Exploring socioeconomic variations in diabetes control strategies: impact of outcome expectations.
OBJECTIVE
Prior studies have suggested socioeconomic differences in outcome expectations for diabetes. This paper explores outcome expectations of adults of varied socioeconomic status with type 2 diabetes, examining differences between African Americans and whites.


METHODS
A qualitative study using focus groups of individuals with type 2 diabetes. Interviews were tape recorded and transcribed verbatim. Data analysis was based on the constant comparative method, assisted by qualitative analysis software. Research was done in outpatient clinics in both a community health center and tertiary care center.


METHODS
Seventy-one participants, 46% African American, 54% with household income less than or equal to $40,000, diagnosed with type 2 diabetes for at least 1 year.


METHODS
Subjects discussed coping mechanisms, including self-control, compliance discipline, and denial regarding diabetes.


RESULTS
Behavior control was typified as (1) beliefs about controlling diabetes and (2) beliefs about controlling one's behavior aside from diabetes control. Patients described a range of strategies, including beliefs as self-efficacy, confidence and willingness to take on self-management, and. positive and negative outcome expectations about ability to modify the natural course of the disease.


CONCLUSIONS
Those of higher socioeconomic status espoused more positive outcome expectations and self-efficacy, while poorer subjects reported more negative outcome expectations. Factors such as perception of control may contribute to root causes of socioeconomic disparities seen in diabetes outcomes. INTERVENTIONS to increase compliance should address class-specific disease perceptions. Practical support that builds on patients' preferred strategies could help improve diabetes disparities.
Figaro
M Kathleen
MK
Department of Medicine, Center for Health Services Research, Vanderbilt University Medical Center, USA. kathleen.figaro@vanderbilt.edu
Elasy
Tom
T
BeLue
Rhonda
R
Speroff
Theodore
T
Dittus
Robert
R
D001741:Black or African American / Q000523:psychology*; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000517:prevention & control / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D044465:White People / Q000523:psychology*