such as auto accidents and prior illnesses (Hunt, Valenzuela, and Pugh, 1998). Others believed diabetes was caused by fate or God (Quotromoni et al., 1994). Still others perceived diabetes as incurable (Weller et al., 1999), and others saw it as a source of frustration and blamed themselves because they could not follow a proper lifestyle (Native Americans: Parker, 1994).

Not surprisingly, hopelessness is associated with beliefs in the importance of external support from family and health care providers. A supportive family is seen as critical for adoption and maintenance of preventive behaviors, and a sympathetic and caring medical provider is essential to provide the emotional reassurances and educational input needed for understanding the disease and developing the skills needed for more complex, and potentially risky and threatening, self-regulation behaviors, such as use of insulin. These feelings were expressed by African-American, Hispanic, Chinese American, and Native American respondents. As is the case for other chronic, difficult-to-understand, and seemingly intractable conditions, respondents vacillate between traditional and “Western” biomedical systems and their respective treatments.

Intervening for Diabetes Prevention and Control

Preparing recommendations for future programmatic communication research would be much easier if one could draw on a body of studies that have identified communication factors known to facilitate effective preventive behaviors. Although studies of communications targeting diabetes-related behaviors are sparse, a substantial number of studies provide information important for the future development of communication research. These studies have three objectives: (1) demonstrating the efficacy of specific treatments for reducing complications of diabetes, (2) evaluating the efficacy of different interventions for changing behavior in the hope of achieving improved control, and (3) attempting to translate efficacy findings to community and treatment settings, such as carrying out studies of effectiveness. Communication broadly de-



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