title: Health-related quality of life and help seeking among American Indians with diabetes and hypertension.
abstract: OBJECTIVE
  To evaluate the Health-Related Quality of Life (HRQoL) of American Indians with diabetes, hypertension, or both conditions using the SF36; and to explore how the HRQoL is associated with help seeking among American Indians with and without these chronic conditions.
  
  
  METHODS
  We analyzed data obtained from respondents with diabetes and/or hypertension who participated in a large epidemiological study of two culturally distinct American Indian tribes. Comparison data were provided by an age, gender, and tribe matched sample from the same study who did not report either condition.
  
  
  RESULTS
  The respondents with both diabetes and hypertension had the lowest HRQoL on all eight subscales of SF36. Confirmatory factor analysis (CFA) showed that the assumption of equivalent factor loadings for participants with and without diabetes and/or hypertension was not satisfied. Biomedical service use was significantly associated with the SF36 physical health factor in those with hypertension only. Help seeking from traditional healers was significantly negatively related to physical factor scores for all the respondents except those with diabetes only.
  
  
  CONCLUSIONS
  Participants with comorbid diabetes and hypertension had worse HRQoL. The relationships between HRQoL and different types of help seeking varied depending on the comorbidity status of the respondents.
authors.affiliation: Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO 80045-0508, USA. Luohua.Jiang@ucdenver.edu
authors.forename: Luohua
authors.initials: L
authors.lastname: Jiang
authors.forename: Janette
authors.initials: J
authors.lastname: Beals
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Whitesell
authors.forename: Yvette
authors.initials: Y
authors.lastname: Roubideaux
authors.forename: Spero M
authors.initials: SM
authors.lastname: Manson
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D055815:Young Adult