Perceptions of diabetes among patients in an urban health care system

A major problem facing health care providers today is adherence to treatment regimens by patients. Adherence is of even greater significance for patients with diabetes, who shoulder a great deal of responsibility in their disease management. Perceptions of diabetes have been found to play a major role in adherence. The effects of race and socioeconomic status on the disease perceptions remain unclear. This exploratory study encompassed two themes: (1) assessing perceptions of diabetes among African American and white American adults with diabetes who were patients in 1994 in a large, Midwestern, urban health care system and (2) examining the psychometric properties of the measurement instruments used to study perceptions.

A stratified random sampling scheme (by race and socioeconomic status (SES)) was used. Diabetes perceptions were measured using three scales from the Meaning of Illness Questionnaire assessing the impact, loss, and stress associated with diabetes. Perceptions of physician efficacy were also measured. The study population consisted of 50 (68% response rate) African American and white American patients aged 18-65 years.

No differences in SES were found between the African American and white American participants (p = 0.44). However, the African Americans in the study indicated a greater sense of loss associated with diabetes than the white Americans in the study (p < 0.05). In the combined racial group, the reliability coefficients, as measured by Cronbach's alpha, were 0.76, 0.78, 0.68, and 0.68 for the Impact, Loss, Stress, and Perceptions of Physician Efficacy scales, respectively. However, the results of within-racial-group analyses tell a different story. The Impact scale fitted the African American and white American subgroups, although there was some item variation by racial group. The Loss scale did not fit the white American subgroup, and the Stress and Perceptions of Physician Efficacy scales did not fit the African American subgroup.

Perceptions of diabetes may vary by race, even when controlling for SES. Health professionals are in a unique position to develop diabetes management programs to help patients understand more about their diabetes, and thus to reduce some of the negative outcomes of diabetes by promoting adherence to recommended treatment regimens. In addition, overall measures of reliability may mask the instability of scales within specific study groups.