Social Determinants of Diabetes Self-Management, and Diabetes Health Care Utilization in African American and Latino Men with Type 2 Diabetes.

Abstract

Diabetes is among one of the leading causes of death in the United States. This dissertation seeks to identify psychosocial and structural factors that influence self-care and health care utilization in Latino and African American men with diabetes on regional and national levels. My dissertation also explores how gender identity is conceptualized among Latino and African American men with diabetes, and examines how conceptualizations of masculinity influence self-care and health care utilization behaviors. Three empirical chapters examined different aspects of these topics. Chapter two identified differences in predictors of diabetes self-management and health care use in Latinos and African Americans with type 2 diabetes participating in a Detroit-based diabetes lifestyle intervention. Regression model results showed that older age increased diabetes self-management, while low levels of diabetes knowledge significantly decreased it, but these associations did not exist for health care utilization. Chapter three used data collected from three focus groups with African American and Latino men with type 2 diabetes to explore structural and psychosocial factors that influence health care use and self-management. Three themes emerged that characterize gender identity and its relationship to health behavior in men: 1) men’s beliefs about being men; 2) manhood’s influence on health behavior; and 3) men’s role in diabetes education. Results suggest that the way men define gender roles may have implications for how they engage in their care. Chapter four explored whether social support and social integration mediate or buffer the relationship between race and health care utilization among U.S. men, using cross-sectional data from the 2001 National Health Interview Survey. My findings showed that non-Hispanic black men with high levels of social integration were less likely to forego care than their non-Hispanic white counterparts with high social integration. Also, non-Hispanic black men who did not attend church had higher odds of foregoing care compared to men Hispanic and non-Hispanic white men who did attend church services. The implications of my work highlight a need for more research on the direct impact of masculine roles, social integration and heterogeneity in predictors of diabetes self-management versus health care use on diabetes care for men.