Microaggressions, diabetes distress, and self-care behaviors in a sample of American Indian adults with type 2 diabetes

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American Indian/Alaska Native people experience the highest age-adjusted prevalence of type 2 diabetes of any racial group in the United States, as well as high rates of related health problems. Chronic stressors such as perceived discrimination are important contributors to these persistent health disparities. The current study used structural equation modeling to examine the relationships between racial microaggressions, diabetes distress, and self-care behaviors (diet and exercise) in a sample of 192 American Indians with type 2 diabetes from the northern United States. We found that microaggressions was positively associated with diabetes distress and that microaggressions had an indirect link to self-care via diabetes distress. Diabetes distress is an important mechanism linking microaggressions to self-care behaviors, which are critical to successful disease management and the reduction of complications. The amelioration of diabetes distress could improve self-care even in the presence of pervasive, chronic social stressors such as microaggressions.

Original languageEnglish (US)
Pages (from-to)122-129
Number of pages8
JournalJournal of Behavioral Medicine
Issue number1
StatePublished - Feb 1 2018

Bibliographical note

Funding Information:
Acknowledgements Research reported in this manuscript was supported by the National Institute on Diabetes, Digestive and Kidney Diseases #DK091250 (M. Walls, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors thank the project’s community members: Sidnee Kellar, Rose Barber, Robert Miller, Tweed Shuman, Lorraine Smith, Sandy Zeznanski, Patty Subera, Tracy Martin, Geraldine Whiteman, Lisa Perry, Trisha Prentice, Alexis Mason, Charity Prentice-Pemberton, Kathy Dudley, Mona Nelson, Eileen Miller, Geraldine Brun, Murphy Thomas, Hope Williams, Betty Jo Graveen, Daniel Chapman, Jr., Mary Sikora-Petersen, Tina Handeland, Phillip Chapman, Sr., GayeAnn Allen, Frances Whitfield, Doris Isham, Stan Day, Jane Villebrun, Beverly Steel, Muriel Deegan, Peggy Connor, Michael Connor, Ray E. Villebrun, Sr., Pam Hughes, Cindy McDougall, Melanie McMichael, Robert Thompson, Sandra Kier.

Publisher Copyright:
© 2017, Springer Science+Business Media, LLC.


  • American Indian
  • Diabetes
  • Diabetes distress
  • Microaggressions
  • Stress


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