A socioecological perspective : the "ups and downs" of living with type 2 diabetes among working adults in the rural south

Abstract

Persons with higher patient activation levels are more likely to engage in preventive health behaviors. This qualitative study addressed a population that may be particularly vulnerable to poor diabetes outcomes: rural, working adults with type 2 diabetes (T2 DM) with low levels of patient activation. This study sought to gain a better understanding of the individual, interpersonal, health system, and community spheres of influence on engagement in diabetes self-management and recommended preventive health services among rural, working adults. A socioecological approach, based on Fisher's (2005) Resources and Supports for Self-Management Model, guided the study. The Patient Activation Measure (PAM-10) was used to identify individuals with low patient activation. Participants (N = 20) had PAM-10 scores less than 75 (M = 59.4) and were predominately African American (n = 12) and female (n = 14), earning incomes less than $50,000 (n = 13). The overarching theme, "ups and downs" of living with diabetes, emerged from the data. Four other major themes emerged: "the struggle", "you don't talk about it", "diabetes is not the priority", and "we're lucky to have what we have". Most participants had social support, employer health benefits, and a trusting, satisfactory relationship with health care providers. However, a lack of equitable workplace and community resources may have contributed to lack of engagement in diabetes self-management and preventive health services.