Cultural and Psychological Influences on Diabetic Adherence

Diabetes mellitus is a serious disease that poses a particular healthcare challenge because progression is considered controllable (Cox, et al, 1985; Vinicor, et al, 1996) yet treatment adherence, and thus outcome, is very poor (Gonder-Frederick, Cox, & Ritterband, 2002; Goodall, 1991). Culture is a lethal risk factor for diabetic contraction and treatment maintenance. Latinos within the United States are two-to-three times more likely to develop complications and die than non-Latinos (Haffner et al, 1996; Rubin, Peyrot, & Saudek, 1991) and are less likely to adhere to treatment (Lipton, Losey, Giachello, Mendez, & Girotti, 1998). Efforts to eliminate health disparities have yet to address how cultural variations may contribute to adherence and diabetic outcomes. The present study examined relationships among cultural value orientations, health beliefs, attribution processes and emotions that may account for variance in adherence. A model demonstrating these relationships was tested using Bender’s (1995) analysis of structural equations (EQS) program. Eighty-one (41 Latino, 40 Anglo) Type II diabetics self-selected to participate. Measures included demographic and blood glucose (Hb1 Ac) information from medical records and self report ratings on culturally relevant value orientations (fatalism and mastery), disease/treatment related beliefs (Harris, Linn, Skyler, & Sandifer’s Diabetes Health Beliefs Scale[1985]), attributions regarding disease controllability (Revised Causal Dimension Scale; McAuley, Duncan, & Russell [1992]) and related emotions. A test of the model resulted in a good fit of the data; CFI = .98, χ2 (56) = 24.39, p = .33 thus, confirming adherence is in part a function of the relationships among cultural influences and psychological processes. More proximal components of behavior, such as cognitive processes and emotions, mediated the negative effect that cultural value orientations (fatalism and mastery) may have on adherence. Particularly, negative emotions (fear, anxiety, and worry) played a fundamental role in buffering the influence of cultural values. The discussion further addresses how the application of similar models may provide a better understanding of cultural components that underlie health disparities as well as guide intervention strategies at the individual (e.g. treatment and professional patient interactions), as well as the social (e.g. public health policy and intervention) level