Family behaviors and type 2 diabetes: What to target and how to address in interventions for adults with low socioeconomic status

Abstract

Objectives: Diabetes-specific family behaviors are associated with self-care and glycemic control among adults with type 2 diabetes. Formative research is needed to inform assessment of these behaviors and interventions to address obstructive family behaviors (sabotaging and nagging/arguing), particularly among racial/ethnic minorities and low-income adults who struggle most with self-care adherence.

Methods: We conducted a mixed-methods study with adults with type 2 diabetes at a Federally Qualified Health Center to better understand experiences with diabetes-specific family behaviors and willingness to engage family members in diabetes interventions. Participants completed a phone survey (N = 53) and/or attended a focus group (n = 15).

Results: Participants were 70% African American and had low socioeconomic status (96% annual income <US$20K, 51% uninsured). Although 62% lived with family members, only 48% lived with the person providing the most diabetes-specific support. Participants' family living situations were diverse and multigenerational. Most (64%) experienced both supportive and obstructive family behaviors from the same person(s). Some participants (40%) said engaging family in interventions would positively affect all members; others (27%) did not want to involve family.

Discussion: Findings can inform the design and content of interventions targeting family involvement in adults' type 2 diabetes, with implications for assessing family behaviors, intervention modalities, and who to engage.

Keywords: Type 2 diabetes; family involvement; intervention; social environment; social support.

© The Author(s) 2016.

Figures

Figure 1. Recruitment and participation flow chart

Depicts how many participants did and did not participate (and reasons why) of the original sample from the parent study, Diabetes MeASURES.

Figure 2. Venn diagram depicting participants’ family living situations

Depicts living arrangements of 33 participants who lived with a family member (not in figure: 17 participants lived alone and 3 lived with a friend).

Figure 3

Information-rich cases with illustrative quotes from two focus group participants (names changed).

Figure 3

Information-rich cases with illustrative quotes from two focus group participants (names changed).