Understanding Type 2 Diabetes Self-Management in Racial/Ethnic Minorities: Application of the Extended Parallel Processing Model and Sensemaking Theory in a Qualitative Study. Issue 5 (October 2022)

• Record Type: Journal Article
• Authors: Bass, Sarah Bauerle; Swavely, Deborah; Allen, Shaneisha; Kelly, Patrick J.; Hoadley, Ariel; Zisman-Ilani, Yaara; Durrani, Maryyam; Brajuha, Jesse; Iwamaye, Amy; Rubin, Daniel J.
• Is Part Of: Science of diabetes self-management and care. Volume 48:Issue 5(2022)
• Page Start: 372
• Page End: 386
• Publication Date: 2022-10
• Subjects: Diabetes -- Study and teaching -- Periodicals; Patient education -- Periodicals; 616.4620071
• DOI: 10.1177/26350106221116904
• Languages: English
• ISSNs: 2635-0114

Abstract

Purpose: The purpose of the study was to understand the role of perceived disease threat and self-efficacy in type 2 diabetes (T2DM) patients' self-management by using the extended parallel processing model (EPPM) and sensemaking theory. Methods: Semistructured interviews (n = 25) were conducted with T2DM patients from an urban safety-net hospital. Participants were 50% male/female median age was 55 years and 76% were Black. Participants were categorized by EPPM group based on validated questionnaires (high/low disease threat [HT/LT]; high/low self-efficacy [HE/LE]). Nine were HT/HE, 7 HT/LE, 6 LT/HE, and 3 LT/LE. Interviews were transcribed and analyzed using inductive and deductive coding. Sensemaking theory was applied to contextualize and analyze data. Results: Those with HT indicated threat fluctuated throughout diagnosis but that certain triggers (eg, diabetic complications) drove changes in disease view. Those in the HT/HE group more frequently expressed disease acceptance, whereas the HT/LE group more often expressed anger or denial. HT/HE participants expressed having adequate social support and higher trust in health care providers. HT/LE participants reported limited problem-solving skills. In those with LT, the HE group took more ownership of self-management behaviors. The LT/LE group had heightened positive and negative emotional responses that appeared to limit their ability to perform self-care. They also less frequently described problem-solving skills, instead expressing reliance on medical guidance from their providers. Conclusions: EPPM and sensemaking theory are effective frameworks for understanding how perceived health threat and self-efficacy may impede T2DM self-care. A greater focus on these constructs is needed to improve care among low-income minority patients, especially those with low threat and self-efficacy.