Abstract
The aim of this study is to examine the relationship between fatalistic beliefs, self-care, and glycemic control among Mexican men with type 2 diabetes mellitus. This is a cross-sectional study in men diagnosed with type 2 diabetes mellitus from 18 to 59 years of age from the Northeast of Mexico. Fatalistic beliefs, self-care, medication adherence, and HbA1C were evaluated. Patients were divided into glycemic control (<7% HbA1c) and without glycemic control (>7% HbA1c). Tests were performed to compare 2 independent groups, Student’s t and U Mann Whitney. Correlation tests and multiple linear regression models were also performed. For statistical analysis, the SPSS v27 program was used. Forty-nine percent of the men had glycemic control (<7% HbA1c). Fatalistic beliefs were negatively correlated with self-care and medication adherence, but not with HbA1c. In multiple linear regression models, fatalistic beliefs were a negative predictor of self-care and medication adherence. In the model for HbA1c, the pessimism subdimension and self-care were the predictors. Fatalistic beliefs negatively affect self-care compliance and medication adherence, while the pessimism subdimension was related to the increase in HbA1c.
Keywords: adult, glycated hemoglobin, hispanic, men, self care, type 2 diabetes
1. Introduction
Type 2 diabetes mellitus (T2DM) is a public health problem with the highest prevalence and growth in low- and middle-income countries.[1] Additionally, the American continent holds the second place in mortality rate and the third place in years lost due to disability.[2] In Mexico, the prevalence of T2DM is 10.3%, 61% of the patient present uncontrolled glycemic (HbA1c > 7%) and mortality is higher in men than in women of reproductive age (25 to 64)[3–5] Nuevo Leon is the fourth state in the country with the highest prevalence of T2DM (12.6%), higher than the national prevalence.[3]
The American Diabetes Association recommends that individuals with T2DM prioritize self-care actions and medication intake as essential elements for maintaining glycemic control levels (<7.0% HbA1c).[6] Studies have reported that men are less likely to prioritize self-care in health and adhere to recommended self-care actions in managing T2DM.[7,8] Within the social construction of masculinity, men are expected to demonstrate strength, aggression, invulnerability, and an ideal state of health. Conversely, engaging in health care actions during an illness can make them feel less masculine because health care is perceived as a feminine characteristic. This leads to an inequality in self-care among men with T2DM.[9]
A cultural belief, considered a key social determinant of health, is an important factor in shaping health behaviors.[10,11] In recent years, fatalistic beliefs have gained increasing relevance in T2DM.[12] Fatalistic beliefs, characterized by the notion of a greater and external force (which can be in the form of luck, destiny, or divine will) that controls the lives of people[13,14] and are often associated with pessimistic attitudes towards the future, are prevalent in Hispanic/Latin American populations.[15] This belief system may impact the health behaviors and attitudes towards T2DM management among Mexican men.
Previous studies on the relationship between fatalistic beliefs and T2DM have produced contradictory results. While some studies reported that fatalistic beliefs can lead to decreased medication adherence,[16] lower self-care compliance,[17,18] and higher HbA1c levels in patients,[19,20] other studies indicated that there was no significant relationship between fatalistic beliefs and those factors.[21]
The aim of this study is to examine the relationship between fatalistic beliefs, self-care, and glycemic control among Mexican men with T2DM.
2. Methods
2.1. Study design and participants
We conducted a cross-sectional study on adult men aged between 18 and 59 with a previous recorded diagnosis of T2DM[6] in Monterrey, Nuevo León. For this research, convenience sampling was used. Patients with Alzheimer’s, dementia, psychiatric problems, and illiteracy were excluded. The final sample comprised of 121 participants. We calculated the sample size using the software G*power 3.1 with an effect size of.30 and a reliability of.05 for a multiple linear regression model with 11 predictor variables, which gave a power of.98.
2.2. Data collection
The researchers identified potential participants through their monthly appointments scheduled for the T2DM consultation and approached them in the waiting room. The principal investigator introduced himself and informed him of the study’s purpose. The investigator verified the inclusion and exclusion criteria. Eligible patients were invited to participate in the research. Once they agreed to participate, the researcher read the consent form to the interested individual then asked them to sign before giving them a copy of the document. After consent was obtained, data collection began.
2.3. Surveys
We evaluated fatalistic beliefs using the Multidimensional Fatalism Scale,[13] which consists of 30 statements that assess beliefs regarding divine control, luck, hopelessness, internality, and fatalism. Participants responded on a 5-point Likert-type scale. The total score of the scale ranges from 30 to 150 points, with the higher scores indicating higher levels of fatalistic beliefs. In this study, the Cronbach’s alpha for the scale was.81.
We evaluated self-care using the summary questionnaire of self-care activities in T2DM,[22] which contains 10 items that assess compliance in the last 7 days (0–7) related to diet, exercise, glucose self-monitoring and foot check. The total score ranges from 0 to 70 points, where the highest values indicate greater self-care. The questionnaire reported a Cronbach’s alpha of 0.72.
We evaluated was medication adherence using the Adherence to Refills and Medications Scale for Diabetes (ARMS-D).[23] It consists of 11 questions focusing on how often participants forgot to take their medications in the past month. Participants responded on a Likert-type scale from 1 (never) to 4 (always). The total score ranges from 11 to 44 points. For this study, we inverted the answers to questions 1 to 10 to indicate that higher scores reflect greater medication adherence. The Cronbach’s Alpha reported in this study was 0.95.
Additionally, the study evaluated various covariates including age, marital status, years of schooling, waist circumference, body mass index, alcohol use, tobacco use, work, and number of years diagnosed with T2DM.
2.4. HbA1c
To assess glycemic control, we measured the percentage of glycosylated hemoglobin (HbA1c) using the High-Pressure Liquid Chromatography (HPLC) method. Glycemic control was considered HbA1c < 7%.
2.5. Statistical analysis
The statistical program SPSS V. 27 was used to capture and analyze the data. In the descriptive analysis, means and standard deviation were used in continuous variables, and for categorical variables, frequencies and percentages. Student t test and the Mann–Whitney U test were employed to compare the glycemic control (<7%) and no glycemic control (>7%) groups. For the inferential analysis, the Pearson correlation coefficient and a multiple linear regression model for self-care, medication adherence, and HbA1c were used.
The study protocol was approved by the institutional review board of Research Ethics Committee of the Nursing School of the Autonomous University of Nuevo León (No. FAEND1198). Informed consent was confirmed by the IRB. This research followed the principles outlined in the Declaration of Helsinki.
3. Results
3.1. Demographics data
The sample consisted of 121 participants, the majority of whom were between 40 to 59 years, having completed secondary school, with a diagnosis time of T2DM of less than 5 years. The men were characterized as overweight/obese, consumers alcohol, tobacco, and working more than 40 hours a week (Table 1).
Table 1.
Description of the characteristics of the participants.
| Variable | % | 5 |
|---|---|---|
| Age | ||
| 20–39 yr | 15.7 | 19 |
| 40–59 yr | 84.3 | 102 |
| Scholarship | ||
| Elementary school | 25.6 | 31 |
| Secondary school | 46.3 | 56 |
| High school | 14.9 | 18 |
| Bachelor’s degree | 3.3 | 4 |
| Postgraduate | 9.9 | 12 |
| Diagnosed with T2DM | ||
| 1–5 yr | 46.3 | 56 |
| 6–10 yr | 31.4 | 38 |
| > 10 yr | 22.3 | 27 |
| Waist circumference | ||
| <90 cm | 14.0 | 17 |
| >90 cm | 85.0 | 104 |
| BMI | ||
| Normal weight | 18.2 | 22 |
| Overweight | 39.7 | 48 |
| Obesity | 42.1 | 51 |
| Hour’s work/wk | ||
| <40 h | 18.2 | 22 |
| >40 h | 81.8 | 99 |
| Alcohol | ||
| No | 53.7 | 65 |
| Yes | 46.3 | 56 |
| Smoking | ||
| No | 71.9 | 87 |
| Yes | 28.1 | 34 |
n = 121 participants with T2DM.
BMI = body mass index, T2DM = type 2 diabetes mellitus.
3.2. Difference between good glycemic control and without glycemic control
Upon comparing individuals with glycemic control and those without glycemic control, it was found that the latter group had lower education levels, longer working hours, lower self-care compliance, lower adherence to medication intake, and higher levels of fatalistic beliefs (Table 2).
Table 2.
Comparison between men with glycemic control and whitout glycemic control in T2DM.
| Variables | HbA1c | P | |
|---|---|---|---|
| <7% M (SD) | >7% M (SD) | ||
| Age* | 49.1 (7.0) | 48.5 (8.0) | .739 |
| Years of education* | 10.3 (4.6) | 8.6(3.1) | .010 |
| Diagnosed with T2DM* | 8.3 (6.5) | 6.9 (5.9) | .209 |
| BMI† | 28.8 (4.5) | 29.5 (4.8) | .400 |
| Waist circumference† | 103.4 (11.5) | 106.1 (12.0) | .214 |
| Work hours/week* | 51.1 (18.0) | 63.4 (19.2) | .000 |
| Self-care* | 3.5 (1.3) | 1.9 (1.0) | .000 |
| Diet* | 4.7 (1.7) | 2.6 (1.5) | .000 |
| Exercise* | 2.8 (2.4) | 1.3 (2.1) | .000 |
| Self-monitoring* | 0.7 (1.2) | 0.4 (1.0) | .008 |
| Feet* | 4.7 (2.6) | 2.5 (2.3) | .000 |
| Medication adherence* | 41.3 (6.8) | 33.5 (11.5) | .000 |
| Fatalistic beliefs† | 75.6 (20.1) | 83.0 (19.2) | .041 |
| Pessimism* | 14.0 (5.9) | 15.1 (6.0) | .255 |
| Internal* | 11.0 (3.1) | 10.6 (3.6) | .366 |
| Lucky† | 14.3 (5.8) | 15.1 (5.6) | .468 |
| Divine control* | 18.6 (6.7) | 21.9 (6.7) | .010 |
| Fatalism† | 17.5 (5.7) | 20.2 (5.5) | .012 |
n = 121 participants with T2DM.
BMI = body mass index, M = mean, SD = standard deviation, T2DM = type 2 diabetes mellitus.
U de Mann–whitney.
t de student.
3.3. Correlation analysis
During bivariate analysis, negative correlations were observed between fatalistic beliefs and self-care (r = −0.239, P = .008) and medication adherence (r = −0.212, P = .020), although no significant correlation was found with HbA1c.
3.4. Multivariable analysis
Subsequently, a multiple regression model was carried out with self-care as the dependent variable, and T2DM diagnosis time, work hours and fatalistic beliefs were identified as the only predictors of self-care, explaining 19.1% of the variance of diabetes self-care (F = 5.039, P = .000) (Table 3). Table 4 presents a multiple linear regression model for medication adherence, where diagnosis time, work hours and fatalistic beliefs explain 9.7% of the variance of medication adherence (F = 2.839, P = .009).
Table 3.
Linear regression model for self-care in T2DM.
| Variables | B | t | P |
|---|---|---|---|
| Age | −0.001 | −0.015 | .988 |
| Years of education | 0.091 | 1.029 | .306 |
| Diagnosed with T2DM | 0.202 | 2.267 | .025 |
| BMI | 0.193 | 0.933 | .353 |
| Waist circumference | −0.308 | −.1.467 | .145 |
| Work hours/week | −0.315 | −3.639 | .000 |
| Alcohol | −0.116 | −1.343 | .182 |
| Smoking | −0.064 | −0.712 | .478 |
| Fatalistic beliefs | −0.183 | −0.2094 | .039 |
n = 121 participants with T2DM.
BMI = body mass index, T2DM = type 2 diabetes mellitus.
Table 4.
Linear regression model for medication adherence in T2DM.
| Variables | B | t | P |
|---|---|---|---|
| Age | 0.030 | 0.325 | .746 |
| Years of education | 0.077 | 0.826 | .410 |
| Diagnosed with T2DM | 0.214 | 2.277 | .025 |
| BMI | 0.137 | 0.628 | .653 |
| Waist circumference | −0.162 | −0.730 | .467 |
| Work hours/week | −0.211 | 2.311 | .023 |
| Alcohol | −0.079 | −0.861 | .391 |
| Smoking | −0.125 | −1.319 | .190 |
| Fatalistic beliefs | −0.184 | −1.995 | .048 |
n = 121 participants with T2DM.
BMI = body mass index, T2DM = type 2 diabetes mellitus.
Table 5 displays a multiple linear regression model for the HbA1c variable, which includes the subdimensions of fatalism individually. Both the first model (R2 = 0.296; F = 8.215, P = .000) and the adjusted model (age, education, years of T2DM diagnosis and body mass index, hours of work) revealed that the subdimension of pessimism and self-care were the only predictors of HbA1c (R2 = 0.302; F = 5.711, P = .000).
Table 5.
Linear regression model for HbA1c in T2DM.
| Variables | Model 1 B† | Model 2 B‡ |
|---|---|---|
| Fatalism | 0.130 | 0.122 |
| Pessimism | 0.273* | 0.340* |
| Internal | −0.005 | −0.004 |
| Luck | 0.063 | 0.052 |
| Divine control | 0.039 | 0.022 |
| Medication adherence | 0.139 | 0.165 |
| Self-care | −0.477** | 0.468** |
n = 121 participants with T2DM.
BMI = body mass index, HbA1c = glycosylated hemoglobin, T2DM = type 2 diabetes mellitus.
P < .05.
P < .01.
Unadjusted analysis.
Adjusted (age, education, years of T2DM diagnosis and BMI, hours of work).
4. Discussion
This study observed participants with type 2 diabetes mellitus, who exhibited habits of alcohol and tobacco consumption, long working hours, low levels of education, overweight/obesity and poor self-care. Notably, men with this condition visit health services less frequently and participate less in health programs.[8] One possible explanation is that individuals with longer work hours worked have less time to go to health services during available hours, or skip it due to long waiting hours, which means that their health needs are not met and do not make the necessary lifestyle changes.[24]
On the other hand, within the construction of masculinity, men are inclined to avoid going to the doctor as a way to demonstrate masculine behaviors. It should also be considered that men have to take time off from work to visit the doctor, resulting in them earning less money. This can potentially undermine their role as an economic provider within their family, as work is prioritized within the norms of masculinity for men.[25]
Fatalistic beliefs were found to be a common trend among participants, as indicated by the mean questionnaire score. They are prevalent among patients who do not present serious or severe symptoms of T2DM.[26] Some researchers consider these beliefs to be a coping mechanism.[18,26] For some, fatalistic beliefs have a religious connotation, believing that their condition is a test from God. While this can lead to resilience and acceptance of their diagnosis of T2DM,[18] it may also result in patients seeking alternative forms of treatment outside of traditional healthcare settings. As a consequence, fatalistic beliefs could deter patients of DMT2 from seeking medical attention that is not aligned with their beliefs (such as healers, traditional medicine).[27]
According to several previous studies, individuals with higher fatalistic beliefs tend to exhibit lower compliance with self-care and medication adherence.[16–18] People with fatalistic beliefs view complications in T2DM and death as inevitable events, which may minimize the importance of compliance with self-care.[28] This may explain why male patients are reluctant to make changes in their lifestyle and adhere to the recommendations of health professionals.
The linear regression model of HbA1c revealed that fatalism was related to an increase in HbA1c, which is consistent with previous studies.[19,20] However, only the pessimism subdimension was the only predictor for this study. Pessimism is a series of negative outlook on the future, often characterized by the belief in predetermined and unchangeable events in life.[29] Pessimistic individuals with T2DM may exhibit resignation and negative coping strategies with their disease.[30] Previous studies have found that pessimism is related to greater physical and mental health problems including stress, anxiety and depression,[30–32] as well as an higher rates of premature mortality.[33]
The study has some limitations that should be acknowledged. Firstly, as a cross-sectional study, it is not possible to establish a cause-and-effect relationship between the study variables. Secondly, convenience sampling was used. However, it is recommended that future research use a probabilistic sampling to guarantee the extrapolation of the results. Lastly, this study focused only on males who attended primary care centers for disease control. Future research could examine individuals who did not attend health services to broaden the scope of the investigation.
5. Conclusions
Fatalistic beliefs were related to lower compliance with self-care and medication adherence. Pessimism subdimension was linked to higher HbA1c levels. Therefore, it is important that health professionals address fatalistic beliefs during interventions to improve self-care and glycemic control in Mexican men with T2DM.
Author contributions
Conceptualization: Geu Mendoza Catalán, Juan Guillermo Figueroa Perea, Esther Gallegos Cabriales, Bertha Cecilia Salazar Gonzalez, Dora Julia Onofre Rodriguez, Javier Gonzalez Ramirez.
Data curation: Geu Mendoza Catalán, Juan Guillermo Figueroa Perea, Esther Gallegos Cabriales, Bertha Cecilia Salazar Gonzalez, Dora Julia Onofre Rodriguez, Javier Gonzalez Ramirez.
Formal analysis: Geu Mendoza Catalán, Juan Guillermo Figueroa Perea, Esther Gallegos Cabriales, Dora Julia Onofre Rodriguez, Javier Gonzalez Ramirez.
Funding acquisition: Geu Mendoza Catalán.
Investigation: Geu Mendoza Catalán, Esther Gallegos Cabriales, Bertha Cecilia Salazar Gonzalez, Javier Gonzalez Ramirez.
Methodology: Geu Mendoza Catalán, Juan Guillermo Figueroa Perea, Esther Gallegos Cabriales, Bertha Cecilia Salazar Gonzalez, Dora Julia Onofre Rodriguez, Javier Gonzalez Ramirez.
Project administration: Geu Mendoza Catalán.
Resources: Geu Mendoza Catalán.
Software: Geu Mendoza Catalán, Bertha Cecilia Salazar Gonzalez, Dora Julia Onofre Rodriguez, Javier Gonzalez Ramirez.
Supervision: Juan Guillermo Figueroa Perea, Esther Gallegos Cabriales, Bertha Cecilia Salazar Gonzalez, Dora Julia Onofre Rodriguez.
Validation: Geu Mendoza Catalán, Juan Guillermo Figueroa Perea, Esther Gallegos Cabriales, Javier Gonzalez Ramirez.
Visualization: Esther Gallegos Cabriales.
Writing – original draft: Geu Mendoza Catalán, Juan Guillermo Figueroa Perea, Esther Gallegos Cabriales, Bertha Cecilia Salazar Gonzalez, Dora Julia Onofre Rodriguez, Javier Gonzalez Ramirez.
Writing – review & editing: Geu Mendoza Catalán, Juan Guillermo Figueroa Perea, Esther Gallegos Cabriales, Bertha Cecilia Salazar Gonzalez, Dora Julia Onofre Rodriguez, Javier Gonzalez Ramirez.
Abbreviations:
- HbA1c
- glycosylated hemoglobin
- T2DM
- type 2 diabetes mellitus
The authors have no funding and conflicts of interest to disclose.
All data generated or analyzed during this study are included in this published article [and its supplementary information files].
How to cite this article: Mendoza-Catalán G, Figueroa-Perea JG, Gallegos-Cabriales EC, Salazar-González BC, Onofre-Rodríguez DJ, González-Ramírez J. Fatalistic beliefs, self-care, and HbA1c in Mexican men with type 2 diabetes mellitus: A cross-sectional study. Medicine 2023;102:31(e34594).
Contributor Information
Juan Guillermo Figueroa-Perea, Email: jfiguer@colmex.mx.
Esther C. Gallegos-Cabriales, Email: esther.gallegos@gmail.com.
Bertha Cecilia Salazar-González, Email: bertha.salazar@uanl.edu.mx.
Dora Julia Onofre-Rodríguez, Email: onofre64@yahoo.com.mx.
Javier González-Ramírez, Email: javier.gonzalez.ramirez@uabc.edu.mx.
References
- [1].International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels, Belgium: International Diabetes Federation; 2021. [Google Scholar]
- [2].PanAmerican Health Organization. Country snapshot of diabetes prevention and control in the Americas. PanAmerican Health Organization; 2021. Available at: https://iris.paho.org/handle/10665.2/55326 [access date February 20, 2023]. [Google Scholar]
- [3].Shamah-Levy T, Vielma-Orozco E, Heredia-Hernández O, et al. National Health and Nutrition Survey 2018-19: National Results. Cuernavaca, Mexico: Instituto Nacional de Salud Pública; 2020. [Google Scholar]
- [4].Basto-Abreu AC, López-Olmedo N, Rojas-Martínez R, et al. Prevalence of diabetes and glycemic control in Mexico: national results from 2018 and 2020. Salud Publica Mex. 2021;63:725–33. [DOI] [PubMed] [Google Scholar]
- [5].National Institute of Statistic and Geography. Statistics about World Diabetes Day: National Data. Mexico: National Institute of Statistic and Geography; 2021. Available at: https://www.inegi.org.mx/contenidos/saladeprensa/aproposito/2021/EAP_Diabetes2021.pdf [access date January 13, 2023]. [Google Scholar]
- [6].American Diabetes Association Professional Practice Committee. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2022. Diabetes Care. 2022;45(Suppl. 1):S17–38. [DOI] [PubMed] [Google Scholar]
- [7].Paiva Neto FT, Sandreschi PF, Dias MSA, et al. Barriers to self-care among men: discourses of men participating in a health education group. Salud Colect. 2020;16:e2250. [DOI] [PubMed] [Google Scholar]
- [8].Mendoza-Catalán G, Chaparro-Díaz L, Gallegos-Cabriales E, et al. Diabetes mellitus type 2 self-management from a gender focused perspective: an integrative review. Enferm Univ. 2018;15:90–102. [Google Scholar]
- [9].Lyons AC. Masculinities, femininities, behaviour and health. Soc Personal Psychol Compass. 2009;3:394–412. [Google Scholar]
- [10].Gherman A, Schnur J, Montgomery G, et al. How are adherent people more likely to think? a meta-analysis of health beliefs and diabetes self-care. Diabetes Educ. 2011;37:392–408. [DOI] [PubMed] [Google Scholar]
- [11].Misra R, Kaster EC. Health beliefs. In: Loue S, Sajatovic M, eds. Encyclopedia of Immigrant Health. New York, NY: Springer; 2012:766–8. [Google Scholar]
- [12].Moreira T, Hernández DC, Scott CW, et al. Susto, Coraje, y Fatalismo: cultural-bound beliefs and the treatment of diabetes among socioeconomically disadvantaged hispanics. Am J Lifestyle Med. 2018;12:30–3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [13].Esparza OA, Wiebe JS, Quiñones J. Simultaneous development of a multidimensional fatalism measure in English and Spanish. Curr Psychol. 2015;34:597–612. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [14].Bernstein M. Fatalism. In: Kane R, ed. The Oxford Handbook of Free Will. New York, NY: Oxford Academic; 2005:65–82. [Google Scholar]
- [15].Lange LJ, Piette JD. Personal models for diabetes in context and patients’ health status. J Behav Med. 2006;29:239–53. [DOI] [PubMed] [Google Scholar]
- [16].Walker RJ, Smalls BL, Hernández-Tejada MA, et al. Effect of diabetes fatalism on medication adherence and self-care behaviors in adults with diabetes. Gen Hosp Psychiatry. 2012;34:598–603. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [17].Osborn CY, Bains SS, Egede LE. Health literacy, diabetes self-care, and glycemic control in adults with type 2 diabetes. Diabetes Technol Ther. 2010;12:913–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [18].Saidi S, Milnes LJ, Griffiths J. Fatalism, faith and fear: a case study of selfcare practice among adults with type 2 diabetes in urban Malaysia. J Clin Nurs. 2018;27:3758–67. [DOI] [PubMed] [Google Scholar]
- [19].Berardi V, Bellettiere J, Nativ O, et al. Fatalism, diabetes management outcomes, and the role of religiosity. J Relig Health. 2016;55:602–17. [DOI] [PubMed] [Google Scholar]
- [20].Sukkarieh-Haraty O, Egede LE, Abi Kharma J, et al. Diabetes fatalism and its emotional distress subscale are independent predictors of glycemic control among Lebanese patients with type 2 diabetes. Ethn Health. 2019;24:767–78. [DOI] [PubMed] [Google Scholar]
- [21].Asuzu CC, Walker RJ, Williams JS, et al. Pathways for the relationship between diabetes distress, depression, fatalism and glycemic control in adults with type 2 diabetes. J Diabetes Complications. 2017;31:169–74. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [22].Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care. 2000;23:943–50. [DOI] [PubMed] [Google Scholar]
- [23].Mayberry LS, González JS, Wallston KA, et al. The ARMSD out performs the SDSCA, but both are reliable, valid, and predict glycemic control. Diabetes Res Clin Pract. 2013;102:96–104. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [24].McBrien KA, Naugler C, Ivers N, et al. Barriers to care in patients with diabetes and poor glycemic control-a cross-sectional survey. PLoS One. 2017;12:e0176135. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [25].Novak JR, Peak T, Gast J, et al. Associations between masculine norms and health-care utilization in highly religious, heterosexual men. Am J Mens Health. 2019;13:1557988319856739. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [26].Mendoza-Catalán G, Gallegos-Cabriales EC, Figueroa-Perea JG. Verbal autopsy of adult men with diabetes type 2: qualitative study. Rev Cuid. 2017;8:1786–98. [Google Scholar]
- [27].López Sánchez O, Nance DC. “Something born of the heart”: culturally affiliated illnesses of older adults in Oaxaca. Issues Ment Health Nurs. 2020;41:235–42. [DOI] [PubMed] [Google Scholar]
- [28].Rustveld LO, Pavlik VN, Jibaja-Weiss ML, et al. Adherence to diabetes self-care behaviors in English- and Spanish-speaking Hispanic men. Patient Prefer Adherence. 2009;3:123–30. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [29].Kristensen MAT, Guassora AD, Arreskov AB, et al. “I’ve put diabetes completely on the shelf till the mental stuff is in place.” How patients with doctor-assessed impaired self-care perceive disease, self-care, and support from general practitioners. a qualitative study. Scand J Prim Health Care. 2018;36:342–51. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [30].Shahid F, Beshai S, Del Rosario N. Fatalism and depressive symptoms: active and passive forms of fatalism differentially predict depression. J Relig Health. 2020;59:3211–26. [DOI] [PubMed] [Google Scholar]
- [31].Hudson JL, Bundy C, Coventry PA, et al. Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. a systematic review with metaanalysis. J Psychosom Res. 2014;76:265–74. [DOI] [PubMed] [Google Scholar]
- [32].Scheier MF, Swanson JD, Barlow MA, et al. Optimism versus pessimism as predictors of physical health: a comprehensive reanalysis of dispositional optimism research. Am Psychol. 2021;76:529–48. [DOI] [PubMed] [Google Scholar]
- [33].Craig H, Freak-Poli R, Phyo AZ, et al. The association of optimism and pessimism and all-cause mortality: a systematic review. Pers Individ Dif. 2021;177:110788. [Google Scholar]