Understanding Type 2 Diabetes Self-Management in Racial/Ethnic Minorities: Application of the Extended Parallel...

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.

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.

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.

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.