Effect of diabetes fatalism on medication adherence and self-care behaviors in adults with diabetes.
OBJECTIVE
Diabetes fatalism is defined as "a complex psychological cycle characterized by perceptions of despair, hopelessness, and powerlessness" and associated with poor glycemic control. This study examined the association between diabetes fatalism and medication adherence and self-care behaviors in adults with diabetes.


METHODS
Data on 378 subjects with type 2 diabetes recruited from two primary care clinics in the Southeastern United States were examined. Previously validated scales were used to measure diabetes fatalism, medication adherence, diabetes knowledge and diabetes self-care behaviors (diet, physical activity, blood sugar testing and foot care). Multiple linear regression was used to assess the independent effect of diabetes fatalism on medication adherence and self-care behaviors controlling for relevant covariates.


RESULTS
Fatalism correlated significantly with medication adherence (r=0.24, P<.001), diet (r=-0.26, P<.001), exercise (r=-0.20, P<.001) and blood sugar testing (r=-0.19, P<.001). In the linear regression model, diabetes fatalism was significantly associated with medication adherence [β=0.029, 95% confidence interval (CI) 0.016, 0.043], diabetes knowledge (β=-0.042, 95% CI -0.001, -0.084), diet (β=-0.063, 95% CI -0.039, -0.087), exercise (β=-0.055, 95% CI -0.028, -0.083) and blood sugar testing (β=-0.055, 95% CI -0.023, -0.087). There was no significant association between diabetes fatalism and foot care (β=-0.018, 95% CI -0.047, 0.011). The association between diabetes fatalism and medication adherence, diabetes knowledge and diabetes self-care behaviors did not change significantly when depression was added to the models, suggesting that the associations are independent of depression.


CONCLUSIONS
Diabetes fatalism is associated with poor medication adherence and self-care and may be an important target for education and skills interventions in diabetes care. In addition, the effect of diabetes fatalism is independent of depression, suggesting that interventions that target depression may not be sufficient to deal with diabetes fatalism.
Center for Health Disparities Research, Medical University of South Carolina, P.O. Box 250593 Charleston, SC, USA.
Rebekah J
RJ
Walker
Brittany L
BL
Smalls
Melba A
MA
Hernandez-Tejada
Jennifer A
JA
Campbell
Kimberly S
KS
Davis
Leonard E
LE
Egede
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D015190:Blood Glucose Self-Monitoring / Q000523:psychology / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D015444:Exercise / Q000523:psychology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D011379:Prognosis; D012648:Self Care / Q000523:psychology / Q000706:statistics & numerical data*; D015144:Southeastern United States; D016903:Drug Monitoring