Date of Award

Spring 5-2019

Degree Name

Doctor of Philosophy (PhD)

Advisor(s)

ANNA V. WILKINSON, PHD

Second Advisor

BELINDA REININGER, DRPH

Third Advisor

STEVEN KELDER, PHD

Abstract

The overall goal of the present study was to assess the effect of fatalistic beliefs and lifetime religiosity on glycemic control and blood sugar monitoring behavior among Mexican-American participants of a chronic care management intervention program of the Rio Grande Valley. In order to achieve these aims, a mixed methods prospective longitudinal study design was utilized among approximately 500 participants of the Salud y Vida program. Qualitatively, a phenomenological approach was used to analyze semi-structured interview data assessing fatalism and religiosity and type 2 diabetes management among 15 participants stratified by engagement in the Salud y Vida program. Fatalistic beliefs and religiosity were assessed quantitatively using the Diabetes Fatalism Scale and a subscale of the National Comorbidity Study-Replication. When assessing these belief systems in relation to Type 2 Diabetes management qualitatively, fatalism and religiosity appeared to play a complex role with long-term participants seeing a connection between both fatalism and religiosity and diabetes management and these participants feeling discussions of these beliefs with a medical professional would be beneficial. The association between fatalistic beliefs and lifetime religiosity with HbA1c and blood glucose monitoring behavior was assessed at baseline. This association was explored utilizing linear and logistic multi-regression methods. Linear regressions models revealed that higher levels of diabetes fatalism and emotional distress related to diabetes management were associated with higher HbA1c values. However, logistic regression models did not show diabetes fatalism and religiosity to be significantly associated with blood glucose monitoring behaviors. The mediation of fatalism and lifetime religiosity on the effect of the Salud y Vida program was measured via change in HbA1c after three-month follow-up; however, none of the factors assessing fatalism or religiosity met the requirements of a mediating variable. Nonetheless, logistic regression models were utilized to assess the effect of the Salud y Vida program on HbA1c at three-month follow-up while controlling for fatalistic beliefs and lifetime religiosity. Frequency of Salud y Vida engagement significantly increased the odds of a participant decreasing their HbA1c at three-month follow-up. Fatalistic beliefs and lifetime religiosity did not have a statistically significant association with change in HbA1c at follow-up.

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