Public Health Genomics. 2016;19(2):69-80. doi: 10.1159/000443471. Epub 2016 Feb 5.
Utilizing Genomics through Family Health History with the Theory of Planned Behavior: Prediction of Type 2 Diabetes Risk Factors and Preventive Behavior in an African American Population in Florida.
- 1Florida Agricultural and Mechanical University, Tallahassee, Fla., USA.
Aim: African Americans are disproportionately affected by type 2 diabetes. The purpose of this study was to assess to what extent African Americans’ knowledge and awareness of family health history and related risk factors for developing type 2 diabetes influence their likelihood of adopting a preventive behavior.
Methods: This study employed an anonymous pencil-and-paper, self-administered survey consisting of two sections. Section 1 was a modified version of the US Surgeon General’s Family Health History Initiative and the American Diabetes Association Diabetes Risk Factor Survey. Section 2 of the survey was based on the constructs of the theory of planned behavior. Over 394 African American participants completed the survey.
Results: ‘Perceived behavioral control’ was the strongest predictor of ‘likelihood of adopting preventive behavior’. Participants were aware of their family history as a risk factor for type 2 diabetes, but it was not a significant predictor of behavior modifications based on that knowledge.
Conclusion: The lack of perceived risk in this population shows the importance of not only knowing one’s risk factors but translating those risk factors to a more personalized form that fits into the current lifestyle of the individual in a meaningful way.
Although family history itself is a risk factor in terms of genetic and genomics, knowing one’s family history did not positively impact the likelihood of adopting preventive behavior in the present study. Family history paired with the social influence of those in the family who have not managed to prevent type 2 diabetes mellitus, may function to bolster a sense of fatalism or modeling of diabetogenic (producing diabetes behaviors through norms or cultural influence) .
Table 1. Beta Coefficients and 95% CI for Predictors of Likelihood to Adopt Preventive Behavior According to Different Regression Models
Table 1 presents a series of regression models estimating the net effects of demographic variables, independent variables, and possible moderators. One of the key findings of the study showed that African-Americans with a known family history of diabetes are not more likely to adopt preventive behavior. The lack of perceived risk in this population shows the importance of not only knowing one’s risk factors but translating those risk factors to a more personalized form that fits into the current lifestyle of the individual in a meaningful way. Adopting personalized preventive behavior may translate into prevention or delay of the development of type 2 diabetes . Lifestyle, dietary habit and physical activity are modifiable risk factors coupled with environmental factors, economics, genomics; all nestled to interact with family history and create the need for preventive behavior . It is this interaction that can change the course of an individual’s risk factor in terms of type 2 diabetes mellitus. This study highlighted the salient components of a widely-used behavioral model with an understudied, high-risk population in an effort to address the disparate burden of type 2 diabetes mellitus in African American populations.
Table 2. Selected Demographic Characteristics of Respondents
The results in Table 2, revealed a potential concern for the majority of the respondents. Participants that were 40 years and younger showed signs of increased risk factors for diabetes. The lifestyle and weight factor can potentially place this group at risk for developing Type 2 diabetes or reaching the pre-diabetic stage at an earlier age. Although more than 70% of respondents were either overweight or obese, only 39% of respondents agreed that their weight increased their risk for type 2 diabetes. Even fewer (30%) agreed that they were at increased risk for type 2 diabetes based on their physical activity level. A Chi-square test was calculated to test the association of Perceived Risk (of diabetes) and BMI of respondents. Perceived Risk was cross-tabulated with the BMI groups (Underweight, Normal, Overweight, and Obese). Despite this risk, the participants were not more likely to adopt preventive behavior. Pierce found similar findings regarding BMI. Participants were aware of their family history and their risk factor, however, it did not cause them to adopt preventive behavior . There was a significant difference between BMI groups, p=001 . Further research is needed in this area.
- Seaborn, C., Suther, S., Lee, T., Kiros, G., Becker, A., Campbell, E., & Collins-Robinson, J., Utilizing genomics through family health history with the theory of planned behavior: prediction of type 2 diabetes risk factors and preventive behavior in an African American population in Florida. Public Health Genomics, (2016) Vol 19, No.2 (pg. 69-80).
- Seal N: Introduction to genetics and childhood obesity? relevance to nursing practice. Biol Res Nurs 2011;13:61.
- Pierce, M., Harding, D., Ridout, D., Keen, H., & Bradley, C. Risk and prevention of Type II Diabetes Mellitus: offspring’s views. British Journal of General Practice, 2001, 51; (464)