Will People With Type 2 Diabetes Speak to Family Members About Health Risk? Free

A questionnaire to assess patient beliefs and actions regarding discussion of type 2 diabetes risk with family members was developed, piloted, and refined based on the Health Belief Model. A sample size of 353 patients was calculated to give 95% power at 5% probability. Based on previous studies (12,13), a 50% response rate was predicted. A random sample intended to achieve 700 patients was drawn from the database of patients attending a Dublin hospital diabetes clinic (n = 4,577). Patients with type 1 diabetes and secondary causes of diabetes were excluded. A postal survey was issued to the resulting sample of 703 patients. Reminders were sent 3 weeks later. The study received ethics approval from Beaumont Hospital Research Ethics Committee.

The response rate was 49% (297 of 607 eligible participants). Respondents had a mean age of 65 years; 56% were male. The mean time since diagnosis of diabetes was 8 years. Half of the patients (52%) had at least one parent or sibling with diabetes (18%, mother; 16%, father; and 35%, sibling).

Two-thirds of the patients (181 of 280) had spoken to at least one of their children or siblings about diabetes risk (Table 1); more patients spoke to children (61%) than to siblings (44%) (χ² = 55.3, 2 d.f.; P < 0.001). Younger respondents (χ² = 15.64, 2 d.f.; P < 0.001) and those still employed (χ² = 7.54, 2 d.f.; P = 0.023) were more likely to have spoken to family members, whereas sex, educational status, marital status, and duration of diabetes had no association. Three variables emerged from a nominal logistic regression analysis accounting for 41% of the variation in speaking to family members about their risk of diabetes: worry about their children developing diabetes (odds ratio 4.37 [95% CI 1.75–10.92]), treatment with insulin (8.97 [1.78–45.28]), and the belief that a benefit would be prevention of diabetes (2.71 [1.01–7.23]).

Over 90% of respondents recognized the benefits of speaking to their family members about the risk of diabetes in terms of improving awareness of diet and exercise, encouraging lifestyle changes, and preventing diabetes. However, many patients (58%) who felt that their own lifestyle was unhealthy reported challenges in speaking with family members. Further barriers concerned family members: not being open to advice (54%), not seeing themselves at risk (45%), and not considering diabetes serious (52%). A different type of challenge was lack of contact with family members (44%). Although most patients identified obesity (75%) and little or no exercise (59%) as risk factors for type 2 diabetes, only 50% identified a parent with diabetes and 28% a sibling with diabetes as risk factors.

Half of the patients (56%) moderately or strongly agreed that they would speak to family members about their risk of developing diabetes if they were offered help to do so. More importantly, 87% of those who had not spoken to family members in the past reported they would do so if they received assistance.

This study shows that many patients with type 2 diabetes had already taken the initiative, without formal prompting, to talk to family members about diabetes risk. Younger patients, patients with an existing family history of diabetes, and patients on more intensive treatment were more likely to have discussed risk with family members. Respondents exhibiting several parameters of the Health Belief Model were most likely to have spoken to family members, including those with greater perception of susceptibility of family members, increased awareness of the seriousness of diabetes, and increased appreciation of the benefits of talking to family members. Greater anxiety about family members developing diabetes appeared to act as a cue to action. This suggests that emphasizing these parameters when educating patients with type 2 diabetes concerning familial risk may lead to increased discussion within families.

This study also reveals an encouraging improvement in knowledge, attitudes, and behaviors of patients with diabetes toward sharing information about risk with family members compared with findings from previous studies (9). However, knowledge of risk factors for type 2 diabetes was still poor, and there were significant barriers to intervening within families. A real challenge for respondents was providing information regarding suggested lifestyle when they did not adequately adhere to such guidelines themselves. Supporting materials on diet and physical activity to use within their families may help overcome this barrier. More challenging to address was the reported lack of regular contact with family members by a substantial minority of respondents.

The typically low postal response rate merits a note of caution in that those participating may be more enthusiastic about engaging with their families. A strength was the use of a theoretical framework (the Health Belief Model) to identify parameters likely to influence preventive health behaviors.

This study suggests that patients with a vascular risk factor such as type 2 diabetes may provide a valuable outreach educational role to at-risk family members. They may benefit from provision of information on familial risk, the seriousness of the risk to family members, and interventions to reduce the risk, along with encouragement to discuss this information with family.

We thank the Health Research Board, Ireland, for funding.

No potential conflicts of interest relevant to this article were reported.

We also thank Onja van Doorslaer for conducting focus groups (the results of which informed questionnaire development); Dr. Chris Thompson and the staff of the Diabetes Centre, Beaumont Hospital, Dublin, Ireland, for help in identifying the sample; and Peter and Daniel Whitford for survey administration.