Social Support from the Faith Community and Family Members: Exploring the Impact on Managing Depression and Type 2 Diabetes Among African Americans

Background and Purpose: Research indicates that social support may be a protective factor in self-management practices for African Americans diagnosed with depression and Type 2 diabetes, are low income, and have had difficulty with stable housing.  Social support experienced from the faith community (church) and family members is interesting to understand among African Americans with complex health conditions. Involvement in the many aspects of the faith community creates networks that may build self-esteem, mastery of health practices, and serve as a social outlet to share health experiences. However, little evidence exists on describing how faith and family related supports affect self-management practices for the dually diagnosed.

Purpose of the Study: This study explored how social supports from the church and family have influenced self-management practices among African Americans with history of homelessness and diagnoses of depression and Type 2 diabetes.

Methods: Participants were recruited from an urban county clinic in California that specializes in providing treatment to homeless and vulnerable populations.  The clinic offers integrated medical and psychiatric services. Qualitative semi-structured face-to-face interviews were conducted with 42 African American men and women older than 18 years in 2014 and repeated in 2015.  Each participant reported previous homelessness for at least three years, received a diagnosis of diabetes from the clinic, and had enrolled in Medicaid by 2015. The semi-structured interview questions were standardized and repeated for both interviews. Participants were asked open-ended questions such as: “Describe the ways in which the church and family have provided support with managing your illnesses?” Question wording elicited a narrative-style response, and the interviewer was instructed to probe or clarify responses when appropriate. All interviews lasted between 1 – 1.5 hours, audio-taped, and transcribed verbatim. The semi-structured interviews were coded into meaningful categories or themes and analyzed using ATLAS.ti (version 7.0).

Results: Participant ages ranged between 28 and 71 years (mean age = 53.5 years).  Women represented the majority of the sample (n = 23; 55%). On average, reported annual incomes were less than $9,400 and more than half were high school graduates (55%). All participants were fairly familiar with a form of a structured religious community. Participants’ religiosity and spirituality strongly influenced depression and diabetes management practices and increased their faith in God.  Nine participants reported that their comorbid conditions. Participants commented that they increased contacts with his or her religious/spiritual leaders before contacting his or her health care professionals, including physician, nurse, therapist, or case manager.  Declines were noted in contacts to family members from 2014 to 2015, but the connections experienced were noted as being more deeply emotional.

Conclusions and Implications: The study findings highlight how participants considered a vulnerable population engaged in the faith community to support his or her depression and diabetes self-care. Few participants blamed religion or his or her connection to spirituality for the times when self-management activities faltered. Future research should expand sample size, cultural interpretations of illness, and focus on determining how social workers might integrate patients' beliefs into clinical and social service practice interventions.