A Survey of Self-Management and Intrusiveness of Illness in Native Americans with Diabetes Mellitus

By Chou, Ann F.; Page, Evaren E. et al. | Care Management Journals, December 1, 2014 | Go to article overview

A Survey of Self-Management and Intrusiveness of Illness in Native Americans with Diabetes Mellitus


Chou, Ann F., Page, Evaren E., Norris, Ann I., Kim, Sue E., Thompson, David M., Roswell, Robert H., Care Management Journals


Diabetes mellitus (DM) has emerged as an important focus of national public health efforts because of the rapid increase in the burden of this disease. In particular, DM disproportionately affects Native Americans. Adequate management of DM requires that patients participate as active partners in their own care and much of patient activation and empowerment can be attributed to their experience with DM and self-care. That is, the degree to which the patient feels the disease intrudes on his or her daily life would impact the motivation for self-care. We conducted a study in collaboration with 2 tribal nations in Oklahoma, collecting data on survey questions regarding intrusiveness of illness and self-management behaviors from a sample of 159 members of the Chickasaw and Choctaw Nations. Previously validated variables measuring intrusiveness of illness and self-care were included in the survey. Descriptive statistics and bivariate analyses illustrated the distribution of these variables and identified possible tribal and gender differences. Our findings showed that our sample adjusted well to DM and in general exhibited high compliance to self-care. However, our findings also revealed striking gender differences where female respondents were better adjusted to their disease, whereas male respondents reported higher adherence to self-management. Findings from our study, particularly those that describe tribal differences and gender disparities, can inform strategies for case management and patient interactions with providers and the health care system.

Keywords: care management; self-care; gender; disparities; intrusiveness of illness

Diabetes mellitus (DM) has emerged as an important focus of national public health efforts because of the rapid increase in the burden of this disease (Bowman, Gregg, Williams, Engelgau, & Jack, 2003). The increasing prevalence of DM is imposing significant human and economic costs on individuals, families, communities, health care systems, and society because DM has a broad spectrum of disabling complications that typically lead to extensive morbidity and mortality. Moreover, more than half of patients with DM have serious comorbidities such as hypertension and hyperlipidemia, further increasing risk of complications. It has been estimated, in 2012 U.S. dollars, that annual costs for a single person with macrovascular complications would be $56,445 for a myocardial infarction, $42,119 for ischemic stroke, $23,758 for congestive heart failure, and $7,388 for a transient ischemic attack. Estimates for microvascular complications are equally costly: A patient with end-stage renal disease would incur $82,295 annually for hemodialysis or $29,983 for a transplant, and $16,297 for an inpatient stay because of hypoglycemic episodes (Ward, Alvarez, Vo, & Martin, 2014).

More than 10 years of clinical evidence has demonstrated that risk factor control is key in preventing or delaying many complications. Glycemic hemoglobin A1c (HbA1c) control markedly reduces rates of microvascular complications such as retinopathy, neuropathy, and nephropathy. Blood pressure (BP) control retards the progression of diabetic renal disease, and lipid (low density lipoprotein [LDL]) control decreases risks for cardiovascular events, which are major causes of morbidity and mortality for patients with DM (Saydah, Fradkin, & Cowie, 2004). To achieve risk factor control, particularly among patients who are high-risk, research in this area needs to expand beyond clinical studies to include behavioral science, health services, and community research, requiring that interventions for risk factor control be innovative and patient-centered (Weingarten et al., 2002). A team-based care delivery or case management would be strategies that can facilitate risk factor control, and these approaches may be informed by an understanding of how DM impacts the patient's daily life.

DM disproportionately affects Native Americans (Centers for Disease Control and Prevention, 2011; Jiang et al. …

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