3128 — Knowledge isn't Everything: Role of Affect and Coping in Diabetes Care for Rural Adults with Uncontrolled Diabetes

Khambaty T, VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center; Miles SR, VA South Central Mental Illness Research, Education and Clinical Center, Michael E DeBakey VA Medical Center; Petersen NJ, VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center; Naik AD, VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center; Cully JA, VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center;

Objectives:
Many patients with diabetes remain poorly controlled and at risk for serious diabetes complications despite the presence of effective treatments and diabetes services. To further understand patient-related factors associated with poor diabetes self-management, we examined the associations between affect (positive and negative), coping, and diabetes self-management behaviors using the Transactional Model of Stress and Coping framework.

Methods:
Rural Veterans (N = 178) with treated but uncontrolled diabetes and elevated depressive symptoms reported their positive and negative affect (Positive and Negative Affect Schedule), diet (Diet Scale) and exercise (Exercise Scale) behaviors, and adaptive and maladaptive coping (BRIEF COPE).

Results:
Multiple regression analyses showed that Positive Affect was significantly associated with Diet (beta = .15) and Exercise (beta = .28) behaviors, as was Negative Affect (Diet beta = .15; Exercise beta = .23), after adjustment for diabetes severity, illness intrusiveness, and diabetes knowledge. In path analyses, adaptive coping mediated the relationships between Positive Affect and Diet (indirect effect: beta = .09, SE = .04, BCa CI = 0.02, 0.16), and Negative Affect and Diet (indirect effect: beta = .07, SE = .03, BCa CI = 0.01, 0.12). Adaptive coping also mediated the relationship between Positive Affect and Exercise (indirect effect beta = .13, SE = .03, BCa CI = 0.06, 0.20), and Negative Affect and Exercise (beta = .10, SE = .03, BCa CI = 0.05, 0.15).

Implications:
Affect and adaptive coping are significantly related to diabetes self-management behaviors. Future diabetes treatment may benefit from addressing broader affective patient needs and assisting patients in recognition and use of adaptive emotional coping skills.

Impacts:
Given the substantial ramifications of uncontrolled diabetes for individuals and society, the current study suggests an important role of health services researchers to further examine the effectiveness of increasing adaptive coping strategies of Veterans with uncontrolled diabetes to improve diabetes self-management, and ultimately, decrease disease burden.