Multidimensional Domains of Social Support: Implications for Prevention and Treatment for American Indian Adults Living with Type 2 Diabetes

Introduction:

The life expectancy of American Indian (AI) people is nearly 5 years less than the U.S. general population and type 2 diabetes (T2D) is a significant contributor to this disparity. AI people are 2.3 times more likely than other Americans to have T2D. Diabetes is a major cause of death for AIs of all ages as well as a risk factor in the leading cause of death, cardiovascular disease.

For these reasons, it is imperative to identify protective factors that may reduce diabetes-related complications and promote better quality of life for AIs living with T2D. Social support has been linked to better diabetes care and health outcomes, but more work is needed to identify specific domains of support most likely to influence health. Furthermore, there is limited research on AI perceptions and preferences for social support and a dearth of empirical examination of the impacts of social support on diabetes in AI communities. In this presentation, we provide: a) community perspectives on social support and intergenerational aspects of diabetes and health, and b) a quantitative investigation of community and social support constructs associated with mental health, self-care behaviors, and physical health status among a sample of AI adults.

Methods:

Data are from Maawaji’ idi-oog Mino-ayaawin (Gathering for Health), a mixed-methods, community-based participatory research (CBPR) collaboration between the University of Minnesota (UMN) and five AI communities. The study involved 2 major phases: 1) a qualitative step including two sets of focus groups, and 2) a longitudinal quantitative phase including computer-assisted personal interviews (CAPI), salivary cortisol samples, and clinic-based medical chart reviews with 194 AI adults diagnosed with type 2 diabetes. We present findings from phase 1 and the CAPI portion of the project, the latter including results from a series of descriptive, bivariate, and multivariate (OLS and Logistic Regression) analyses using multiple measures of social support and health behaviors/outcomes.

Results:

Focus group participants called for support groups where people living with T2D could gather to share experiences, successes, and frustrations related to diabetes management. In addition to diabetes-specific groups, participants frequently mentioned family, friends, and elders as critical supports for mental and physical health. Intergenerational impacts of diabetes were also commonly discussed: participants worried about future generations and expressed a desire to serve as role models for better health. Quantitative data reveal significant associations between multiple domains of social support (e.g., diabetes support, family support, general social support, and cultural/community connectedness) and better physical, mental, and behavioral health outcomes.

Conclusions:

We provide evidence of community interest and positive health impacts of social support for diabetes care, prevention, and intervention in American Indian communities.