Date of Conferral

7-9-2024

Date of Award

July 2024

Degree

Doctor of Public Health (DrPH)

School

Public Health

Advisor

Dr. Simone Salandy

Abstract

There is a lack of knowledge on hardly-reached patients’ socioeconomic status (SES). This quantitative study examined the extent to which SES moderated or impacted the relationships of African American status, rural status, or insurance status with type-2 diabetes mellitus (T2DM) management outcomes (testing for elevated glucose levels, patient education, and regular doctor visits) for African American individuals of low SES living in rural areas. The theoretical foundation for this study was the ecological systems theory (EST). Secondary data were from the publicly available Behavioral Risk Factor Surveillance System (BRFSS) 2021 dataset. Binary and linear regression analyses showed insufficient results to reject the null hypothesis, which stated that status did not significantly moderate the relationship between African American ethnicity and T2DM management outcomes (blood sugar monitoring, frequency of doctor visits, participation in diabetes education) moderated by SES for adults with T2DM living in rural Pennsylvania. Insufficient evidence existed to reject the second null hypothesis using health insurance as the predictor, the third hypothesis using age as the predictor, and the fourth hypothesis using urban/rural status as the predictor. However, the study showed that the SES difference in T2DM outcomes might have decreased relative to the incidence of the disease across SES strata; however, better data are needed on rural Pennsylvanians, especially African Americans. The results contribute to positive social change by showing the inadequacies in BRFSS data collections for rural Pennsylvanians, especially African Americans. Improving the BRFSS coverage of these groups in the future can contribute to positive social change.

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