RUNNING HEAD: Relationship of Diabetes Diagnosis

Southwestern Adventist University

Adenike Adefuye
The Relationship of Diabetes Diagnosis Between African-
Americans, Mexican-Americans and Caucasians
Research Proposal





Vesa Naukkarinen
KINT 201
April 10, 2013


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Introduction
The number one cause of death in the United States can now be attributed to
chronic diseases. One of the diseases that falls into this category is diabetes. According to the
National Diabetes Facts Sheet that was released in January of 2011, about 18 million children
and adults have been diagnosed with diabetes. Another 7 million people have diabetes have
diabetes and are yet to be diagnosed (Center of Disease Control, 2011). Although diabetes affects
different people from all over the world, there seems to a prevalence of African and Hispanic
Americans who are diagnosed with diabetes in the United States (NDSS, 2010). The purpose
of this study is to explore why minorities have a higher incidence of diabetes compared to
Caucasians in the city of Dallas. This study will focus on three primary objectives: 1) the
relationship between ethnicity and the diagnoses of diabetes, 2) determining what factors affect
and create diabetes, and 3) finding ways and methods to help decrease the rate of diabetes in
African and Hispanic Americans. The factors that will be examined in this study are going to be
physical activity, health insurance, and patient/health provider communication. The design of my
research will be a survey questionnaire.
Theoretical Framework
The theoretical framework for this study is based upon two articles, one by J.A
Vaccaro and F.G Huffman and another one by Nelda Martinez and Julia Bader. The first article
was based on a survey by the National Health and Nutrition Examination Survey in 2007-2008.
The purpose of the article was to examine the relationships among reported medical advice,
diabetes education, health insurance and health behavior of individuals with diabetes by
race/ethnicity and gender. The results of the study showed that African Americans were more
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likely than Caucasians to be told to reduce fat or calories in their diet (Vaccaro & Feaster, 2012).
Also African Americans were also more likely than Caucasians to report being told to increase
their physical activity while Mexican Americans were less likely to self-monitor their blood
glucose than Caucasians (Vaccaro & Feaster, 2012). Overall the study showed that having recent
diabetes education increased the likelihood of performing several diabetes self-management
behaviors independent of race (Vaccaro & Feaster, 2012). The second article was dealing with an
actual study of Mexican Americans that live in the county of El Paso, Texas. The results of this
study showed Mexican Americans in this area are at a higher risk of developing diabetes than
other racial groups in the same area (Martinez & Bader, 2007). Some of the factors that increased
the development of diabetes include education and income level for Mexican Americans
according to this specific article (Martinez & Bader, 2007).
Research Question(s)
Are African and Hispanic Americans more likely to develop diabetes than
Caucasians in the city of Dallas? What factors influence the development of diabetes in African
and Hispanic Americans rather than in Caucasians? What factors can help to reduce the rate of
the development of diabetes in African and Hispanic Americans in the city of Dallas, Texas?
Literature Review
Physical Activity
One of the factors that has been shown to improve or prevent diabetes and a host
of other chronic diseases is physical activity. Moderate physical activity has the greatest benefit
to those who are obese, and/or have a positive family history of type II diabetes (Gill & Cooper,
2008). But does physical activity have a positive or the same effect in African and Hispanic
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Americans as it does in Caucasians? A study was done in 2009 to explore exercise perceptions
among individuals with diabetes. The authors operationally defined self-efficacy for exercise as
an individuals perception that they can engage in a specified activity when faced with potential
barriers [such as diabetes](Dewitt & Yeshiva, p. 1338). The results of this study showed that
exercise perceptions were not found to cause changes in physical activity. The study concluded
that African-American population may show different influences on participating in physical
activity than a Caucasian population would (Dewitt & Yeshiva, 2009). Based on this study, an
argument could be made that African-American do not place as high value on physical activity
as Caucasians might. This could help explain why physical inactivity could possibly be higher in
minorities than in Caucasians.
Health Insurance
Another important factor that needs to be looked at is health insurance. Health
insurance is a necessity to keep doctor visits affordable and to prevent diseases from developing.
However, there are plenty of people in the United States that do not own health insurance. This
can be disastrous for people with diabetes because of the high expense of medications and
treatment. A study was done by Christine Huttin that compared results of disease economic
model on two chronic diseases (hypertension and type II diabetes) to analyze the role of health
insurance in the access, payment and patterns of drug use (Huttin, 2007). The study was done on
694 individuals who had type II diabetes without complications. The results of the study showed
that physicians tend to differentiate their prescription practices with different chronic disease.
However, this is not based on health insurance, but rather on the availability and variety of drug
choices(Huttin, 2007). This may prove that health insurance is not a determining factor of
diabetes minorities or Caucasians.
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Patient/ Healthcare provider Communication
Another important factor that can influence the rate of diabetes in African,
Mexican and Caucasian Americans is the relationship or the communication between the patient
and health care provider. This relationship is crucial in the management of diabetes because one
of the ways people with diabetes get educated about the disease is through their healthcare
provider. The more knowledgeable the healthcare provider is about how to manage, or prevent
the onset of diabetes, the more likely that the patient will have a easier time adjusting to a
lifestyle with diabetes or become more educated on how to prevent diabetes. A study was done
by Lisa Marceau, John McKinlay, Rebecca Shackelton and Carol Link (2010) about how much
the patient, healthcare provider and organization influence the appropriate diagnosis and
management of diabetes. The purpose of their study was to estimate the relative contribution of
[a] patients attributes, provider characteristics and organizational features of the doctors
workplace to the diagnosis and management of diabetes (Marceau, McKinlay, Shackelton &
Link, 2010. pg. 1122). The study was done in an experimental design on 192 doctors. The
doctors were classified according to gender and level of experience. The experiment was done by
real patients asking them question during a one-on-one interview. The results showed that patient
attributes or symptoms only explained 4.4% of the variability in diabetes diagnosis (Marceau,
McKinlay, Shackelton & Link, 2010). Only 20% of the total variance was explained by patient,
healthcare provider and organizational factors (Marceau, McKinlay, Shackelton & Link, 2010).
This means that there is still about 80% of the variability is diabetes diagnosis is still
unexplained. Patient/healthcare provider communication is still important to help manage
diabetes.
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According to the study done by Marceau, McKinlay, Shackelton & Link (2010)
there are still many other factors that can influence or contribute to the diagnosis of diabetes.
However one important variable to the patient/healthcare provider relationship is trust(Marceau,
McKinlay, Shackelton & Link, 2010). Trust can help the patient open up more and allow the
healthcare provider to better diagnose the patient.
Research Design
The methodology for this proposal will be based upon a study done by J. A.
Vaccaro, D. J. Feaster, S.L. Lobar, M.K. Baum and M. Magnus and F.G. Huffman (2012). In
their study they used a survey questionnaire from the National Health and Nutrition and
Examinations Survey (NHANES)in 2007-2008. This study will also use sample questions about
health insurance, nutrition, physical activity and patient/healthcare provider from NHANES.
Sampling Method
The initial sampling method for the pilot study will be 15 volunteers from three
diabetic clinics in the city of Dallas, Texas. The volunteers will be between the ages of 18 and
65. This age group was chosen because this is the age that most people will be diagnosed with
diabetes. The volunteers will be made up of five African-Americans, five Caucasians and five
Mexican-Americans. They will not be given rewards or incentives for filling out the
questionnaire and possible follow up visits.
Data Collection
The survey questionnaire will be given to each participant in the diabetic clinical
setting. The survey questionnaires will then be collected by me and I will tally the results based
on the scores on the questionnaire for this proposal.
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Analysis of Data
The type of analyses that will be used in this proposal will be multiple regression
and an analysis of variance or commonly referred to as ANOVA. Multiple regression is a way
to examine the extent to which one variable can be predicted by another (Sapsford & Jupp,
1996). Multiple regression will be relevant to this proposal because it enables me to explore the
effects of more than one independent variable or to control statistically for the effects of
extraneous variables (Sapsford & Jupp, pg. 268). ANOVA is used in situations where
researchers want to examine the effects of [two] or more independent or dependent variables at
a time (Sapsford & Jupp, pg. 268). This will help determine which ethnicity has the highest rate
of diabetes and which factors influence that the most.










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References
Balsa, A., McGuire, T. & Meredith, L. (2005). Testing for statistical discrimination in health care
Health Services Research. Vol. 40(1), p. 227-252.
Centers for Disease Control and Prevention,. U.S Department of Health and Human Services.
(2011). National Diabetes Fact Sheet: National Estimates and General Information
on Diabetes and Prediabetes in the United States. Atlanta, GA. Division of Diabetes
Translation. Retrieved from http://www.cdc.gov/diabetes.
Dewitt, T. & Yeshiva U. (2009). Understanding mediators of physical activity among individuals
with diabetes. Dissertation Abstracts International Section B: The Sciences and
Engineering. Vol 70(2-B), p. 1338.
Gill, J. & Cooper A. (2008) Physical activity and prevention of type II diabetes mellitus. Sports
Medicine. Vol 38(10), p. 807-824.
Huttin, C. (2007) The role of different types of health insurance on access and utilization:
comparative results on two chronic conditions (hypertension and type II diabetes without
complication): How patient economics may influence physicians prescribing decisions.
Managerial & Decision Economics. Vol 28 (4-5), p. 503-507.
Martinez N.C & Bader J.,(2007). Analysis of behavioral risk factor surveillance system data to
assess the health of hispanic americans with diabetes in El Paso County, Texas. The
Diabetes Educator. Vol 33(4), p. 691-699.
Marceau,L., McKinlay, J., Shackelton, R.& Link, C. (2010). The relative contribution of patient,
provider, and organizational influences to the appropriate diagnosis and management of
diabetes mellitus. Journal of Evaluation in Clinical Practice. Vol 17(6), p. 1122-1128.
National Diabetes Surveillance System. (2010). Age-adjusted prevalence of diagnosed diabetes
per 1,000 population online table. National Diabetes Surveillance System. Retrieved from
http://www.cdc.gov/diabetes/statistics/incidences.
Nelson, K., Chapko, M., Reiber, G. & Boyko, E., (2005). The association between health
insurance coverage and diabetes care: data from the 2000 behavioral risk factor
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surveillance system. Health Services Research. Vol 40(2), p. 361-372.
Sapsford R. & Jupp V. (1996). Data Collection and Analysis. Thousand Oaks, CA. Sage
Publications Inc.
Vaccaro, J.A., Feaster, D.J., Lobar,S.L., Baum, M.K., Magnus, M & Huffman, F.G. (2012)
Medical advice and diabetes self-management reported by mexican-american, black
american, and white non-hispanic adults across the United States. BioMedCentral Public
Health.Vol 12, p. 185-195.











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