Experience of Uninsured in Southern Appalachia after Type 2 Diabetes Diagnosis

University Of Virginia, Charlottesville VA

Investigators

Abstract

DESCRIPTION (provided by applicant): The purpose of this proposed phenomenological study is to describe the experiences of uninsured men and women in Southern Appalachia with type 2 diabetes during the first year of diagnosis. Diabetes is a progressive chronic disease with multiple complications and a higher incidence and prevalence among people in rural regions. Diabetes has been linked with lower socioeconomic status, obesity, poor nutrition, membership in certain racial and/or ethnic groups, and a family history of diabetes - factors often present among people living in rural regions. Intensifying the effect of these risk factors are barriers to effective diabetes self-management that include depression and certain cultural beliefs/norms. In addition, residents of rural regions contend with disparities caused by geographical isolation, lack of access to primary and specialty healthcare, fewer healthcare providers, mistrust of outsiders, and excessive self-reliance. Diabetes self- management is essential for all people with diabetes to monitor the disease process, prevent complications, improve glycemic control, and improve quality of life. Successful self-management training enhances knowledge and skill, and facilitates ongoing support. There are many approaches to diabetes self-management training, but to be successful, the perspective of individuals diagnosed with diabetes must be understood by healthcare providers. This proposed study supports core NINR strategic objectives to eliminate disparities in health, to improve quality of life, and to enhance self-management for persons with chronic illness. Results of qualitative studies have revealed some culturally-based perspectives and attitudes towards type 2 diabetes among residents of Appalachia; however, past studies have not focused on the experience of rural southern Appalachian residents within the first year of diagnosis - a crucial time for initiating self- management. Numerous studies have focused on Hispanic and African American populations in rural and urban settings; however, uninsured rural residents of southern Appalachia have not been studied. There are several studies about the meaning of self-management of type 1 diabetes in adolescents and elderly populations, but no studies were found with uninsured adults with type 2 diabetes. Knowledge about the experience of self-management of diabetes, from the perspective of adults diagnosed with type 2 diabetes within the first year may bridge the gap between patients and healthcare providers, thus enhancing culturally- tailored care. This proposed phenomenological study will inform providers and thus allow for future research to develop and test diabetes self-management programs tailored for uninsured rural Appalachian adults with type 2 diabetes.