Removing barriers to promote more positive thinking for people with diabetes: implications for social work.

The purpose of this study is to understand changes in thinking in patients with diabetes and factors related to the health care providers and significant others that would mediate changes in thinking. Cross-sectional data were collected from three sites. Adults age 21 and older with type 2 diabetes were asked about their thinking regarding diabetes at diagnosis and the present time. In addition, respondents were asked questions about their perceptions of health care providers (that is, physicians, nurses, diabetes educators), significant others, and manage- ment of diabetes. Significant other blame and self-efficacy were found to be partial mediators in thinking about diabetes; the model explained 29 percent of the variance. Social workers are uniquely trained in the person-in-environment framework, which allows flexibility in creating interventions to provide patients with diabetes the support necessary to have a more positive orientation toward diabetes self-management, increase self-efficacy, and reduce feelings of blame from significant others. Improving the support of significant others and the patients' level of self-efficacy can provide mediation of negative thinking, which may result in an environment that supports improved diabetes self-management behaviors.