Effect of diabetes fatalism on medication adherence and self-care behaviors in adults with diabetes

• Published in: General hospital psychiatry Vol. 34; no. 6; pp. 598 - 603
• Main Authors: Walker, Rebekah J., M.S, Smalls, Brittany L., M.H.S.A, Hernandez-Tejada, Melba A., M.S, Campbell, Jennifer A., A.A, Davis, Kimberly S., M.D, Egede, Leonard E., M.D., M.S
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2012; Elsevier
• Subjects: Adult; Aged; Attitude to Health; Biological and medical sciences; Blood Glucose Self-Monitoring - psychology; Blood Glucose Self-Monitoring - statistics & numerical data; Diabetes; Diabetes Mellitus, Type 2 - psychology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Exercise - psychology; Fatalism; Female; Fundamental and applied biological sciences. Psychology; Humans; Illness and personality; Linear Models; Male; Medical sciences; Medication adherence; Medication Adherence - psychology; Medication Adherence - statistics & numerical data; Middle Aged; Patient Compliance - psychology; Patient Compliance - statistics & numerical data; Personality, behavior and health; Prognosis; Psychiatry; Psychology and medicine; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Self Care - psychology; Self Care - statistics & numerical data; Self-care; Southeastern United States; United States; North America; America; Southeastern United States; Medication adherence; Diabetes; Self-care; Fatalism; Endocrinopathy; Human; Type 2 diabetes; Social environment; Attitude; Mental health; Pharmacotherapy; Metabolic diseases; Drug compliance; Treatment; Selfcare; Young adult; Health behavior; Adult; Elderly; Public health
• ISSN: 0163-8343; 1873-7714
• DOI: 10.1016/j.genhosppsych.2012.07.005

Abstract 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. Conclusion 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.