The Texas Medical Center Library DigitalCommons@TMC UT School of Public Health Dissertations (Open Access) School of Public Health Spring 5-2019 EVALUATING RELIGIOSITY ACROSS THE LIFESPAN AND FATALISTIC BELIEFS AMONG PATIENTS OF A CHRONIC CARE MANAGEMENT INTERVENTION PROGRAM WITH TYPE 2 DIABETES CINDY LYNN SALAZAR UTHealth School of Public Health Follow this and additional works at: https://digitalcommons.library.tmc.edu/uthsph_dissertsopen Part of the Community Psychology Commons, Health Psychology Commons, and the Public Health Commons Recommended Citation SALAZAR, CINDY LYNN, "EVALUATING RELIGIOSITY ACROSS THE LIFESPAN AND FATALISTIC BELIEFS AMONG PATIENTS OF A CHRONIC CARE MANAGEMENT INTERVENTION PROGRAM WITH TYPE 2 DIABETES" (2019). UT School of Public Health Dissertations (Open Access). 80. https://digitalcommons.library.tmc.edu/uthsph_dissertsopen/80 This is brought to you for free and open access by the School of Public Health at DigitalCommons@TMC. It has been accepted for inclusion in UT School of Public Health Dissertations (Open Access) by an authorized administrator of DigitalCommons@TMC. For more information, please contact [email protected]. EVALUATING RELIGIOSITY ACROSS THE LIFESPAN AND FATALISTIC BELIEFS AMONG PATIENTS OF A CHRONIC CARE MANAGEMENT INTERVENTION PROGRAM WITH TYPE 2 DIABETES by CINDY LYNN SALAZAR, MPH APPROVED: ANNA V. WILKINSON, PHD BELINDA REININGER, DRPH STEVEN KELDER, PHD DEAN, THE UNIVERSITY OF TEXAS SCHOOL OF PUBLIC HEALTH Copyright by Cindy Lynn Salazar. PhD MPH 2019 DEDICATION To my parents and husband EVALUATING RELIGIOSITY ACROSS THE LIFESPAN AND FATALISTIC BELIEFS AMONG PATIENTS OF A CHRONIC CARE MANAGEMENT INTERVENTION PROGRAM WITH TYPE 2 DIABETES by CINDY LYNN SALAZAR MPH, Baylor University, 2013 BA, Baylor University, 2011 Presented to the Faculty of The University of Texas School of Public Health in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY THE UNIVERSITY OF TEXAS SCHOOL OF PUBLIC HEALTH Houston, Texas May, 2019 Acknowledgements I would like to thank the Salud y Vida program team for making data collection for this dissertation possible. A big thanks to Belinda Garza, Rachel Avila, Carolina Alejandro- Ruiz, Elvia Garcia, and Yolanda Gonzalez for implementing the survey instrument for the present study in to their workday while enrolling participants in the Salud y Vida program. I especially want to thank Pablo Sanchez, Maria Zolezzi, and Julie Gomez for their incredible support in facilitating the data cleaning process. Lastly, I would like to thank my dissertation committee for their invaluable guidance and mentorship. EVALUATING RELIGIOSITY ACROSS THE LIFESPAN AND FATALISTIC BELIEFS AMONG PATIENTS OF A CHRONIC CARE MANAGEMENT INTERVENTION PROGRAM WITH TYPE 2 DIABETES Cindy Lynn Salazar, MPH, PhD The University of Texas School of Public Health, 2019 Dissertation Chair: Belinda Reininger, DrPH The overall goal of the present study was to assess the effect of fatalistic beliefs and lifetime religiosity on glycemic control and blood sugar monitoring behavior among Mexican-American participants of a chronic care management intervention program of the Rio Grande Valley. In order to achieve these aims, a mixed methods prospective longitudinal study design was utilized among approximately 500 participants of the Salud y Vida program. Qualitatively, a phenomenological approach was used to analyze semi-structured interview data assessing fatalism and religiosity and type 2 diabetes management among 15 participants stratified by engagement in the Salud y Vida program. Fatalistic beliefs and religiosity were assessed quantitatively using the Diabetes Fatalism Scale and a subscale of the National Comorbidity Study-Replication. When assessing these belief systems in relation to Type 2 Diabetes management qualitatively, fatalism and religiosity appeared to play a complex role with long-term participants seeing a connection between both fatalism and religiosity and diabetes management and these participants feeling discussions of these beliefs with a medical professional would be beneficial. The association between fatalistic beliefs and lifetime religiosity with HbA1c and blood glucose monitoring behavior was assessed at baseline. This association was explored utilizing linear and logistic multi-regression methods. Linear regressions models revealed that higher levels of diabetes fatalism and emotional distress related to diabetes management were associated with higher HbA1c values. However, logistic regression models did not show diabetes fatalism and religiosity to be significantly associated with blood glucose monitoring behaviors. The mediation of fatalism and lifetime religiosity on the effect of the Salud y Vida program was measured via change in HbA1c after three-month follow-up; however, none of the factors assessing fatalism or religiosity met the requirements of a mediating variable. Nonetheless, logistic regression models were utilized to assess the effect of the Salud y Vida program on HbA1c at three-month follow-up while controlling for fatalistic beliefs and lifetime religiosity. Frequency of Salud y Vida engagement significantly increased the odds of a participant decreasing their HbA1c at three-month follow-up. Fatalistic beliefs and lifetime religiosity did not have a statistically significant association with change in HbA1c at follow-up. Table of Contents List of Tables .........................................................................................................................i List of Figures ...................................................................................................................... ii List of Appendices .............................................................................................................. iii Background ........................................................................................................................... 4 Literature Review ............................................................................................................ 4 Public Health Significance ............................................................................................. 21 Specific Aims ................................................................................................................ 22 Methods .............................................................................................................................. 24 Study Setting ................................................................................................................. 24 Study Design ................................................................................................................. 26 Study Subjects ............................................................................................................... 27 Sample Size Calculation and/or Study Power ................................................................. 29 Data Collection .............................................................................................................. 31 Measures ....................................................................................................................... 32 Title of Journal Article (Exploration of fatalism and religiosity by gender and varying levels of engagement among Mexican-American adults of a Type 2 diabetes management program) ................................................................................................... 46 Name of Journal Article Proposed for Article Submission (The Diabetes Educator) ............ 46 Journal article (Fatalistic and Religiosity Beliefs Among a Mexican-American Sample of a Chronic Care Management Program for Patients with Type 2 Diabetes) ....................................................................................................................... 73 Name of Journal Proposed for Article Submission (Journal of General Internal Medicine) ...................................................................................................................... 73 Journal article (Evaluating the Effect of Fatalistic Beliefs and Lifetime Religiosity on Decreasing HbA1c Scores among Mexican-American Patients of a Type 2 Diabetes Chronic Care Management Program) .............................................................. 96 Name of Journal Proposed for Article Submission (General Hospital Psychiatry Journal) ......................................................................................................................... 96 Conclusion ........................................................................................................................ 115 Appendices........................................................................................................................ 117 References ......................................................................................................................... 125 List of Tables Table 1: Sample Size Calculations ....................................................................................... 30 Table 2: Measured Constructs and Selected Measures ......................................................... 34 i List of Figures Figure 1: Structural Equation Model .................................................................................... 44 ii List of Appendices Appendix A ....................................................................................................................... 117 Appendix