Social role-strain in midlife: Harmonizing social roles with diabetes care in Korean women

Background. Middle-aged women in Korean society have traditionally assumed multiple roles (e.g. caregiver for elderly parents and children, wife, worker etc.). Having a chronic illness such as diabetes mellitus can be viewed as an additional social role that these women are obliged to manage which may result in problematic levels of role-strain. Further, the cultural experience of social role-strain in middle-aged Korean women who have diabetes has not been clearly understood.; Purpose. The purpose of the study was to describe levels of role-strain, diabetes self-efficacy, depression, diabetes knowledge, and social support as well as to investigate the potential association between social role-strain, social support, depression, diabetes knowledge and diabetes self-efficacy while describing the cultural experience of role-strain in this population.; Methods. A sequential mixed model design was used. In the quantitative phase, levels of role-strain, diabetes self-efficacy, diabetes knowledge, depression and social support were measured and their relationships were investigated among a convenience sample of 154 middle-aged Korean women with type 2 diabetes. In the subsequent qualitative phase of the study, 10 women representing both the upper (n=5) or lower (n=5) 25 percentile of role-strain score were recruited for in-depth interviews to explore the highest and lowest levels of role-strain, respectively. An interview guide consisting of semi-structured, open-ended questions addressing cultural experience of role-strain was used in all interviews.; Results. Role-strain and social support are significant predictors of diabetes self-efficacy in middle-aged Korean women with type 2 diabetes. The level of role strain is negatively associated with diabetes self-efficacy (r = -.20, p< 0.05) whereas social support is positively associated with diabetes self-efficacy ( r = .22, p< 0.05). Findings from the qualitative inquiry include three themes. The first theme related to the experience of role-strain, 'Resentment regarding previous role-strain', represent prior role-strain women project onto their current situation, thereby increasing/aggravating their current role-strain. 'Prioritizing others over self' is a predominant characteristic of the middle-aged Korean women in which they consider other roles, especially those related to social norms, more important than their sick role as a diabetes patient. Finally, 'Striving to avoid burdening others' is described as contributing to women's role-strain as they expend additional effort to isolate themselves and aspects of their disease from friends and family.; Conclusions. Findings from this study highlight the important relationships between role-strain and perceived social support to diabetes self-efficacy. Past experiences with role-strain and how this may be projected onto middle-aged Korean women's current situation should be considered along with the tendency to prioritize culturally-related social norms/expectations and difficulties in seeking/allowing support which may serve as potential barriers to diabetes self-management.