negative attitude towards their diabetes self-care, lower positive attitude, and higher mood disturbances, (all p-values < .01). Higher BMI was significantly associated with worse mood disturbance (rho=.31) and lower positive attitude (rho = -.27, p <.01).

Conclusion. Data collection took place during a period of economic depression for many individuals in the United States. In a sample of participants for whom the majority experience financial insecurity, there was a relationship between the perception of their ability to pay for their basic needs and their attitude towards being able to manage their diabetes self-care.