“Dismissingness always matters”: An examination of tobacco smoking, frequency of visits to healthcare providers, and trust in the provider as potential mediators between attachment style dismissingness and diabetes health status

Thesis (Master's)--University of Washington, 2016-06Background: Attachment theory describes highly stable patterns of responses to threats, known as attachment styles, that previous research indicates affect diabetes health outcomes differentially. Multiple studies reported associations between the dismissing attachment style and worse diabetes health outcomes (e.g., increased HbA1c, higher rates of tobacco smoking, and worse adherence to exercise, foot care, glucose monitoring, and medication regimens). Some evidence also suggests that the patient-provider relationship mediates these pathways. This thesis sought to evaluate relationships between attachment style dismissingness, a diabetes health outcome (i.e., HbA1c), and three potential mediators that constitute maladaptive coping behaviors and/or indicators of the patient-provider relationship: tobacco smoking, the frequency of visits to a primary care provider, and trust in the primary healthcare provider, in a low SES sample of type 2 diabetics from a safety-net hospital setting in Seattle, Washington. It hypothesized that higher levels of attachment style dismissingness predict higher levels of HbA1c, in addition to more cigarette smoking, inadequate visits to primary care providers, and a lack of trust in the primary healthcare provider, and also that each potential mediator predicts higher HbA1c. The associated literature review and discussion section critically appraise the extant research on attachment theory and diabetes, and delineate some of its implications for the practices of clinical medicine and public health. Methods: The study included in this thesis constructed its hypotheses a priori, and tested them using regression analyses, in a subsample of 178 type 2 diabetic adults who presented with no missing data for any of the study’s variables. The participants derived from a sample of diabetic patients who sought medical care at the Adult Medicine and Family Medicine clinics of Harborview Medical Center—a safety-net health care organization serving low-income and uninsured people in Seattle, Washington. Results: Statistical analyses revealed non-significant trends in the expected directions for most of the hypotheses evaluated by this thesis. One significant finding indicated that a lack of trust, among participants, in their primary healthcare providers consociated with worse diabetes health statuses (i.e., higher HbA1c). An observed association between attachment style dismissingness and cigarette smoking, while statistically non-significant, occurred in the direction opposite to that hypothesized by this study. Conclusions: Trust in the primary healthcare provider promotes better diabetes health, relative to the diabetes health outcomes of individuals who lack trust in their primary healthcare providers. Attachment style dismissingness may be associated with higher levels of HbA1c, inadequate visits to primary care providers, and lower trust in primary healthcare providers, although the coefficients that corresponded to the regression analyses that tested these hypotheses in the current study failed to reach statistical significance