Date of Award

2026-05-31

Degree Name

PhD Nursing

Dissertation Committee

Razel B. Milo, PhD, DNP, MSN, FNP-C, Chairperson; Cynthia D. Connelly, PhD, RN, FAAN, Committee Member; Caroline Etland, PhD, RN, CNS, ACHPN, Committee Member

Keywords

Arab Americans, diabetes self-management, diabetes fatalism, self-efficacy, Health Belief Model

Abstract

Background: Diabetes is a prevalent chronic condition affecting more than 38 million individuals in the United States and contributing substantially to morbidity, mortality, and healthcare costs. Despite a higher prevalence of diabetes compared with non-Hispanic White populations, Arab Americans remain understudied and inadequately captured in national health datasets due to racial classification practices. Psychosocial and contextual factors influencing diabetes self-management in this population remain poorly understood.

Purpose/Aims: The purpose of this study was to examine relationships among sociodemographic and clinical factors, diabetes fatalism, self-efficacy, and diabetes self-management among Arab Americans. Guided by the Health Belief Model, the aims were to: describe participant characteristics and study variables in a community health setting; examine relationships among sociodemographic and clinical factors, fatalism, self-efficacy, and self-management; and determine the variance in self-management explained by sociodemographic factors, HbA1c, diabetes fatalism, and self-efficacy.

Methods: A descriptive cross-sectional design was used. A convenience sample of 101 Arab American adults with type 1 or type 2 diabetes was recruited from a Southern California community health center between July and November 2025. Participants completed validated English or Arabic instruments, including the Diabetes Fatalism Scale and Diabetes Self-Management Questionnaire, along with a demographic survey and self-reported HbA1c. Data were analyzed using descriptive statistics, bivariate analyses, and multiple regression.

Results: Participants were primarily older adults (84% aged ≥ 65), female (55.4%), and of Iraqi origin (98%). Knowledge gaps were evident: 35% did not know their diabetes type and 59% did not know their most recent HbA1c. Mean self-management was moderately high (M = 7.30, SD = 1.44), and fatalism was moderate (M = 39.33, SD = 6.52). Gender, employment status, income, diabetes type knowledge, and perceived HbA1c knowledge were significantly associated with self-management. The regression model was significant and explained 35% of the variance in self-management (R² = .350). Gender and perceived HbA1c knowledge remained significant predictors, with perceived HbA1c knowledge emerging as the strongest independent predictor; fatalism was not significant.

Implications:Findings suggest that perceived understanding and structural factors may influence diabetes self-management more strongly than fatalistic beliefs in this population. Results highlight the need for culturally responsive, language-concordant diabetes education that strengthens patient understanding of HbA1c and other key indicators. Interventions emphasizing health literacy, patient empowerment, and access to supportive resources may improve diabetes self-management among Arab Americans.

Document Type

Dissertation: USD Users Only

Department

Nursing

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