The Role of Psychosocial Distress on Diabetes Management in Rural Dominican Republic

Type 2 diabetes (T2D) is changing the burden of illness across Latin America and the Caribbean, particularly in rural communities, where research on living with T2D remains sparse. Since 2015 Dr. Wallace and collaborators have conducted a longitudinal, qualitative study to explore the lived experience of living with T2D among adults in rural communities in the central region of the Dominican Republic. From these studies, our team has highlighted that diabetes-related stress started at diagnosis and continued as participants managed T2D as a chronic condition. Insufficient food access, medication access worries, fears about illness injury, and the cyclical process of experiencing stress produced stress. Sources of social support varied across the process of T2D diagnosis to management, with more support from friends and communities when enrolling into care and more support from partners and family when managing T2D over time. Participants lacked sufficient emotional support to cope with the stress of T2D. One way participants coped was to employ the strategy of “no le doy mente”, or not thinking about it. Providers shared parallel experiences regarding their perceptions of the emotional burden of managing T2D for the patients. These results supported the adaptation of a 17-item diabetes distress scale for use among Dominican adults with T2D to improve clinical and community care.