Perceptions of diabetes among patients in an urban health care system

Objectives. A major problem facing health care providers today is adherence to treatment regimens by patients. Adherence is of even greater significance for patients with diabetes who shoulder a great deal of responsibility in their disease management. Perceptions of diabetes have been found to play a major role in adherence. The effects of race and socioeconomic status on the disease perceptions remain unclear. This exploratory study encompassed two themes: (1) assessing perceptions of diabetes among African American and white American adults with diabetes who were patients in 1994 in a large Midwestern urban health care system and (2) examining the psychometric properties of the measurement instruments used to study perceptions. Design. A stratified random sampling scheme (by race and socioeconomic status (SES)) was used. Diabetes perceptions were measured using three scales from the Meaning of Illness Questionnaire assessing the impact loss and stress associated with diabetes. Perceptions of physician efficacy were also measured. The study population consisted of 50 (68% response rate) African American and white American patients aged 18-65 years. Results. No differences in SES were found between the African American and white American participants ( p = 0.44). However the African Americans in the study indicated a greater sense of loss associated with diabetes than the white Americans in the study ( p < 0.05). In the combined racial group the reliability coefficients as measured by Cronbach's alpha were 0.76 0.78 0.68 and 0.68 for the Impact Loss Stress and Perceptions of Physician Efficacy scales respectively. However the results of within-racial-group analyses tell a different story. The Impact scale fitted the African American and white American subgroups although there was some item variation by racial group. The Loss scale did not fit the white American subgroup and the Stress and Perceptions of Physician Efficacy scales did not fit the African American subgroup.