Corresponding Author

Brittany L. Smalls, PhD, MHSA

2195 Harrodsburg Road, Suite 125

Lexington, KY 40504

P: 859-323-4916

E: Brittany.smalls@uky.edu

Author Affiliations

Brittany L. Smalls1,2, Tofial Azam3, Maddie Dunfee2,4, Philip M. Westgate2,3, Susan Westneat5, Nancy Schoenberg2,6

1 Department of Family and Community Medicine, College of Medicine, University of Kentucky, 2195 Harrodsburg Road, Lexington, KY 40504

2 Center for Health Equity Transformation, College of Medicine, University of Kentucky, 372 Healthy Kentucky Building, Lexington, Ky 40536

3Department of Biostatistics, College of Public Health, University of Kentucky, 725 Rose Street, MDS 205, Lexington, KY 40536.

4 University of Kentucky College of Medicine, William R. Willard Education Building, MN 150, Lexington, KY 40536

5 Department of Epidemiology, College of Public Health, University of Kentucky, 151 Washington Ave, Bowman Hall 425, Lexington, KY 40504.

6 Department of Behavioral Science, College of Medicine, University of Kentucky, UK Medical Center, MN 150, Lexington, KY 40536

Author Area of Expertise

BLS--health services research, health inequities, rural health

TA, PMW--Statistics

MD--health disparities

SW--data managment, epidemiology

NS--health inequities, rural health


Introduction: Appalachian residents are more likely than other populations to have Type 2 Diabetes Mellitus (T2DM) and to experience more severe complications from the disease, including excess and premature mortality.

Methods: This study examines health alongside sociodemographic factors, psychosocial factors (including knowledge, empowerment, social support/function, religiosity, distress), and perceived problems in diabetes management that may influence self-care and HbA1c among vulnerable rural residents. A survey of a community–based sample of 356 adults with diagnosed diabetes or HbA1c > 6.5 was conducted in six counties in Appalachian Kentucky.

Results: Findings suggest that neither religiosity nor social support/function mediate/moderate the relationship between psychosocial factors and dependent variables (problem areas in diabetes, T2DM self-care or HbA1c). Results also suggest that distress is a predictor of problem areas in diabetes, and both distress and empowerment are predictors of T2DM self-care.

Implications: This study addresses the gap in the literature concerning the influence of psychosocial factors on problem areas in diabetes, T2DM self-care and HbA1c among vulnerable rural residents, as well as the potential mediating/modifying effects of religiosity and social function/support. Future research is needed to inform strategies for identifying and addressing distress among vulnerable populations burdened by T2DM, including Appalachian adults.



Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Recommended Citation

Smalls BL, Azam T, Dunfee M, Westgate PM, Westneat SS, Schoenberg N. The relationship between psychosocial factors, self-care, and blood sugar in an Appalachian population. J Appalach Health 2022;4(3): 1–22. DOI: https://doi.org/10.13023/jah.0403.01.