A Mixed-methods Approach to Understanding the Perspectives, Experiences and Attitudes of Cognitive Behavioral Therapy for African Americans with Type-2 Diabetes 公开
Cornely, Ronald (Spring 2020)
Abstract
Background: Type-2 diabetes is a chronic disease which diminishes the body’s ability to properly metabolize blood glucose. As a result, people with diabetes have persistently high blood sugar levels which may cause severe adverse health effects, such as kidney failure or blindness. When stratified by race, diabetes has demonstrated to disproportionately impact marginalized groups. More specifically, Black or African American people in the U.S. face stark diabetes-related health disparities when compared to non-Hispanic White people in the population. As the U.S. population continues to age and levels of obesity rise, diabetes is becoming an increasingly important public health concern. In considering the disproportionate load carried by the African American population, this mixed-methods approach will explore the perspectives and attitudes of African American patients using a novel approach to cognitive behavioral therapy.
Methods: A concurrent quantitative and qualitative study design was applied to assess the perspectives, experiences and attitudes of African American patients with type-2 diabetes. The quantitative strand of data provided measures of participant psychological, emotional and physical well-being as well as self-efficacy and cognitive functioning. The qualitative data strand provided an in-depth exploration of participant perspectives using focus-group interviews, followed in-depth coding methods and subsequent qualitative analysis. The different data strands were independently analyzed, and inferences were subsequently drawn based on the quantitative and qualitative results.
Results: On average participants were 56 years old, ranging 39 to 71 years of age. 79% (n=11) of participants self-identified as women, while 21% (n=3) self-identified as men. The height and weight of participants were also used to measure each participant’s Body Mass Index (BMI). BMI calculations revealed that 64% (n=9) of participants were obese, 21% (n=3) were overweight and 14% (n=2) were within a normal weight range for their reported height. 50% of study participants reported having a college degree or higher while the remainder of the participants indicated that they did not attain a college degree. Quantitative results demonstrated statistically significant differences between pre and post study data in diabetes-related distress, generalized anxiety, and patient-related quality of life (p< 0.05). Qualitative results elucidated themes in relation to social support, information sharing, contributing factors to diabetes management and intervention receptivity of study participants.
Conclusion: This innovative mixed-methods approach revealed that the skills and knowledge gained from Cognitive Behavioral Therapy may improve perception of diabetes; alleviating the stresses of diabetes self-management. The concurrent results also demonstrated that disseminating health information in a communal setting may mitigate health literacy disparities while bolstering participant social support networks.
Table of Contents
Acknowledgements..........................................................................................................ii
Chapter 1: Introduction & Statement of Purpose........................................................1
Chapter 2: Review of the Literature.............................................................................7
A Deeper Discussion of the Theoretical Framework..................................8
Literature Review............................................................................13
Summary & Study Relevance.............................................................22
Chapter 3: Methodology.................................................................................................24 Introduction.................................................................................24
Population & Research Design...........................................................25
Quantitative Procedures & Measures...................................................26
Qualitative Procedures & Measures.....................................................31
Chapter 4: Results..........................................................................................................34 Introduction..........................................................................................................34
Quantitative Results.............................................................................................34
Table 1. CBT Intervention Participant Demographic Information.......40
Table 2. CBT Intervention Quantitative Scale Data.........................41 Qualitative Results.......................................................................44
Chapter 5: Conclusions, Implications & Recommendations....................................56
Introduction & Study Summary..........................................................................56 Discussion...........................................................................................................57
Strengths & Limitations......................................................................................63
Implications & Recomendations.........................................................................66
Conclusions................................................................................67
References......................................................................................................................68
Appendices.....................................................................................................................71
Appendix A: Interview Guide.............................................................................71
Appendix B: Code System..................................................................................74
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