Period: 2006-2010
Funding: Diabetes Fonds Nederland (Dutch Diabetes Research Foundation), VUmc
Research Institute: EMGO+
Contact person: S.C.M. van Esch
Type 2 diabetes (T2D) is best described as a multi factorial disease. Family history may serve as a good predictor of T2D risk since it reflects inherited genetic susceptibilities as well as shared environmental, cultural, and behavioral factors.
We do know that family communication about genetic or 'familial' risk is influenced by pre-existing familial, social and cultural factors. If we understand more about how these factors influence communication within families with high risk on T2D, we might be able to identify effective strategies of using the family system and family communication in diabetes prevention addressing high risk family members.
The main focus in our project was to explore (family) illness perceptions and identify potential barriers in diabetes related family communication. Since T2D is highly prevalent in some ethnic minority groups, we explored possible cultural influences as well.
Methods & Participants
In a cross-sectional, observational study patients (n=546, response rate 41.6%) and their relatives (n=114, response rate 53.6%) filled in a questionnaire assessing demographic factors, causal illness beliefs (Illness Perception Questionnaire-Revised, IPQ-R), family history, risk perception, and diabetes-related family communication.
Patients' mean age is 63.8 (±11.7) and 50.2% is female. Almost 30% is from Surinamese-South Asian descent. Half of the relatives (51.3%) is younger than 45 year, 61.1% is female and 88.4% is a first degree family member.
Results
Comparing causal illness beliefs of patients and relatives indicate that both groups generally have accurate risk perception concordant with multi factorial T2D etiology. Ethnic differences in illness beliefs and causal attributions are found. In general, risk perception is low in patients and relatives.
It appears that in most families (85%) talking about diabetes is not taboo; T2D is 'sometimes' or 'often' discussed. However, topics related to developing or preventing T2D onset are rarely discussed. In addition, T2D is more often a subject of conversation in Surinamese families.
The majority of patients seems willing to educate relatives about possible increased susceptibility and primary prevention, under the condition that there is good family contact and relatives show interest in T2D. Receptive relatives do not reject the idea of being informed via the family system; they seem appreciative of patients' information and consider it reliable.
Conclusion
Some findings in our study may suggest that promoting family risk communication might be a suitable strategy in diabetes prevention. However, we detected also factors that may complicate family awareness raising, such as low risk perception, troubled family relations and lack of relatives' interest.
More detailed research is needed to explore the potential (cultural) effect of patients' illness beliefs and experienced diabetes burden on messages they spread out in their families.
S.C.M. van Esch, MSc