Journal of Community Health

, Volume 31, Issue 5, pp 393–412 | Cite as

Assessing Sources Of Support For Diabetes Self-Care In Urban And Rural Underserved Communities

  • Benjamin A. Shaw
  • Mary P. Gallant
  • Mary Riley-Jacome
  • Linda S. Spokane


The ability of adults with diabetes to manage their illness properly and prevent complications is, in part, a function of support provided by the people and institutions surrounding them. Using data from over 200 adults with diabetes in two medically underserved communities – one urban and one rural – this study examines the self-care specific support provided by four key sources: family and friends, community organizations, one’s neighbors and neighborhood, and resources in the wider community. More specifically, this study aims to assess the support needs of adults with diabetes in these communities by estimating their rates of various self-care behaviors, the amount of support provided by key sources, and the associations between support from these sources and adherence to recommended diabetes self-care behaviors. Descriptive findings indicate that close to 40% of the sample failed to report at least moderate levels of adherence, and that physical activity in the rural community, and smoking in the urban community represent particular problem areas. Individuals from the urban subsample reported receiving more support from all of the sources assessed. Logistic regression models indicated that one’s neighbors and neighborhood resources appear to have a broad influence on adherence to diabetes self-care behaviors. Support from family and friends, as well as from community organizations, also seems to be important. These results have implications for the design of interventions aimed at bolstering support for diabetes self-care, and point to the need for an enhanced focus on strengthening the social environmental resources of adults with diabetes.


type 2 diabetes diabetes self-care underserved communities urban and rural communities needs assessment 



This research was supported by a Prevention Research Center grant from the Centers for Disease Control and Prevention.


  1. 1.
    Boyle JP, Honeycutt AA, Narayan KM, et al. (2001). Projection of diabetes burden through 2050: Impact of changing demography and disease prevalence in the US. Diabetes Care 24:1936–1940PubMedGoogle Scholar
  2. 2.
    Fisher EB Jr., Arfken CL, Heims JM, Houston CA, Jeffe DB, Sykes RK (1997). Acceptance of diabetes regimens in adults. In: Gochman DS (eds.), Handbook of Health Behavior Research II: Provider Determinants. Plenum Publishing, New York, pp. 189–212Google Scholar
  3. 3.
    Kurtz SM (1990). Adherence to diabetes regimens: Empirical status and clinical applications. Diabetes Educ 16:50–59PubMedGoogle Scholar
  4. 4.
    Glasgow RE, Wagner EH, Kaplan RM, Vinicor F, Smith L, Norman J (1999) If diabetes is a public health problem, why not treat it as one? A population-based approach to chronic illness. Ann Behav Med 21:159–170PubMedCrossRefGoogle Scholar
  5. 5.
    Connolly V, Unwin N, Sherriff P, Bilous R, Kelly W (2000) Diabetes prevalence and socioeconomic status: A population based study showing increased prevalence of type 2 diabetes mellitus in deprived areas. J Epidemiol Community Health 54:173–177PubMedCrossRefGoogle Scholar
  6. 6.
    Glasgow RE, Eakin EG (1998). Issues in diabetes self-management. In: Shumaker SA, Schron EB, Ockene JK, McBee WL (eds.), The Handbook of Health Behavior Change. Springer, New York, pp. 435–461Google Scholar
  7. 7.
    Cox RH, Carpenter JP, Bruce FA, Poole KP, Gaylord CK (2004). Characteristics of low-income African-American and Caucasian adults that are important in self-management of type 2 diabetes. J Community Health 29:155–170PubMedCrossRefGoogle Scholar
  8. 8.
    Clark NM, Becker MH, Janz NK, Lorig K, Rakowski W, Anderson L (1991) Self-management of chronic disease by older adults. J Aging Health 3:3–27Google Scholar
  9. 9.
    McLeroy KR, Bibeau D, Steckler A, Glanz K (1988). An ecological perspective on health promotion programs. Health Educ Q 15:351–377PubMedGoogle Scholar
  10. 10.
    Sallis JF, Owen N (1997) Ecological models. In: Glanz K, Lewis FM, Rimer BK (eds.), Health Behavior and Health Education: Theory, Research, and Practice. Jossey-Bass, San Francisco, pp 403–424Google Scholar
  11. 11.
    Gallant MP (2003). The influence of social support on chronic illness self-management: A review and directions for research. Health Educ Behav 30:170–195PubMedCrossRefGoogle Scholar
  12. 12.
    Kawachi I, Berkman LF (2003) Neighborhoods and Health. Oxford University Press, New York, pp 1–19Google Scholar
  13. 13.
    New York State Department of Health (2001). Diabetes Surveillance in New York State. Unpublished manuscriptGoogle Scholar
  14. 14.
    Toobert DJ, Hampson SE, Glasgow RE (2000). The Summary of Diabetes Self-Care Activities measure. Diabetes Care 23:943–950PubMedGoogle Scholar
  15. 15.
    Brown DW, Balluz LS, Health GW, et al (2003). Associations between recommended levels of physical activity and health-related quality of life: Findings from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) survey. Prev Med 37:520–528PubMedCrossRefGoogle Scholar
  16. 16.
    Ainsworth BE, Haskell WL, Whitt MC, et al (2000). Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc 32:S498–504PubMedCrossRefGoogle Scholar
  17. 17.
    Glasgow RE, Strycker LA, Toobert DJ, Eakin E (2000) A social-ecological approach to assessing support for diabetes self-management: The Chronic Illness Resources Survey. J Behav Med 23:559–583PubMedCrossRefGoogle Scholar
  18. 18.
    Glasgow RE, Toobert DJ, Barrera M Jr., Strycker LA (2005) The Chronic Illness Resources Survey: Cross-validation and sensitivity to intervention. Health Educ Res 20:402–409PubMedCrossRefGoogle Scholar
  19. 19.
    Centers for Disease Control. (2002). Behavioral Risk Factor Surveillance System Survey Data. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GeorgiaGoogle Scholar
  20. 20.
    Dorfman LT, Murty SA, Evans RJ (2004) History and identity in the narratives of rural elders. J Aging Studies 18:187–203CrossRefGoogle Scholar
  21. 21.
    Carmines EG, Zeller RA (1979) Reliability and Validity Assessment. Sage Publications, Thousand Oaks CA, p 46Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Benjamin A. Shaw
    • 1
  • Mary P. Gallant
    • 1
  • Mary Riley-Jacome
    • 1
  • Linda S. Spokane
    • 1
  1. 1.Department of Health Policy, Management, and Behavior School of Public HealthUniversity at AlbanyRensselaerUSA

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