Patterns of chronic illness management, psychosocial development, family and social environment and adaptation among diabetic women

Abstract

On a daily basis, individuals with chronic illness must cope with complex treatment regimens and symptoms of illness as they try to integrate these demands into their personal, family, social, and work lives. Furthermore, personal, illness, and environmental factors may influence how people cope with and adapt to chronic illness. The overall purpose of this study was to generate knowledge about the processes by which women manage and adapt to a chronic illness that mandates daily intervention. Factors that influenced adjustment to illness were also examined.Semistructured interviews and standardized instruments were used to generate data on diabetes management, psychosocial development, family and social factors, and psychosocial adaptation in 40 women with diabetes mellitus. The average age of women was 38 years. Most women were married with a school-aged child, moderately well educated, middle to upper-middle class, and employed outside the home. Thirty-five of the women had insulin-dependent diabetes. The mean duration of illness was 13 years.Responses to an open-ended interview guide on diabetes management were used to generate key elements of the diabetes regimen from the perspective of the participants. A core variable, Clinical Safety Work, evolved that integrated the key elements of the regimen. A typology of illness management patterns was derived also from the interview data. The six patterns of diabetes management ranged from rigid to flexible approaches. The illness management patterns were linked to stages of psychosocial development, family and social factors, and psychosocial adaptation.Women whose management style was most chaotic had few anchors in their lives such as other family members, and/or were not employed, and had the lowest incomes of the sample. These women were the most anxious and depressed. Furthermore, they had the lowest stage of psychosocial development. Women with higher stages of psychosocial development were more likely to take control of their diabetes regimens and some were able to adjust their regimens to accommodate the demands of family and work.