Making the Connection: Examining the Role of Social Support and Social Determinants in Chronic Disease Management

Healthcare systems worldwide are challenged with caring for patients with multiple chronic conditions (Palmer et al., 2018). Anderson (2010) defines chronic conditions as illnesses or impairments expected to last a year or greater, limits what a person can do, and/or require ongoing medical care. Buttorff, Ruder, and Bauman (2017) acknowledge that as of 2014, at least 60% of Americans have at least one chronic condition with diabetes being among the top five chronic conditions. For the purpose of this dissertation, we will examine the effects of the chronic condition related to Type 2 Diabetes via a mixed methods approach. Chronic conditions such as diabetes are associated with medical illness such as heart disease, stroke, peripheral vascular disease, and hyperlipidemia (American Diabetes Association, 2016), increasing an individual’s risk of adverse outcomes, including mortality, disability, reduced quality of life, and increased healthcare costs (Palmer et al., 2018). However, evidence has shown that self-management and glucose control can prevent or delay complications associated with diabetes (American Diabetes Association, 2016). Self-management (SM) along with the self-management support (SMS) by others is critical to optimal diabetes control (Brady, Sacks, Terrillion, & Colligan, 2018). Schmitt et al. (2013) define self-management as the recommended dietary changes, exercise, blood sugar monitoring, and provider appointments a person endures for optimal management of Type 2 Diabetes (T2DM). While self-management support refers to the support received for implementing and sustaining the coping skills needed to achieve self-management on a long-term basis (Powers et al., 2017). However, in spite recommendations for SMS, the number of individuals with T2DM receiving SMS is small despite its, being recognized as a crucial component of diabetes care due to reduced access to care, inadequate resources, lack of insurance, and reduced referral practices (Foss et al., 2016). Current recommendations by the American Diabetes Association (2018c) advise health providers to consider population-level health while delivering individualized patient care, resulting in a combination of system level and patient level approaches to care. In other words, providers are recommended to provide patient-centered care, by considering patients’ preferences, needs, and values when making clinical decisions along with adjusting for social factors that vary across settings and the population level (American Diabetes Association, 2018c). Unfortunately, healthcare delivery is fragmented and inefficiently coordinated (American Diabetes Association, 2018c). Foss et al. (2016) argued that the evaluation of the population level and support networks are not usually considered in chronic disease management as the focus instead, is prioritized with individualized behavioral change failing to recognize multiple level technological, organizational, and social changes. In addition to social support and networks, social determinants are shown to have a significant impact on the management of T2DM. Cantor and Thorpe (2018) define social determinants as complex, integrated, social structures that are responsible for most health inequities. Mayberry, Harper, and Osborn (2016b) contended that disparities in self-care and adherence contribute to population disparities in diabetes control and complications. Sources of health determinants and disparities include neighborhood and community environments, access to community and recreational resources (Rasmussen, Wrosch, Scheier, & Carver, 2006), access to supermarkets and high-quality food, (Larson, Story, & Nelson, 2009), and access to high-quality medical care. This dissertation will have several empirical and practical contributions. First, this research will contribute to increasing public awareness of social determinants and their influence on T2DM health outcomes. Second, dissertation has implications for healthcare providers, healthcare leaders, policymakers, and patients to gain a greater understanding of how social factors affect chronic disease health outcomes. Third, this integrative research approach has implications for developing interventions tailored according to the patient’s individual needs while considering population level and support networks impact when evaluating chronic disease outcomes.