Family and Disease Management in African-American Patients With Type 2 Diabetes

Family and Disease Management in African-American Patients With Type 2 Diabetes Catherine A. Chesla , RN, DNSC, FAAN 1 , Lawrence Fisher , PHD 2 , Joseph T. Mullan , PHD 3 , Marilyn M. Skaff , PHD 2 , Phillip Gardiner , DRPH 4 , Kevin Chun , PHD 5 and Richard Kanter , MD 6 1 Department of Family Health Care Nursing, University of California, San Francisco, California 2 Department of Family and Community Medicine, University of California, San Francisco, California 3 Department of Social and Behavioral Science, University of California, San Francisco, California 4 Tobacco Related Disease Research Program, Office of the President, University of California, San Francisco, California 5 Department of Psychology, University of San Francisco, San Francisco, California 6 Northern California Kaiser Permanente, San Francisco, California Address correspondence and reprint requests to Catherine A. Chesla, Professor, Department of Family Health Care Nursing, University of California, San Francisco, CA 94143-0606. E-mail: kit.chesla{at}nursing.ucsf.edu Abstract OBJECTIVE —The aim of this project is to specify features of family life that are associated with disease management in African Americans with type 2 diabetes. RESEARCH DESIGN AND METHODS —A total of 159 African-American patients with type 2 diabetes were assessed on three domains of family life (structure/organization, world view, and emotion management) and three key dimensions of disease management (morale, management behaviors, and glucose regulation). Analyses assessed the associations of family factors with disease management. RESULTS —Multivariate tests for the main effects of three family variables were significantly related to the block of disease management variables for morale ( F = 3.82; df = 12,363; P < 0.0001) and behavior (2.12; 9,329; P < 0.03). Structural togetherness in families was positively related to diabetes quality of life (DQOL)–Satisfaction ( P < 0.01). High family coherence, a world view that life is meaningful and manageable, was positively associated with general health ( P < 0.05) and DQOL-Impact ( P < 0.05) and negatively associated with depressive symptoms ( P < 0.001). Emotion management, marked by unresolved family conflict about diabetes, was related to more depressive symptoms ( P < 0.001), lower DQOL-Satisfaction ( P < 0.01), and lower DQOL-Impact ( P < 0.001). No family measures were related to HbA 1c levels. CONCLUSIONS —The family domain of emotion management demonstrates t