Date of Graduation


Document Type


Degree Type



School of Nursing


Not Listed

Committee Chair

Laurie Theeke

Committee Member

Roger Carpenter

Committee Member

Jennifer Mallow

Committee Member

Kesheng Wang

Committee Member

Catherine Chua


Background: Diabetes is a complex, debilitating illness that imposes disease burden on the individual and society. T2DM is more prevalent in the Appalachian region than in any other Region of the United States. If diabetes is poorly controlled, patients are at risk for negative health outcomes. A gap exists in the literature related to understanding of the relationships among person factors, psychosocial factors, and coping patterns. Another gap in the literature is sex differences among these variables.

Purpose: The purpose of this study is to examining relationships among person factors, psychosocial factors, and coping patterns in people living with T2DM in north central Appalachia.

Method: A convenience sample of 40 men and 40 women who receive chronic management care for T2DM at a small hospital-based rural clinic, Davis Family Care was recruited. Participants were seen between February 2021-August 2021 and met the following inclusion criteria: adults between the age of 18 and 64 years old, able to read and write English, and diagnosed with T2DM. Data was analyzed using the appropriate statistical test based on variable type to seek relationships. Chi-square was conducted on categorical variables. Independent-Sample t tests was conducted on continuous variables. Pearson correlation coefficient, Pearson’s r, was used when variables were normally distributed. Continuous variables that were not normally distributed, Spearman correlation was utilized. For continuous variable of the sum score of coping patterns, a general linear model (GLM) was employed. Linear regression was also employed with coping subscales as the dependent variable and the independent variables were determined by significant relationship to the outcome variable. The enter method was investigated first and then the stepwise method.

Results: The largest segment of the sample included those aged 60-64 (31.3%), white (97.5%), who are married or partnered with spouse present (60%), with a high school education (30%), an income level less than $30,000 (61.3%), and unemployed (63.7%). Most common comorbidities were high blood pressure (55%), hyperlipidemia (53.8%), depression (27.5%), lung disease (20%), anxiety (17.5%), coronary artery disease (12.5%), arthritis (12.5%), and stroke (1.3%). Nineteen people had zero comorbidities and one person had all eight comorbidities. Average number of comorbidities in addition to T2DM was 2.11 (SD = 1.916). The average A1C was 8.21 (SD = 2.54), with participants measuring an average BMI of 37.38 (SD = 8.74). Participants reported living with 1.45 people in the home on average and traveling an average of 10.22 (SD = 11.31) miles to Davis Family Care. Participants reported having T2DM for a mean of 8.62 years (SD = 7.97) and being prescribed a mean of 9.4 medications a day (SD = 6.521). Positive correlation was identified among perceived stress of anxiety, depression, diabetes distress, and loneliness. In general, sex differences were identified as female sex in psychosocial factors such as anxiety, depression, and diabetes distress. General linear modeling revealed positive frame of mind to be predictive of four positive coping subscales (active, planning, positive reframing, and acceptance). Diabetes distress was identified as predictive for behavioral disengagement coping and self-blame coping. Female sex was predictive for planning, positive reframing, religion, use of instrumental support, venting, self-distraction, and self-blame coping. Positive frame of mind was predictive for humor and religion coping.

Conclusions: People with T2DM in Appalachia are living with a cluster of psychological factors, anxiety, depression, diabetes distress, and loneliness. These factors, along with the known sex differences in coping further complicate the care of persons with T2DM. Findings of this study are foundational to further research that targets diabetes distress and is sex specific.