Coping Styles, Well-Being, and Self-Care Behaviors Among African Americans With Type 2 Diabetes

African Americans living with diabetes cope every day with stress from the disease itself, fear of complications secondary to diabetes, and other social factors. Among African Americans older than 20 years of age, 1 in 10 lives with type 2 diabetes, and among African American women older than age 55, rates are as high as 1 in 4.1 In addition to higher prevalence rates (1.8 times higher than Caucasian Americans), African Americans suffer greatly from the complications of diabetes, resulting in rates of blindness, kidney disease, and lower limb amputations that are 2 to 5 times that of Caucasian Americans.1 Given this context, it may be important to understand how African American adults with diabetes cope with the stress of living with diabetes. Understanding how African Americans cope with diabetes is important to developing strategies for promoting healthful self-care behaviors and enhancing psychological and physical well-being. The relationships among coping, stress, and one’s appraisal of a stressful event or situation have been explored in a small number of studies among patients with diabetes.2–6 Only a few studies, however, specifically address the coping styles of African Americans with diabetes,7–10 and most have been qualitative research with very small study samples. More generally, racial differences in the use of coping strategies have been suggested. Studies suggest that Caucasians predominately use problem-solving coping mechanisms, whereas African Americans rely more on emotion-focused or affective coping and less on active forms of coping.11 In the diabetes context, studies list religious activity or spirituality as prevalent coping efforts among African Americans.10,12,13 Other research identifies family and individual resilience, as well as a strong value system, as inherent coping skills for African Americans.14 What is missing from the literature are quantitative data describing how African Americans with diabetes cope with the disease and how their coping styles relate to self-care behaviors and health-related well-being or quality of life. The purpose of this study is to explore some of these issues by asking the following questions: (1) How do coping styles relate to self-care behaviors and measures of general and diabetes-related quality of life or well-being? (2) What is the association between coping styles and appraisals of diabetes control, competence, and self-efficacy? (3) How does spirituality or church involvement relate to coping styles, well-being, and self-care behaviors? The last question is especially important in this study because of the study sample (selected from church congregations) and research among African Americans that suggests a relationship between church/religious involvement and health.15,16 The transactional model of stress and coping17 serves as the theoretical framework (Figure 1) for this study. In this model, perceived stress is conceptualized as a “transactional phenomenon” between person and environment, such that the perception of the event (the appraisal) rather than the event itself determines the subsequent response or behavior. Coping is defined as constantly changing cognitive and behavioral efforts to manage specific internal and/or external demands that are considered taxing or exceeding the resources of an individual.18 Coping styles, in this transactional model, are considered dispositional traits that influence how stressful events are appraised and consequently have an effect on what strategies are used to manage or address the stressor. Figure 1 Transactional model of stress and coping17 emphasizing constructs (in boxes) measured in this study. This study investigated 4 key concepts in the transactional model: dispositional coping styles, stress, secondary appraisals (perceptions of diabetes control, competence, and self-efficacy), and outcomes (self-care behaviors, functional status, and well-being). The transactional framework posits that in the presence of stressors, coping styles influence both secondary appraisals and outcomes—behavioral (self-care) and psychological (quality of life). Coping styles can, therefore, have a direct effect on emotional and physical outcomes of stress, as well as an indirect effect on how stressors are appraised and what is done as a result of the appraisal. In the transactional model, spiritual beliefs and the use of religion induce positive emotions that affect how the process of coping influences outcomes.17