Renal Disease Risk and Risk Perceptions Among African-American Women with Type 2 Diabetes

<p>Abstract</p><p>Problem: African Americans face a disparate risk for renal disease development secondary to type 2 diabetes (T2D), and African-American women have shown to be at the highest risk. Despite this, there is minimal research on African American's awareness of renal disease and existing renal disease risk perceptions, and none focused specifically on African-American women with T2D. Although the literature has shown that a portion of this disparate risk is due to modifiable social and cultural factors, there is still a significant amount of unexplained risk. Since past research has shown that risk perceptions can influence preventative behaviors, it is important to gain an in-depth understanding of renal disease beliefs and existing risk perceptions among high-risk African-American women with T2D. Once risk perceptions are better understood in this population, interventions can be developed to correct inaccurate beliefs and risk perceptions and aim to decrease renal disease risk.</p><p>Methods: Three different methods of analyses were employed in this dissertation, including: 1) a systematic review of the literature, 2) an exploratory, descriptive, qualitative study, and 3) a quantitative secondary analysis, including descriptive statistics, a cluster analysis and mixed modeling. The Common Sense Model guided all three studies and these three methods of evaluation helped us to gain a more complete understanding of renal disease risk perceptions in African Americans, particularly African-American women with T2D, and provided guidance for future intervention research in this population. </p><p>Conclusions: The findings of this dissertation illustrated there is a significant gap in the literature on African American's renal disease awareness and risk perceptions, yet the available research was used to guide the in-depth interviews with African-American women with T2D. Overall, African Americans underestimate their renal disease risk and lack an understanding of the disease, even in the presence of risk factors. African-American women, in particular, related renal disease directly to the end-stages of the disease, perceived a greater risk for other complications of diabetes, and exhibited significant fear related to their perceived consequences of the disease. This fear frequently initiated maladaptive coping mechanisms, which influenced risk perceptions negatively and hindered preventative behaviors. This study also found that health care providers rarely discussed the disease and often exhibited provider control. Therefore, these findings suggest an urgent need for clinical practice suggestions and intervention research aimed at correcting inaccurate risk perceptions. The secondary analysis findings showed that a culturally relevant intervention with coping skills training resulted in significant improvements in renal disease risk factors among high-risk African-American women with T2D; however, we cannot be sure which facets of the intervention or control care for equal attention may have influenced these outcomes, and renal disease beliefs and risk perceptions were not assessed in the parent study. Therefore, the knowledge gained from this dissertation can be used to guide intervention research that evaluates change over time in renal disease risk representations, risk perceptions, coping procedures and outcomes among participants at high-risk for renal disease.</p>Dissertatio