9 9. Questionnaire results (2): Social and other variables · Questionnaire results (2): Social and...
Transcript of 9 9. Questionnaire results (2): Social and other variables · Questionnaire results (2): Social and...
9. Questionnaire results (2): Social and other variables
9 While lifestyle and behavioural factors, such as nutrition and physical activity, are known to
contribute directly to diabetes risk, there are social and other variables which may influence
diabetes risk, either directly, or through their impact on risk behaviours.
This chapter details the responses to the survey that were not directly nutrition- or lifestyle-
focused. All percentages, unless stated otherwise, are based on the total number of participants
within each group (women: 49 diagnosed, 15 high-risk, 47 low-risk, 12 gestational; men: 38
diagnosed, 15 high-risk, 40 low-risk). Where possible, qualitative responses have been included
verbatim. Percentages do not necessarily sum to 100, as those unable or not wishing to answer
are included in the totals.
Participant categories are abbreviated as follows: D = diagnosed, H = high-risk, L = low-risk, G
= women who have in the past had gestational diabetes but are not currently diabetic. Where
differences between groups are tested for significance, ANOVA has been used unless otherwise
stated. Some survey responses are analysed in relation to BMI, as obesity is the most tangible
modifiable risk factor.
9.1. Sociodemography
9.1.1. Place of birth and mother’s place of birth
Is place of birth associated with birthweight? Places of birth for participants and their mothers
are shown in Tables 9.1 to 9.4. The lower percentages of diagnosed diabetics with mothers who
had been born in Cherbourg is likely to be a factor of the participants’ older ages; older
participants and/or their mothers are more likely to have been removed to Cherbourg from other
parts of Queensland. As health conditions on the settlement were poor (especially with high
rates of infections), this may affect the health of newborns and infants, both directly and through
the effects on their mother’s nutritional status during pregnancy. Mothers’ birthplace was
included as the effects of poor growth in utero can be passed from mother to child.
Social and other variables 307
Table 9.1. Participants’ place of birth Frequency Percent
Beaudesert 1 .5
Brewarrina 1 .5
Brisbane 10 4.6
Charleville 2 .9
Cherbourg 131 60.6
Collinsville 1 .5
Cunnamulla 1 .5
Gympie 2 .9
Herberton 1 .5
Kilcoy 1 .5
Kingaroy 3 1.4
Maryborough 1 .5
Monto 1 .5
Murgon 1 .5
Nambour 1 .5
Rockhampton 3 1.4
Roma 1 .5
Thursday Island 1 .5
Townsville 1 .5
Wondai 9 4.2
Not stated 43 19.9
Total 216 100.0
Table 9.2. Participants’ place of birth by category Females % Males %
(n) D(49) H(15) L(40) L(47) G(12) D(38) H(15)
Cherbourg 53.1 93.3 59.6 41.7 55.3 66.7 65.0
Other 14.3 6.7 31.9 50.0 5.3 33.3 15.0
Not stated 30.6 0 8.5 8.3 39.5 0 20.0
Social and other variables 308
Table 9.3. Participants’ mothers’ place of birth Frequency Percent
Blackwater 1 .5 Bogabilla NSW 1 .5
Bowen 2 .9 Brewarrina 1 .5
Burnett Downs 1 .5 Burnett Station 1 .5
Charleville 2 .9 Cherbourg 126 58.3 Childers 1 .5
Cloncurry 1 .5 Collinsville 1 .5
Cooroy 1 .5 Cunnamulla 2 .9
Dalby 1 .5 Eisvold 1 .5 Emerald 2 .9 Gayndah 1 .5
Georgetown 1 .5 Goondiwindi NSW 2 1 Gundagai, NSW 1 .5
Hervey Bay 1 .5 Ipswich 1 .5
Ival 1 .5 Kilkivan 1 .5 Kingaroy 2 .9 Mitchell 2 .9 Murgon 2 .9
NSW (no further detail) 2 .9 Palm Island 5 2.3
Queensland (no further detail) 4 1.9 Quilpie 4 1.9
Scarness 1 .5 St George 1 .5
Taroom 1 .5 Toorowm 1 .5 Warwick 1 .5 Winton 1 .5
Yandina 1 .5 Yarrabah 1 .5 Not stated 33 15.3
Total 216 100.0
Social and other variables 309
Table 9.4 Participants’ mothers’ place of birth Females % Males %
(n) D(49) H(15) L(47) G(12) D(38) H(15) L(40)
Cherbourg 40.8 53.3 70.2 75.0 42.1 73.3 72.5
Other 36.7 33.3 19.1 16.7 36.8 20.0 15.0
Not stated 22.4 13.3 10.6 8.3 21.1 6.7 12.5
Approximately 35% of diagnosed participants and 10% of those who had never been diagnosed
did not state their place of birth. This is most likely a function of the age differences between
these groups.
There were no significant differences in birthweight among participants who were born in
Cherbourg and those who were born elsewhere (Table 9.5). Males who did not state their place
of birth had significantly higher birthweights than those who named where they were born
(p=0.031) (Table 9.6).
Table 9.5. Birthweights and birthplace: Cherbourg and elsewhere Females Males
Place of birth n mean (g) SD n mean (g) SD
Cherbourg 43 3265 494 34 3267 590
Other 15 3262 689 16 3563 783
p 0.982 0.143
Table 9.6. Birthweights and birthplace: stated and not stated Females Males
n mean (g) SD n mean (g) SD
Stated 54 3244 556 38 3248 582
Not stated 4 802 3538 261 12 3719
P 0.301 0.031
Place of birth
Social and other variables 310
Mother’s place of birth was not significantly associated with participant birthweight (Tables 9.7
and 9.8), although those born in Cherbourg tended to have babies who were lighter at birth. The
absence of statistical significance here may again be due to small sample size.
Table 9.7. Birthweights and mothers’ birthplace: Cherbourg and elsewhere Females Males
Place of birth n mean (g) SD n mean (g) SD
Cherbourg 39 3186 498 35 3313 591
Other 14 3500 632 9 3518 969
P 0.065 0.424
Table 9.8. Birthweights and mothers’ birthplace: stated and not stated Females Males
Place of birth n mean (g) SD n mean (g) SD
Stated 39 3186 498 35 3313 591
Not stated 19 3426 612 15 3475 823
P 0.115 0.436
9.1.2. Parity
Does number of siblings relate to diabetes risk? Participants’ mothers had given birth to
between 2 and 19 children. The mean numbers of babies were 8.2(D♀), 8.4(H♀), 7.1(L♀),
7.0(G♀), 7.6(D♂), 7.0(H♂) and 7.3(L♂). There were no significant differences between groups
(ANOVA, p=0.227). Birth order mean of participants was 3.9(D♀), 5.0(H♀), 4.2(L♀), 4.5(G♀),
4.2 (D♂) and 3.9(H♂), 4.2(L♂) and again there were no significant differences between groups
(ANOVA, p=0.958).
9.1.3. Natural family
Is being raised by people other than family (such as in the dormitories) associated with
subsequent diabetes risk? 16.3%(D♀), 6.7%(H♀), 12.8%(L♀), 33.3%(G♀), 21.1%(D♂), and
13.3%(H♂) and 27.5(L♂) reported that they did not grow up with either of their biological
parents. These frequency differences were not significant (Chi-square, p=0.357). Those who
did not grow up with their families were significantly older than those who did (t-test: mean
ages 41.8 and 37.1 years, p=0.027). The reasons participants gave for not growing up with their
Social and other variables 311
family included being ‘under the Act’ (Section 4.2), family problems, staying with relatives
elsewhere for school, mother or both parents had died, or they had been abandoned or fostered
out.
9.1.4. Education
The highest levels of education reported by participants are given in Table 9.9 below. In
contrast to the wider Australian community (Turrell et al. 1999), education level is not
significantly associated with BMI (ANOVA, females p=0.780; males p=0.441), suggesting that
there is little class difference within the community, either overall or as it is manifested in
health.
Table 9.9. Highest level of education by diabetes risk group Females % Males %
(n) D(49) H(15) L(47) G(12) D(38) H(15) L(40)
Didn’t go to school 2.4 0.0 0.0 1.9 3 0.0 2.6
Primary school 26.2 0.0 0.0 0.0 24.2 6.7 5.1
Year 8 or 9 35.7 42.9 37.0 25.0 39.4 33.3 23.1
Year 10 or 11 28.6 35.7 45.7 50.0 18.2 46.7 41.0
Year 12 2.4 14.3 13.0 8.3 3 0.0 20.5
Trade qualification 0.0 0.0 0.0 0.0 6.1 6.7 5.1
Tafe diploma / certificate 4.8 0.0 4.3 0.0 6.1 0.0 2.6
University degree 0.0 7.1 0.0 0.0 0.0 6.7 0.0
Postgraduate degree 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Among all participants over 35 years old, there is no significant association between education
level and category (Chi-square, p=0.414), but among those who are younger than 35 years the
association is significant (p=0.001) and strong (Chi-square value = 60.4) with younger
participants attaining a higher level of education. The differences between diagnosed and
never-diagnosed participants may have more to do with cohort effects than anything else, for
two related reasons. Firstly, school facilities and Indigenous access to them have improved
greatly over recent years, and secondly, extensive schooling in the past was often viewed by
authorities as unnecessary and wasteful and irrelevant to building the labouring class of
Social and other variables 312
Aboriginal workers – they were deemed to be more compliant if they only had basic education
(Section 4.3.5). It was common for children in Cherbourg to leave school at 14; boys to learn a
trade, and girls to go into domestic service.
9.1.5. Occupation and hours of work
The most common occupation for women was ‘home duties’: (28.6% D♀, 33.3% H♀, 31.9%
L♀ and 58.3% G♀), and for men: office worker (15.8%) followed by heavy trade, CDEP and
those unable to work (each 10.5%) for diagnosed males, and CDEP (26.7% for high-risk and
40.0% for low-risk). Table 9.10 shows frequencies for all occupations.
Table 9.10. Occupation
Females % Males %
(n) D(49) H(15) L(47) G(12) D(38) H(15) L(40)
Office worker 6.1 6.7 4.3 16.7 15.8 20.0 5.0
Shop assistant 4.1 6.7
Light trade / labour 2.0 6.7 7.9 13.3 12.5
Heavy trade / labour 10.5 10.0
Home duties 28.6 33.3 31.9 58.3 2.6 6.7 2.5
CDEP 6.1 6.7 25.5 16.7 10.5 26.7 40.0
Unemployed 13.3 10.6 8.3 5.3 13.3 10.0
Unable to work 18.4 6.7 4.3 10.5 10.0
Other 22.4 17.0 23.7 20.0 5.0
Not stated 12.2 20.0 6.4 13.2 5.0
Hours worked per week (all jobs) ranged from 2 to 50. Divisions along gender lines were
apparent. On average, women do roughly half the number of hours of paid work that men do,
(t-test, means 8.5 hours of paid employment for females and 20.8 hours for males, p<0.001)
(Figure 9.1). This illustrates that although unemployment is fairly low, underemployment is a
significant issue.
Social and other variables 313
Mean number of hours in paid work per week
malesfemales
num
ber o
f hou
rs30
25
20
15
10
5
0
diagnosed
gestational
high risk
low risk
9.2. General health
9.2.1. Self-rated general health
Overall, people with diagnosed diabetes rated their health more poorly than
never been diagnosed, and women rated their health more poorly than men in ea
(Table 9.11).
Table 9.11. Self rated health response frequencies (%) Females % Ma
(n) D(49) H(15) L(47) G(12) D(38) H
Poor 16.3 21.4 4.4 16.7 6.1 0
Fair 39.5 7.1 22.2 41.7 30.3 2
Good 27.9 57.1 40.0 25.0 48.5 2
Very good 4.7 14.3 24.2 8.3 9.1 3
Excellent 11.6 0.0 8.9 8.3 6.1 1
Figure 9.1. Mean number of hours spent in paid employment each week.
those who had
ch risk category
les %
(15) L(40)
.0 0.0
6.7 15.4
6.7 48.7
3.3 17.9
3.3 17.9
Social and other variables 314
That participants with diagnosed diabetes rated their health more poorly than others is probably
due to the intrusiveness of diabetes into daily life. They are aware they have a chronic illness,
they are under pressure to manage the disease, from doctors, health workers and themselves and
family, through their diet and activity, which means that it is something they are always
thinking about, for example, whether they should eat certain foods, and the guilt associated with
eating some foods.
When health rating was considered as a score out of five, where ‘poor’ = 1 and ‘excellent’ = 5,
males in the low-risk group gave the highest rating (3.4 out of 5) for their health while
diagnosed and gestational women gave the lowest (2.6 and 2.5 out of 5) (Figure 9.2). Both
high-risk females and males rated their health as slightly worse than the low-risk of each sex,
but better than those who had been diagnosed.
Self-rated health
malesfemales
self-
rate
d he
alth
(sco
re fr
om 5
)
3.6
3.4
3.2
3.0
2.8
2.6
2.4
diagnosed
gestational
high risk
low risk
Lower self-ratings of health is not confined to people who have been diagnosed; BMI might be
more important. For example, Ferraro and Yu (1995) found higher BMI was related to lower
self-ratings of health. This association is also apparent in the present study, as undiagnosed
women and men with lower BMIs tended to rate their health as better (Figure 9.3), although
these differences were not significant (ANOVA, p=0.774 for women, 0.399 for men).
Figure 9.2. Mean self-rated health, where: poor=1 fair=2, good=3 very good=4 excellent=5.
Social and other variables 315
Association between BMI and self-rated health
self-rated health
54321
BMI
36
34
32
30
28
26
females
males
Figure 9.3. Mean BMI of never-diagnosed females and males according to their self rated health (1=poor, 5=excellent).
Although not significant, this tendency is consistent with findings among young Australian
women that women with a normal BMI (i.e. <25) reported fewer morbidities than those with
higher BMIs (Brown et al. 2000). Younger age and better self-assessed health status are usually
associated (Cunningham et al. 1997), but in the present study age was not significantly
associated with self-rated health among women (ANOVA, p=0.088) or men (p=0.782).
Self-rated health was significantly negatively correlated with the number of times participants
reported they had been sick or unwell in the last 12 months (Pearson correlation = -0.352,
p<0.001), meaning that those who rated their health better reported fewer illness episodes. Self-
ratings of health are therefore probably a valid measure, although recall bias is possible; those
who perceive their health to be poorer may recall a greater number of illness episodes than those
who perceive their health to be relatively better. Diagnosed women reported the highest mean
number of episodes (Table 9.12).
Social and other variables 316
Table 9.12. Mean number of medical visits in the previous 12 months Females % Males %
(n) D(49) H(15) L(47) G(12) D(38) H(15) L(40)
Mean number of visits 3.9 2.3 2.5 2.0 3.0 2.6 1.4
9.2.2. Family history of diabetes
The majority of participants reported one or more members of their immediate families as
having had diabetes (Table 9.13). Category and family history were not independent of each
other (Chi-square: p=0.004). The associations were not independent of age; in those over 35
years there were no significant associations between category and family history (Chi-square:
p=0.331), while in younger participants category was strongly associated with family history
(Chi-square: p<0.001, value=24.43).
Table 9.13. Positive family history of diabetes by category and age group (%)
Females Males
(n) D H(15) L(47) G(12) D(38) H(15) L(40)
<35 years % 100 100 76.5 77.8 0 83.3 29.2
positive n (total n) 4 (4) 6 (6) 26 (34) 7 (9) 0 (1) 5 (6) 7 (24)
≥35 years % 73.3 66.7 46.2 100 64.9 55.6 50.0
positive n (total n) 33 (45) 6 (9) 6 (13) 3 (3) 24 (37) 5 (9) 8 (16)
All % 75.5 80.0 68.1 83.3 63.2 66.7 37.5
positive n (total n) 37 (49) 12 (15) 32 (47) 10 (12) 24 (38) 10 (15) 15 (40)
The mean numbers of family members reported by participants as having had diagnosed
diabetes were 2.05(D♀), 1.86(H♀), 1.74(L♀), 3.00(G♀), 1.52(D♂) and 1.21(H♂) and 0.92(L♂),
but this is not adjusted for total number of family members (calculation includes those with zero
family members diagnosed).
9.2.3. Stress
Subjective total stress ratings were calculated out of a maximum of 27, based on scales of 0-3
for each of the nine variables. The group reporting the highest overall subjective stress rating
was the gestational women, followed by diagnosed women, then diagnosed men; high-risk and
Social and other variables 317
low-risk women were the next most stressed, and low-risk and high-risk men were the least
stressed. (Table 9.14). The dominant identified causes of stress were different between groups.
Among those diagnosed, the variables likely to cause the most stress were the participants’ own
health (probably explaining why people with diagnosed diabetes rated the highest overall),
health of family members, and money, while among the remainder it was health of family,
relationships with partner, family and friends, and money which were the most stressful. That
few significant differences were found for ratings of subjective stress may indicate that levels of
stress within the community are fairly uniform. Overall, female and male participants differed
significantly in their subjective stress levels for work (t-test: means 0.37 and 0.67 out of 3,
p=0.020), and relationship with family (t-test: means 0.83 and 0.48 out of 3, p=0.009).
Table 9.14. Mean subjective stress ratings for health and social variables. N.B. Mean for each variable is out of 3, total is out of 27. Tests for significance were ANOVA and post-hoc Scheffe test.
Females Males ANOVA
(n) D(49) H(15) L(47) G(12) D(38) H(15) L(40) p
Own health 1.49 (43)a
0.93 (14)
0.83 (46)
1.17 (12)
1.3 (33)
0.80 (15)
0.51 (39)a 0.002
Health of family members
1.07 (43)
0.93 (14)
0.80 (46)
0.92 (12)
1.12 (33)
0.53 (15)
0.82 (39) 0.537
Work 0.37 (43)
0.50 (14)
0.26 (46)
0.87 (15)
0.64 (14)
1.25 (12)
0.76 (46)
Relationship with friends
0.67 (12)
0.94 (33)
0.36 (39) 0.007
Study 0.14 (43)
0.29 (14)
0.09 (46)
0.17 (12)
0.27 (33)
0.07 (15)
0.21 (39) 0.628
Money 1.02 (43)
0.79 (14)
0.74 (46)
1.17 (12)
0.88 (33)
0.40 (15)
0.49 (39) 0.133
Living conditions 0.86 (43)
0.57 (14)
0.39 (46)
0.75 (12)
0.42 (33)
0.40 (15)
0.38 (39) 0.160
Relationship with partner
0.58 (43)
0.63 (46)
0.64 (33)
0.33 (15)
0.51 (39) 0.437
Relationship with family members
0.98 (43)
0.86 (14)
0.58 (12)
0.70 (33)
0.13 (15)
0.44 (39) 0.062
0.30 (43)
0.14 (14)
0.37 (46)
.033 (12)
0.30 (33)
0.14 (15)
0.07 (39) 0.749
Total 6.8 (43)
5.6 (14)
4.9 (46)
7.0 (12)
6.6 (33)
3.6 (15)
4.0 (39) 0.031
a Significant difference, Scheffe: p=0.011
In coping with stress, the majority of participants felt that there was someone they could talk to,
Social and other variables 318
although this may not be the action they usually take (Table 9.15). The remainder report usually
choosing other, disparate, means to cope. Examples include prayer, cleaning, exercising,
reading, drinking alcohol, or smoking cannabis.
Table 9.15. Action available and action taken when feeling stressed Females % Males %
(n) D(49) H(15) L(47) G(12) D(38) H(15) L(40)
Have someone to talk to when stressed 61.2 60.0 74.5 83.3 63.2 66.7 80.0
Talk to friend or family member when stressed
28.6 26.7 38.3 16.7 21.1 33.3 25.0
Do nothing 22.4 13.3 29.8 41.7 18.4 32.5 Usu
al a
ctio
n w
hen
stre
ssed
26.7
Women and men did not differ in reporting whether or not they had someone they could talk to
(Chi-Square, p=0.883), nor did they differ on the action they usually took (p=0.577). Diagnosed
and high risk women as a group were less likely to talk to someone than low risk women, but
this did not reach statistical significance (p=0.097). No such difference was apparent for men
(p=0.491).
9.3. Body image
Participants were asked whether they were happy with their body size and shape, and whether
they thought their body size and shape were normal, healthy and attractive for someone of their
age and sex. The group that was the most confident with their bodies were the low-risk males,
rating the most positive for happy, normal and healthy, although high-risk males were more
positive about their body attractiveness. The least confident, rating the lowest for positive
responses and the highest for negative responses to all questions, were the diagnosed females
(Table 9.16). Differences between the groups were significant for happy, healthy and attractive,
but not for whether they considered their bodies to be normal (Table 9.17). Men had greater
body confidence than women overall.
Social and other variables 319
Table 9.16. Participants’ body image: happy, normal, healthy, attractive Females Males
(n) D(49) H(15) L(47) G(12) D(38) H(15) L(40)
Yes 37.4 46.7 66.0 41.7 44.7 60.0 82.5
Hap
py
No 51.0 40.0 27.7 58.3 42.1 40.0 15.0
Yes 36.7 33.3 57.4 50.0 44.7 40.0 72.5
Nor
mal
No 44.9 53.3 36.2 41.0 42.1 53.3 22.5
16.3 33.3 40.0 16.7 36.8 33.3 65.0
No 49.0 33.3 29.8 33.6 28.9 46.7
Don’t know 20.4 20.0 23.4 41.7 21.1 15.0
Yes 6.1 13.3 14.9 16.7 15.8 40.0 25.0
No 51.0 33.3 38.3 50.0 36.8 20.0 12.5
Attr
activ
e
Don’t know 26.5 33.3 38.3 25.0 31.6 33.3 55.0
Yes
15.0
Hea
lthy
13.3
Table 9.17. Chi-square: significant differences between groups for body image
Chi-square value p value
Happy 30.12 0.003
Normal 23.25 0.181
Healthy 31.90 0.023
Attractive 30.89 0.030
The ‘don’t know’ option was included for the questions on healthy and attractive as they were
deemed more difficult to assess subjectively without feeling embarrassment. The high rate of
people who gave ‘don’t know’ responses, especially for the question on attractiveness, was
probably due more to embarrassment or shyness rather than an absence of a opinion. Some of
the younger men in particular were a little embarrassed (but amused) by the question (asked by
young women), and they were unsure how to respond. Men still rated themselves as attractive
at about twice the rate of women.
Social and other variables 320
Body image depended very much on BMI. For women, those who were happy with their shape
had a mean BMI that was 6.2 kg/m2 lower than those who were not happy (t-test: means 28.4
and 34.6, p<0.001). Similar result were found for ‘normal’ (t-test: means 28.3 and 34.2, p =
0.002) and for both ‘healthy’ (t-test: means 28.6 and 34.1, p = 0.024) and ‘attractive’ (t-test:
means 27.0 and 32.0) although the last difference was not significant (p=0.209), possibly due to
the high percentage of ‘don’t know’ responses to this particular question (59.1%).
For men, those who were happy with their shape also had significantly lower BMIs than those
not happy (means 26.2 and 32.2, p<0.001). Again this was similar pattern as those who thought
their shape was normal (26.0 and 31.7, p<0.001), healthy (25.7 and 32.4, p<0.001) or attractive
(27.1 and 31.5) although again the latter difference was not significant (p=0.102).
Participants were also asked what would make a healthier or more attractive body shape (fatter,
thinner, taller, shorter, more muscled, less muscled). The most frequent response for women
was thinner for both healthier and more attractive respectively, and these were occasionally
coupled with more muscled and taller (Tables 9.18 and 9.19). For men, being healthier was
associated most with being thinner or being more muscled. It seems that, for men at least, the
same ideal relates to being both healthy and attractive, with men choosing thinner or more
muscled at almost the same rates. As the main differences appeared to be along gender lines,
high- and low-risk participants are combined as there was so little difference between them.
That body shapes that are considered healthy and attractive are similar to each other is
consistent with findings from Craig et al. (1999) in both Tongan and Australian samples.
Social and other variables 321
Table 9.18. What a healthier body would look like
Females %a Males %a
(n) D(49) H(15) L(47) G(12) D(38) H(15) L(40)
Fatter 8.1 13.4 8.5 8.3 10.5 6.7 12.5
Thinner 36.8 20.0 33.6 50.0 28.9 20.0 12.5
More muscled 4.1 26.7 6.4 8.3 23.7 40.0 22.5
Less muscled 0.0 0.0 0.0 0.0 2.6 6.7 2.5
Taller 4.1 6.7 4.3 0.0 0.0 0.0 5.0
Shorter 0.0 0.0 0.0 0.0 5.2 0.0 2.5 aAs some participants gave more than one response, totals may be greater than 100%.
Table 9.19. What a more attractive body would look like
Females %a Males %a
(n) D(49) H(15) L(47) G(12) D(38) H(15) L(40)
Fatter 6.1 20.0 4.3 0.0 13.1 6.7 5.0
Thinner 34.7 58.3
26.7 25.0
40.0 26.7 28.9 16.7 10.0
More muscled 6.1 13.4 17.0 16.6 23.7
Less muscled 4.1 0.0 4.2 0.0 2.6 6.7 5.0
Taller 4.1 6.7 4.2 8.3 0.0 0.0 7.5
Shorter 0.0 0.0 0.0 0.0 2.6 0.0 2.5
aAs some participants gave more than one response, totals may be greater than 100%.
When asked what type of body shape they would themselves prefer to have, in general women –
and diagnosed men – would rather be thinner, while men who had never been diagnosed chose
more muscled (Table 9.20). This is consistent with findings in the United States and Australia
from Sciacca et al. (1991) and Donath (2000) who found that women were about twice as likely
as men to consider themselves overweight, and with Rand and Wright (2001) (United States)
who found a bias towards a preference for thinner females across age groups, which was
particularly marked among young adults. In another United States study, Leit et al. (2001)
Social and other variables 322
concluded that the cultural norms of the ideal male body were becoming more muscular. This
trend could be reflected here too, through the influence of dominant images on television and in
magazines. Pressure is not just on women to have particular body shapes, but also on men. An
additional option of ‘happy as I am’ was added to this question, which many people chose.
Table 9.20. Preferred body shape
Males %Females %a a
(n) D(49) H(15) L(47) G(12) D(38) H(15) L(40)
Fatter 4.1 13.4 4.4 0.0 7.9 0.0 7.5
Thinner 36.7 20.0 34.0 49.9 34.1 19.9 5.0
More muscled 8.1 0.0 8.5 0.0 13.1 26.7 12.5
Less muscled
0.0 2.1
0.0 0.0 0.0 0.0 2.6 6.7 0.0
Taller 4.0 0.0 4.3 0.0 0.0 0.0 2.5
Shorter 0.0 0.0 5.2 0.0 2.5
Happy as I am 38.8 46.7 38.3 41.1 31.6 46.7 67.5 aAs some participants gave more than one response, totals may be greater than 100%.
9.4. Diabetes knowledge and beliefs
This part of the questionnaire was to ascertain community understandings of diabetes. Most of
the questions in this section appeared in the section of the questionnaire aimed at diagnosed
diabetics only.
9.4.1. Perceived risk of diabetes and heart disease
Participants’ responses to how likely they thought it was that they would get diabetes and heart
disease are shown in Table 9.21. There were no significant differences between high-risk, low-
risk and gestational groups in their perceived risk of developing diabetes (Chi-square: p=0.582),
but differences were approaching significance level for heart disease (Chi-square: p=0.050,
value = 51.7).
Social and other variables 323
Table 9.21. Self-rated likelihood of developing diabetes and heart disease
Females Males
(n) D(49) H(15) L(47) G(12) BMI D(38) H(15) L(40) BMI
n/a 6.7 6.4 33.3 31.2 n/a 20.0 7.5 29.5 Somewhat
likely n/a 6.7 12.8 16.7 33.0 n/a 20.0 12.5 31.9
Not very likely n/a 20.0 10.6 0.0 29.3 n/a 6.7 22.5 26.0
Not at all likely n/a 20.0 14.9 16.7 29.8 n/a 13.3 17.5 25.1
Don’t know n/a 40.0 51.1 25.0 27.7 n/a 33.3 37.5 27.0
Very likely 8.2 6.7 2.1 8.3 40.1 13.2 13.3 5.0 32.4 Somewhat
likely 4.1 13.3 2.1 16.7 30.3 15.8 20.0 17.5 30.0
Not very likely 4.1 20.0 19.1 8.3 32.4 5.3 20.0 15.0 27.5
Hea
rt di
seas
e
Not at all likely 6.1 6.7 14.9 16.7 30.0 0.0 13.3 17.5 25.3
Don’t know 46.9 40.0 53.2 25.0 30.3 42.1 26.7 40.0 27.8
Already have it 8.2 0.0 0.0 0.0 32.3 5.3 0.0 2.5 30.0
Very likely
Dia
bete
s
Among women who did not currently have diagnosed diabetes, perceived risk of diabetes
tended to be lower among those with lower BMIs, but this was not significant (ANOVA:
p=0.589). Among men who did not have diagnosed diabetes, the trend was similar, but again
not significant (ANOVA: p=0.180). There was no such trend for perceived risk of heart disease
among female (p=0.111) or male (p=0.131) participants. This does suggest, though, that there is
some understanding that being overweight increases a person’s risk for these diseases, but that
overweight is not seen by most people as sufficient in itself to put a person at risk.
The following sections refer only to those participants with diagnosed diabetes, who were asked
to complete an additional section of the survey, about their knowledge, beliefs and behaviour to
do with diabetes.
9.4.2. Time since diagnosis
The mean time since diagnosis (as recalled by participant) was 4.2 years for women and 3.9
years for men. The responses ranged from two weeks to 14 years.
Social and other variables 324
9.4.3. Causal beliefs
Participants were asked open-ended questions about both what their doctor had said had caused
their diabetes, and also what they personally thought caused it. These responses were then
categorised into two primary themes: lifestyle or heredity. Results are presented in Table 9.22.
Table 9.22. Participants’ recall: what did the doctor tell you caused your diabetes?
(n) Examples of participant responses Females % (49)
Males % (38)
Heredity
Hereditary
It’s come from your mother
It’s in the family my mother had it
Through family history
Genes
Runs in the family
8.2 15.8
Lifestyle
Sweets, fats, stress
Too much sugar in my foods and fatty foods
Too much sugar
Unhealthy eating habits
Due to alcohol
Obesity
8.2 21.1
Both lifestyle and hereditary factors Overweight, family history 2.9 0.0
No explanation given
The doctor said nothing
Never said anything 25.4 13.2
Explanation given but cannot
remember what they said
Can’t remember
Forgot what he said 2.0 3.6
Did not answer - 53.3 46.3
There was no mention of physical inactivity in the patient’s recall of contributing lifestyle
factors.
Social and other variables 325
Participants were also asked what they thought had caused their diabetes. Participants were
about twice as likely to say they thought their lifestyle caused their diabetes than to think it was
hereditary (Table 9.23).
Table 9.23. Participants’ beliefs: what do you think caused your diabetes?
(n) Examples of participant responses Females % (49)
Males % (38)
Heredity
Mum or Dad
Hereditary
Family history
Reckon it’s through the blood - mother, brothers and sister have it. Through the family
tree I s’pose
8.2 13.2
Lifestyle
Eating the wrong food
Drinking grog a lot
Fat and sugar
Being overweight
I was overweight for my age
Too fat
Too much beer
Wrong food and drink
16.3 31.6
Both lifestyle and hereditary factors Too much salt, runs in the family 4.1 2.6
Don’t know - 16.3 7.9
Did not answer - 55.1 44.7
9.4.4. Complications
The most frequently reported complications from diabetes were eye problems followed by feet,
breathing and kidneys (Table 9.24). Problems with ‘skin’ refers to ulcers, while ‘breathing’
refers to feeling out of breath, most likely due to a general lack of fitness or a side effect of
some blood pressure lowering medications. These categories do not exclude other, non-diabetes
Social and other variables 326
related health problems, such as asthma or emphysema (‘breathing’) or ringworm, scabies or
boils (‘skin’) which were most likely alluded to in the responses. Females were significantly
more likely than males to report breathing difficulties that they associated with diabetes (Chi-
square: p=0.025, value=5.058). There were no significant differences in reported frequencies
between females and males for any other diabetes associated problem.
Table 9.24. Diabetes complications reported by participants
Females % (49) Males % (38)
Eyes 32.7 42.1
Feet 26.5 26.3
Breathing 30.6 10.5
Kidneys 22.4 13.2
Heart 16.3 10.5
Skin 16.3 18.4
9.4.5. Medication
Participants were asked whether they were taking medication for their diabetes, whether they
took it exactly as prescribed, and whether they knew how it was meant to help (Table 9.25).
The types of medication people were taking varied, and included blood-pressure-lowering
medication, and metformin (Glucophage) to improve insulin sensitivity, and in the few months
leading up to the survey, a newly arrived doctor had placed several participants on insulin.
Social and other variables 327
Table 9.25. Participants on medication for diabetes
Females (49) Males (38)
% of diagnosed participants currently
on medication for diabetes
57.1 (28) 57.9 (22)
Of those taking medication, % who
report taking it exactly as prescribed
71.4 (20) 72.7 (16)
Of those taking medication, % who were able to give a
simple explanation of how the medication
helps
42.9 (12) 31.8 (7)
Examples of explanations given by participants of
how their medication helps
Helps me to lose weight
Keeps my sugar levels down
It slows down the sugar build up in my body
Keeps my sugar at a even level
Controls sugar and blood pressure
9.4.6. Lifestyle advice and behaviour change
Participants were asked open-ended questions about the advice on diet and exercise they had
been given. Responses were categorised into general advice (for example ‘eat healthy’ or ‘do
more exercise’), specific advice (for example ‘eat high fibre foods, less sugar and salt’ or to
‘walk for 20 minutes a day’), and no advice.
Diet
General advice for changing their diet was recalled by 10 (20.4%) women and 11 (28.9%) men,
and specific advice by 11 (22.4%) women and six (15.8%) men. Four (8.2%) women and four
(10.5%) men stated that they were not given any advice about diet at all.
Social and other variables 328
When asked if they had implemented any changes to their diet since finding out they had
diabetes, 17 (34.7%) women and 16 (42.1%) men said they had. Among those who had made
dietary changes, the perceived health benefits were widespread, with 14 (88.2%) of the women
and 100% of men who had made dietary changes reporting that it had improved their health.
Exercise
Receiving general advice on exercise was recalled by 10 (20.4%) women and 11 (28.9%) men,
while specific advice was recalled by 11 (22.4%) women and five (13.2%) men. Four (8.2%)
women and five (13.2%) of men said they had not been given any advice about exercise.
Changes to exercise had been made by fewer people than changes to diet, with only five
(10.2%) women and nine (23.7%) men reporting that they had implemented changes since
diagnosis to improve their health. Again, these changes were perceived to be beneficial, with
four of the five women (80.0%) and eight of the nine men (88.9%) who had made changes
reporting that these had improved their health.
Receiving specific advice may increase the likelihood of changes being implemented. Only one
person from nine (11%) who said they had not been given any dietary advice had made some
changes to their diet, while 10 (47.6%) of those recalling general advice and 15 (88.2%) of
those recalling specific advice had made some changes. Seven (33.3%) who recalled general
advice and four (25%) who recalled specific advice had implemented changes to their exercise
regime. These results suggest that people are more willing to make changes to their diet than to
how much exercise they do. Of course, with both diet and exercise it may be that those who
have made changes that are more likely to recall having received advice than those who did not
make changes.
9.5. Women
To determine whether reproductive history was linked with diabetes risk among women, female
participants were asked additional questions regarding their experiences relating to pregnancy,
how many children they had and how old they were when they had their first baby.
Of the 123 women who took part in the survey, 79.7% had had at least one baby. The ages at
which they had their first baby ranged from 13 years to 29 years (mean =18.46) and the number
of children ranged from 1 to 14 (mean 4.15) (Table 9.26).
Social and other variables 329
Table 9.26. Mean number of babies (of those who had given birth at least once), mean age at first birth and mean age at time of survey
(n) Number of babies Age at first birth (years) Age at time of survey
(years)
Diagnosed (49) 4.4 18.7 46.5
High-risk (15) 3.9 16.9 34.5
Low-risk (47) 3.9 19.0 31.1
Gestational (12) 4.4 17.7 31.3
Given their relatively older ages, women in the diagnosed group are more likely to have
completed their families at the time of the survey. Interestingly, women who had been
diagnosed with gestational diabetes began having their children at a slightly younger age, and
had given birth to more children at the time of the survey than other, currently undiagnosed,
women. This may be because each pregnancy provides an additional opportunity to develop
gestational diabetes, or there may be some other relationship, such as where risk of gestational
diabetes in subsequent pregnancy increases.
Seven of the women who currently had diabetes reported that they had been diagnosed with
gestational diabetes (in addition to the 12 others who had had gestational diabetes in the past but
who were not currently diagnosed with diabetes).
Female participants were asked whether they received enough advice from doctors and health
care workers when they were pregnant about having a healthy pregnancy. About 10% of
women in each group stated that they had not been given enough advice. One woman in the
gestational diabetes category, who was 15 when she had her first child, responded: ‘I was so
young and they just used too many big words for me and I just nodded if they asked if I
understood’.
9.6. Conclusions
These descriptive results from the questionnaire part of the survey go some way to illustrate
some of the lifestyle and behavioural features that may be contributing to diabetes in Cherbourg,
and where improvements in health education might be made. In the following chapter, the main
findings of the study are presented and discussed in their social context.