Social indicators, illness behaviour and mortality among patients with diabetes mellitus in Jamaica, West Indies

This dissertion presents the results of research which used interview techniques to obtain data that describe illness behaviour in diabetic patients who were either outpatients or hospitalized for complications of their illness. It also analyses mortality in Jamaican diabetics who died between 1970 and 1979. Quality of control of diabetes as determined by testing of urine or blood was a major dependent variable against which illness behaviour was evaluated. In general it was poor and this was associated with use of some bush teas. Positive attitudes towards compliance with the therapeutic regime and increased age were associated with better control. Knowledge of the illness, educational or socio-economic status had no effect on control. The appreciation of communicated information bore no relation to educational or socio-economic status. The most important finding was that only after experiencing a medical crisis did patients alter their perception of the seriousness of the illness to the extent that their compliance improved. Fear of the illness and its complications and financial difficulties were important factors affecting compliance. Mortality data from 8,799 diabetics showed that they accounted for 6.5 percent of all deaths in the 10 year period, with females having a higher risk of dying from diabetes than males. Life table analyses of data for 1977 showed that female and male diabetics had death rates of 79.36 and 45.56 per 100,000 stationary population respectively. Thus, the findings of this research quantify the magnitude of the problem of diabetes and show that the major determinant of illness behaviour in diabetes is the perceived susceptibility to and fear of the complications of the illness and consequent medical crises.