ABSTRACT

Background

Resilience is the ability to adapt to adverse life events. Studies that explore diabetes self-management interventions integrating resilience in African-Americans with diabetes include few African-American men, who have higher diabetes-related mortality and complication rates compared to African-American women.

Design

We conducted a cross-sectional study of African-American men with uncontrolled diabetes living in diabetes hotspots. We measured resilience levels using the General Self Efficacy Scale (GSES), adherence to diabetes self-management behaviors using the Diabetes Self-Management Questionnaire (DSMQ), and incarceration history by phone survey. We categorized participants as higher or lower resilience level and higher or lower adherence to diabetes self-management behaviors. Using multivariable logistic regression, we examined the relationship between resilience and adherence to diabetes self-management behaviors. Our model accounted for potential confounders, including age, incarceration history, and socioeconomic factors.

Results

Of 234 patients contacted by mail and phone, 94 (40.2%) completed the survey. Mean age was 60.6 years, 59.5% reported an annual household income of less than $20,000, and 29.8% reported a history of incarceration. The mean unadjusted GSES score was 25.0 (sd 5.2; range: 0–30, higher scores indicate greater resilience), and the mean DSMQ score was 7.34 (sd 1.78; range: 0–10, higher scores indicate greater adherence to diabetes self-management behaviors). In multivariable analyses, higher levels of resilience were associated with higher adherence to diabetes self-management behaviors (aOR = 9.68, 95% CI 3.01, 31.12). History of incarceration was negatively associated with higher adherence to diabetes self-management behaviors (aOR = 0.23, 95% CI 0.06, 0.81).

Conclusions

Resilience and personal history of incarceration are associated with adherence to diabetes self-management behaviors among African-American men residing in diabetes hotspots. Future interventions should incorporate resilience training to improve diabetes self-management behaviors. At a societal level, social determinants of health that adversely affect African-American men, such as structural racism and mass incarceration, need to be eliminated.

中文翻译：

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在城市安全网医院接受初级保健的非裔美国男性的复原力和糖尿病自我管理：一项横断面调查

摘要

背景

复原力是适应不利生活事件的能力。探索糖尿病自我管理干预措施的研究将非洲裔美国人的复原力与糖尿病相结合，其中包括少数非洲裔美国男性，与非洲裔美国女性相比，他们的糖尿病相关死亡率和并发症发生率更高。

设计

我们对生活在糖尿病热点地区的糖尿病未控制的非裔美国男性进行了横断面研究。我们使用一般自我效能量表 (GSES) 测量复原力水平，使用糖尿病自我管理问卷 (DSMQ) 测量糖尿病自我管理行为的依从性，以及通过电话调查的监禁历史。我们将参与者分为较高或较低的复原力水平以及较高或较低的糖尿病自我管理行为依从性。使用多变量逻辑回归，我们检查了复原力与糖尿病自我管理行为依从性之间的关系。我们的模型考虑了潜在的混杂因素，包括年龄、监禁历史和社会经济因素。

结果

在通过邮件和电话联系的 234 名患者中，94 名（40.2%）完成了调查。平均年龄为 60.6 岁，59.5% 的人报告家庭年收入低于 20,000 美元，29.8% 的人报告有监禁史。未经调整的平均 GSES 评分为 25.0（标准差 5.2；范围：0-30，分数越高表明复原力越大），平均 DSMQ 评分为 7.34（标准差 1.78；范围：0–10，分数越高表明对糖尿病自我治疗的依从性越高）管理行为）。在多变量分析中，较高水平的复原力与较高的糖尿病自我管理行为依从性相关（aOR = 9.68, 95% CI 3.01, 31.12）。监禁史与更高的糖尿病自我管理行为依从性呈负相关（aOR = 0.23, 95% CI 0.06, 0.81）。

结论

居住在糖尿病热点地区的非裔美国男性的复原力和个人监禁史与坚持糖尿病自我管理行为有关。未来的干预措施应纳入复原力训练，以改善糖尿病的自我管理行为。在社会层面，需要消除对非裔美国男性产生不利影响的健康社会决定因素，例如结构性种族主义和大规模监禁。