548-P: Understanding T2D Self-Management in Racial/Ethnic Minorities: Application of the Extended Parallel Processing Model and Sensemaking Theory

Behavioral health interventions are needed to address disparities among low-income racial/ethnic minorities with type 2 diabetes (T2D). We aimed to gain a better understanding of the role of disease threat perception and self-efficacy using the Extended Parallel Processing Model (EPPM) as a guide in T2D self-management among Black and Hispanic patients. Semi-structured interviews were conducted with minority T2D patients who receive care in endocrinology, internal or family medicine practices in an urban safety-net hospital. Participants were placed in one of 4 EPPM groups based on validated questionnaires: High or low disease threat and high or low self-efficacy. The interviews were transcribed then analyzed using both inductive and deductive coding based on Sensemaking Theory. From this ongoing study, the current analysis includes 11 interviews. The cohort had a median age of 52 years, was 55% female, 82% were black and 18% were Hispanic. Participants in the high threat groups indicated disease threat fluctuated throughout their diabetes history and that certain triggers (e.g., diabetic complications) drove changes in disease view. Participants with high threat/high efficacy (n=4) expressed acceptance of T2D and reported adequate social support, whereas those with high threat/low efficacy (n=2) expressed anger or denial about T2D. Participants with low threat/high efficacy (n=2) reported poor social support, while those with low threat/low efficacy (n=3) had heightened positive and negative emotional responses. Both low efficacy groups reported less problem-solving skills than the high efficacy groups. Perceived health threat and low self-efficacy may impede T2D self-care, presenting barriers to achieving good diabetes control. A greater focus on the role of diabetes threat perception and self-efficacy is needed to improve T2D care among low-income minority patients.