Apathy and type 2 diabetes among American Indians: Exploring the protective effects of traditional cultural involvement

Amanda E. Carlson, Benjamin D. Aronson, Michael Unzen, Melissa Lewis, Gabrielle J. Benjamin, Melissa L Walls

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


In this study we examine relationships between traditional cultural factors, apathy, and health- related outcomes among a sample of American Indian adults with type 2 diabetes. Participants completed cross- sectional interviewer- assisted paper and pencil surveys. We tested a proposed model using latent variable path analysis in order to understand the relationships between cultural participation, apathy, frequency of high blood sugar symptoms, and health- related quality of life. The model revealed significant direct effects from cultural participation to apathy, and apathy to both health- related outcomes. No direct effect of cultural participation on either health- related outcome was found; however, cultural participation had a negative indirect effect through apathy on high blood sugar and positive indirect effects on health- related quality of life. This study highlights a potential pathway of cultural involvement to positive diabetes outcomes.

Original languageEnglish (US)
Pages (from-to)770-783
Number of pages14
JournalJournal of health care for the poor and underserved
Issue number2
StatePublished - May 2017

Bibliographical note

Funding Information:
This research was funded by a National Institutes of Health (NIH) grant (MH085852), M. Walls, Principal Investigator and Pathways to Advanced Degrees in Life Sciences grant (GM086669). The contents of this manuscript are produced by the authors and do not necessarily represent the official views of the National Institutes of Health. B. Aronson gratefully acknowledges support from an American Foundation for Pharmaceutical Education Fellowship and a Health Services Dissertation Award (R36) from the Agency for Healthcare Research and Quality (1R36HS024180-01). The authors would like to thank Community Research Council members: Doris Isham, Julie Yaekeal- Black Elk, Tracy Martin, Sidnee Kellar, Robert Miller, Geraldine Whiteman, Peggy Connor, Michael Conner, Stan Day, Pam Hughes, Jane Villebrun, Muriel Deegan, Beverly Steel, and Ray Villebrun.

Publisher Copyright:
© Meharry Medical College.

Copyright 2017 Elsevier B.V., All rights reserved.


  • American indians
  • Apathy
  • Community- based participatory research
  • Culture
  • Type 2 diabetes mellitus


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