Self efficacy, self reliance, adherence to self care, and glycemic control among Cherokee with type 2 diabetes

Abstract

<p><strong>Background:</strong> Type 2 diabetes is responsible for disability and shortened life span among Native Americans. Adherence to recommendations for diet, exercise and medication is essential to optimizing outcomes. Few studies of self care have included Native American participants.</p> <p><strong>Specific Aims:</strong> Among Cherokee adults, aims are to (a) describe self efficacy, Cherokee self reliance, adherence to self care recommendations and glycemic control; (b) explore the relationship between self efficacy and Cherokee self reliance; and (c) predict glycemic control from self efficacy, Cherokee self reliance, adherence to self care recommendations, and personal characteristics.</p> <p><strong>Methods: </strong>The design was observational and cross-sectional. A convenience sample of 164 female and 136 male Cherokee adults with type 2 diabetes receiving care at three Cherokee Nation clinics participated. Subjects completed the Diabetes Self Efficacy Scale, Cherokee Self Reliance Questionnaire, and Summary of Diabetes Self Care Activities. Glycemic control was indexed using the most recent A1C value.</p> <p><strong>Results:</strong> The average age of participants was 58.29 ( SD = 12.07); they had had type 2 diabetes for an average of 9.06 years (SD = 7.85). Using exploratory maximum likelihood factor analysis with orthogonal rotation, items from self efficacy and self reliance measures loaded on separate factors. Self efficacy, years since diagnosis, age and clinic (C compared with B) were significant predictors of A1C.</p> <p><strong>Conclusions:</strong> Glycemic control was only partly explained. Diabetes self care is complex. Continued research on psychosocial and educational aspects of self care is needed to better understand diabetes management and outcomes among Cherokee adults.</p>