Rural Culture and Diabetes Self-Management Beliefs, Behaviors and Health Outcomes

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Abstract Background Rural populations in the United States face a diabetes mortality penalty. Self-management is a core component of treatment for type 2 diabetes, but there is low uptake of self-management education and support interventions in rural areas. Rural structural barriers to diabetes self-management have been described, yet the role of rural culture has not been extensively explored. Objective The purpose was to examine the relationships among rural culture, diabetes beliefs, self-management behaviors and health outcomes. Methods A stratified random sample of 500 adults with type 2 diabetes were recruited from a rural integrated health care system and invited to participate in this non-experimental cross-sectional study. Participants completed a survey that included validated measures of rural identity, self-reliance, perceived diabetes threat, and diabetes self-management behaviors. The most recent A1c was collected from the medical record. Descriptive, bivariate, multivariate and moderation analyses were conducted. Results 128 participants returned completed surveys. Having an A1c < 8% was associated with better diabetes self-management behaviors, lower perceived threat, being female, and older age. Better diabetes self-management behaviors were associated with lower self-reliance, lower perceived threat, and older age. The combined moderation effect of both self-reliance and rural identity on the relationship between perceived threat and self-management behaviors was significant. Discussion Findings highlight the complex relationship between diabetes beliefs and behavior in rural populations and demonstrate that components of the rural culture have both direct and moderating effects on diabetes beliefs and self-management behaviors. These findings have important ramifications for nurses practicing in rural settings.