The Influence of Food Insecurity, Low-Income, and Race on Diabetes Self-Management Practices Among Women with Diabetes

The Influence of Food Insecurity, Low-Income, and Race on Diabetes Self-Management Practices Among Women with Diabetes by Jill La Capria MS, Hunter College, 1996 BA, Boston University, 1991 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University May 2019 Abstract Diabetes is a chronic condition affecting more than 30 million adults living in the United States. Diabetes self-management (DSM) can prevent or delay the complications of diabetes and improve clinical outcomes; however, data show that low-income, food insecurity, female gender, and race contribute to challenges performing effective DSM. The health belief model was the theoretical framework for this cross-sectional study, which examined how food insecurity, low-income, and race affect DSM activities in women with diabetes. The sample population from the 2017 Behavioral Risk Factor Surveillance System survey consisted of 1,842 women with diabetes who were 18 years of age or older, had an annual income of less than $50,000, and were food insecure. Results of the chi square analyses indicated a significant association between food insecurity and DSM activities (χ2 = 48.99, p < 0.0001); however, results showed no significant association between low-income or race (p > 0.05). Results of a binary logistic regression model revealed that food secure and younger women had 1.618 and . 584 times the odds of having effective DSM activities than food-insecure and older women (OR=1.618, 95% CI=1.282 2.041, p < 0.001; OR=.584, 95% CI=.465 .733, p < 0.001,Diabetes is a chronic condition affecting more than 30 million adults living in the United States. Diabetes self-management (DSM) can prevent or delay the complications of diabetes and improve clinical outcomes; however, data show that low-income, food insecurity, female gender, and race contribute to challenges performing effective DSM. The health belief model was the theoretical framework for this cross-sectional study, which examined how food insecurity, low-income, and race affect DSM activities in women with diabetes. The sample population from the 2017 Behavioral Risk Factor Surveillance System survey consisted of 1,842 women with diabetes who were 18 years of age or older, had an annual income of less than $50,000, and were food insecure. Results of the chi square analyses indicated a significant association between food insecurity and DSM activities (χ2 = 48.99, p < 0.0001); however, results showed no significant association between low-income or race (p > 0.05). Results of a binary logistic regression model revealed that food secure and younger women had 1.618 and . 584 times the odds of having effective DSM activities than food-insecure and older women (OR=1.618, 95% CI=1.282 2.041, p < 0.001; OR=.584, 95% CI=.465 .733, p < 0.001, respectively). These results might provide researchers with guidance regarding food insecure and younger women with diabetes who might require additional support for their diabetes management. Tailored public health interventions might lead to positive social change by increasing food stability and nutrition knowledge, potentiating improvements in hemoglobin A1C, a 90-day measure of glucose control, which could reduce risk of diabetes-related morbidity and mortality. The Influence of Food Insecurity, Low-Income, and Race on Diabetes Self-Management Practices Among Women with Diabetes by Jill La Capria MS, Hunter College, 1996 BA, Boston University, 1991 Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University May 2019 Dedication This doctoral study is dedicated to my family and friends who supported my journey with their patience, understanding, and encouragement. To my wonderful husband Jay, without your support I could not have accomplished this goal. You worked double time taking over as chef, “tucker inner”, chauffeur, and weekend warrior to our boys and assured me that you had “everything covered” – and you did it without complaint. To my amazing boys, Michael and Ian, thank you for not complaining (too much) that I couldn’t always tuck you in or be at all of your games. I am hopeful you didn’t feel too neglected during these years and that you were able to see that with hard work and dedication, anything is possible. To my friends I haven’t seen in a while, I’ll be back soon. Thank you for your patience! Lastly, to my parents, Arlene and Richard, thank you for your encouragement and support. It is because of you that I always strive to do more. You taught me that it is only through hard work, not luck, that success is possible and that sometimes you have to fail in order to succeed. You also taught me that I can do whatever I set my mind to – it’s amazing to me that you were right! Acknowledgments I would like to thank my family, friends, and colleagues who supported and encouraged me throughout this journey. I would also like to acknowledge and thank all of my instructors and my committee members: Dr. Vasileios Margaritis, Dr. Aaron Mendelsohn, and Dr. German Gonzalez. To all of my instructors, thank you for challenging me to think outside of the box and learn how to become a scholar practitioner. You prepared me well for my final “assignment” in this long journey. To my second chair, Dr. Mendelsohn, thank you for your expeditious reviews and valuable feedback. Your advice was instrumental in ensuring I always maintained doctoral level writing. To my university research reviewer, Dr. Gonzalez, as the last person in the review process, you kept your comments focused and returned them in a timely manner. Lastly, to my committee chair, Dr. VM, thank you for your encouragement, wisdom, and patience. In times when I was falling behind, you did your very best to keep me on track. You were patient yet you knew those were the very times I needed a gentle kick in the rear to get going. I greatly appreciate your timely and constructive feedback as well as your guidance in getting through each step in the process. I am truly grateful to all of you for guiding me throughout this amazing journey!