Journal of Behavioral Medicine

, Volume 41, Issue 1, pp 122–129 | Cite as

Microaggressions, diabetes distress, and self-care behaviors in a sample of American Indian adults with type 2 diabetes

  • Kelley J. SittnerEmail author
  • Brenna L. Greenfield
  • Melissa L. Walls
Brief Report


American Indian/Alaska Native people experience the highest age-adjusted prevalence of type 2 diabetes of any racial group in the United States, as well as high rates of related health problems. Chronic stressors such as perceived discrimination are important contributors to these persistent health disparities. The current study used structural equation modeling to examine the relationships between racial microaggressions, diabetes distress, and self-care behaviors (diet and exercise) in a sample of 192 American Indians with type 2 diabetes from the northern United States. We found that microaggressions was positively associated with diabetes distress and that microaggressions had an indirect link to self-care via diabetes distress. Diabetes distress is an important mechanism linking microaggressions to self-care behaviors, which are critical to successful disease management and the reduction of complications. The amelioration of diabetes distress could improve self-care even in the presence of pervasive, chronic social stressors such as microaggressions.


Diabetes Microaggressions Diabetes distress Stress American Indian 



Research reported in this manuscript was supported by the National Institute on Diabetes, Digestive and Kidney Diseases #DK091250 (M. Walls, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors thank the project’s community members: Sidnee Kellar, Rose Barber, Robert Miller, Tweed Shuman, Lorraine Smith, Sandy Zeznanski, Patty Subera, Tracy Martin, Geraldine Whiteman, Lisa Perry, Trisha Prentice, Alexis Mason, Charity Prentice-Pemberton, Kathy Dudley, Mona Nelson, Eileen Miller, Geraldine Brun, Murphy Thomas, Hope Williams, Betty Jo Graveen, Daniel Chapman, Jr., Mary Sikora-Petersen, Tina Handeland, Phillip Chapman, Sr., GayeAnn Allen, Frances Whitfield, Doris Isham, Stan Day, Jane Villebrun, Beverly Steel, Muriel Deegan, Peggy Connor, Michael Connor, Ray E. Villebrun, Sr., Pam Hughes, Cindy McDougall, Melanie McMichael, Robert Thompson, Sandra Kier.

Compliance with ethical standards

Conflict of interest

Kelley J. Sittner, Brenna L. Greenfield, and Melissa L. Walls declare that they have no conflicts of interest

Human and animal rights and Informed consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Kelley J. Sittner
    • 1
    Email author
  • Brenna L. Greenfield
    • 2
  • Melissa L. Walls
    • 2
  1. 1.Department of SociologyOklahoma State UniversityStillwaterUSA
  2. 2.Department of Biobehavioral Health and Population SciencesUniversity of Minnesota Medical SchoolDuluthUSA

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