Researching the Role of the Family in African American Patients Diagnosed with Type 2 Diabetes

Abdul Niazi

1/17/2009

The role of the family is often undervalued or overlooked when disease management is being discussed with the patient. Studies have shown that behavior modification in not only the patient but in the patients family as well is an essential factor in coping with disease. Although all diseases require some form of change in diet, activity and overall behavior, type 2 diabetes involves alterations in all facets of the patients life. A study conducted in 2004 researched the effects of family life on the management of type 2 diabetes in African Americans. (Chesla et al., 2004) Much of the concerns related to type 2 diabetes management in African Americans focus on incorporating ethnic foods and social participation, however many patients have reported that family members support is also an important factor. There is a high level of interdependence and value placed in family life in African Americans, therefore making familial support a key factor in disease management. (Samuel-Hodge et al., 2000) Studies have shown that African Americans diagnosed with type 2 diabetes also lack support from their family members in regards to their dietary changes because of the demands it creates for the family member giving care. (Batts et al., 2001) The aim of the study conducted by Chesla et al (2004) was to explore two specific questions: Is the family context associated with disease management in African-Americans patients with type 2 diabetes? And, if so, which aspects of family life demonstrate the most significant relationships with disease management in this population? (Chesla et al., 2004)

Abdul Niazi

1/17/2009

Criteria for participating in the study consisted of being diagnosed with type 2 diabetes for at least 1 year, between 25 and 70 years of age, not afflicted with major diabetes complications, who had at least one person they identified as family who was involved in their care and who identified as being African American. (Chesla et al., 2004) The operational definition of the word family in the context of this research study was very broad, a group of intimates living together or in geographic proximity, with strong emotional bonds, and with a history and a future (Chesla et al., 2004) The study divided family life into three separate domains, family structure and organization, family world view and family emotional management. As defined by the study, family structure and organization explored the roles of the family members and the responsibilities each member had in regards to themselves and each other. This was measured by an eight-item scale assessing degree of interpersonal closeness and family work and roles. Family world view, as defined by the study, was the basic beliefs and assumptions of the family which would dictate social context. This was measured using a thirteen-item scale assessing the degree to which the family believes the world is understandable, meaningful, and manageable. Family emotion management was defined by the familys expression and management of emotions such as conflict, anger, intimacy and loss. It was assessed by a five-item scale that measured diabetes-specific conflict within the family. (Chesla et al., 2004) Of 300 eligible African Americans, 205 agreed to participate in the study. The research was conducted by initial phone interviews followed by a home visit, for 1.5 hours. Questionnaires which covered the family life domains as identified by the study were distributed to the participants. Additional data was collected by mail in questionnaires. A second visit (60 minutes) was conducted to discuss patient education and understanding of the illness. (Chesla et al., 2004)

Abdul Niazi

1/17/2009

Data was analyzed using the multivariate likelihood criterion (Wilks ) and its associated F statistic to assess the effects of the three family domains on the two questions explored by the study. Based on the studys findings, family measures and familial involvement had the strongest association with patient morale. Unresolved conflict about diabetes was related to more depressive symptoms and lower satisfaction as well as higher impact of the disease. High family coherence was positively attributed to higher satisfaction of life and negatively associated with depressive symptoms. Although there was no apparent correlation between unresolved family conflict and diabetes management behavior, there was a direct connection between unresolved family conflict and patient morale. The study found that family dysfunction can lead to distraction and or neglect of the patients health. (Chesla et al., 2004) Conversely, patients whose family had a positive outlook and life and believed that life has order, meaning and manageability, had fewer depressive symptoms, better self-assessed general health and a higher degree of quality of life. These qualities were found in addition to strong family coherence which resulted in the patient feeling as though diabetes is manageable and can reinforce the patients personal sense of health and emotional well-being. Because diabetes is an illness that requires much attention to self-care and diet and daily regimens, those patients who do not have the tension of family conflict can more readily adapt to caring for themselves. (Chesla et al., 2004) Based on this studys findings and the research data that was analyzed it can be concluded that patient education is the root of familial support in coping with type 2 diabetes. Patients whose families have had health education interventions in place, in terms of office visits and reading material distributed by healthcare providers will have a better chance of gaining family support. The disease should be explained in a way that encourages a positive outlook and highlights the

Abdul Niazi

1/17/2009

manageability of the disease. It should also be stressed that unresolved (or newly occurring) family conflict can negatively effect the patients progress in establishing and maintaining a daily regimen for disease management. Support for the patient should be emphasized in terms of encouraging and respecting the patients changes in diet and activity. Patient/family education will help the family members understand the patients dietary restrictions and limitations as well as actions to take in the event that the patient becomes hypo/hyper glycemic. An important factor in offering support is educating the patient and the family about realistic goals for blood sugar levels. It is important to reiterate that sometimes blood sugar levels will fluctuate despite dietary alterations and control. The family should be cautioned to avoid blaming the patient and causing emotional distress and discord. As shown by the outcomes of the study, family support and a coherence of the familial unit positively affects the diabetic patient in coping with the disease. The start of this should be at the time of diagnosis and proper patient education should be conducted to encourage the patient and the family to support the patient in caring for him/her.

Abdul Niazi

1/17/2009

References Batts M.L., Gary T.L., Huss K., Hill M.N., Bone L., Brancati F.L. (2001) Patient priorities and needs for diabetes care among urban African American adults. Diabetes Education, 27, 405-412

Chesla, C. A. R.N., DNSC, FAAN; Fisher, L. Ph.D.; Mullan, J.T., Ph.D.; Skaff, M.M., Ph.D.; Gardiner, P., Dr.PH.; Chun, K., Ph.D.; Kanter, R., M.D. (2004) Family and Disease Management in African-American Patients With Type 2 Diabetes. Diabetes Care, 27 (12) 2850-2855

Samuel-Hodge C.D., Headen S.W., Skelly A.H., Ingram A.F., Keyserling T.C., Jackson E.J., Ammerman A.S., Elasy T.A. (2000) Influences on day-to-day Self Management of type 2 Diabetes among African-American women: Spirituality, the Multi-Caregiver role, and Other Social Context Factors. Diabetes Care, 23, 928 933

Abdul Niazi

1/17/2009