Relationships among Distress, Appraisal, Self-Management Behaviors, and Psychosocial Factors in a Sample of Rural Appalachian Adults with Type 2 Diabetes


Background: Diabetes contributes to the development of multiple chronic conditions including cardiovascular disease, stroke, blindness, kidney disease, and lower-limb amputations. Currently, it is known that the Appalachian Region is an area of significant disparity in the occurrence of Diabetes. Persons with Diabetes can develop high levels of cognitive stress related to the experience of living with Diabetes.
Method: This paper presents the results of a descriptive study guided by the Transactional Model of Stress and Coping (TMSC), aiming to enhance understanding of the relationships among diabetes-related distress, appraisal, and self-management in a sample of 102 adults who were living rurally in Appalachia.
Findings: The majority of the study sample were low-income, obese, and had mean A1C levels above the goal for adequate diabetes control. Over one-third of the sample had a high likelihood or possibility of limited literacy Participants reported adhering to medication on over 6 days of the week but adhering to diet and exercise on fewer days per week. Overall, the sample had a lower level of distress related to the diagnosis of diabetes. Participants perceived diabetes as more of a challenge than a threat, harm, or benign stressor. Diabetes related distress was inversely correlated to challenge appraisals and benign appraisals, but positively correlated to threat and harm appraisals. Anxiety and depression were significantly positively related to diabetes related distress, threat appraisals, and harm appraisals and significantly negatively correlated with challenge and benign appraisals.
Conclusions: Recommendations for future research include the development and testing of targeted interventions that address the study findings including health literacy level, challenge appraisals, and the interrelationships of psychological and physical health variables. Knowing that diabetes is appraised as a challenge enhances the likelihood that it may be amenable to intervention. The interrelatedness of anxiety and depression to self-management further informs future intervention design.

Keywords:  Psychosocial Factors,  Rural, Diabetes, Adults, Self Management, Cognitive appraisal, Distress


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