Intrusive social support among Black and White individuals with type 2 diabetes: A “Control issue” or a sign of “Concern and love”?

PLOS ONE RESEARCH ARTICLE Intrusive social support among Black and White individuals with type 2 diabetes: A “Control issue” or a sign of “Concern and love”? Jeanean B. Naqvi ID1*, Rachael S. Liu1, Vicki S. Helgeson1, Megan E. Hamm2 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America, 2 Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America * Abstract OPEN ACCESS Citation: Naqvi JB, Liu RS, Helgeson VS, Hamm ME (2023) Intrusive social support among Black and White individuals with type 2 diabetes: A “Control issue” or a sign of “Concern and love”? PLoS ONE 18(8): e0288258. https://doi.org/ 10.1371/journal.pone.0288258 Editor: Julia Morgan, University of Greenwich, UNITED KINGDOM Received: January 4, 2023 Accepted: June 22, 2023 Published: August 8, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0288258 Copyright: © 2023 Naqvi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Data cannot be shared publicly due to ethical restrictions. The interview transcripts contain personally identifiable information that cannot be redacted without Family members and friends play an important supportive role in the management of chronic illnesses like diabetes, which often require substantial lifestyle changes. Some studies suggest that there may be racial differences in the kinds of support people receive, though little research has examined this idea within a chronic illness context. The current research takes a qualitative approach to examining similarities and differences between Black and White individuals with type 2 diabetes in the dimensions of support received from their family members, with a particular focus on better understanding more intrusive forms of support, such as unsolicited and overprotective support. Semi-structured interviews were conducted (N = 32) to characterize differences in support received by Black and White individuals with type 2 diabetes. The results of the thematic analysis suggested that unsolicited and overprotective support were not universally perceived to be negative, as previous work on White populations seemed to suggest. Rather, if the support provided was perceived as inhibiting autonomy, it was generally undesired by participants from both racial groups—however, for Black participants, knowing that the support was provided out of love could make it more acceptable. The analysis also revealed several underexplored dimensions of received support, including the directiveness of support and the tone used to deliver support. The current study provides an initial step towards grounding social support theory in the experiences of marginalized populations and will inform further development of a culturally sensitive measure of social support for individuals with chronic illness. Introduction About 34.2 million people in the United States have diabetes [1]—an illness that requires a complicated self-management regimen of adherence to medication, blood glucose checking, and doctor’s visits, as well as changes to diet and physical activity [2]. Non-Hispanic Black individuals suffer a disproportionate burden of diabetes prevalence [1], diabetes-related PLOS ONE | https://doi.org/10.1371/journal.pone.0288258 August 8, 2023 1 / 20 PLOS ONE removing content relevant to the research. However, anonymized data excerpts can be accessed upon reasonable request by contacting the Carnegie Mellon University Institutional Review Board (). Funding: JN received funding from the National Institute on Minority Health and Health Disparities (https://www.nimhd.nih.gov/) F31MD015922, the National Heart, Lung, and Blood Institute (https:// www.nhlbi.nih.gov/) T32HL079891, and the Society for Personality and Social Psychology (https://spsp.org/) Jenessa Shapiro Graduate Research Award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Race differences in intrusive support in diabetes complications like retinopathy and lower limb amputation [3], and diabetes-related comorbidities like cardiovascular disease or chronic kidney disease [4] compared to non-Hispanic White individuals. However, receiving social support from close others has shown vast benefits for both non-Hispanic Black and non-Hispanic White individuals with diabetes, including better self-management behaviors, reduced diabetes distress and lower HbA1c [5]. Despite these benefits, studies have rarely explored whether there may be race differences in the characteristics or dimensions of social support received by Black and White individuals. To address this gap in the literature, the current study used an inductive approach to compare the dimensions of social support received from family by Black and White individuals with type 2 diabetes, focusing particularly on more intrusive forms of support like unsolicited support (support that is unasked for) and overprotective support (support that underestimates the person’s capabilities). Race differences in support There is reason to believe that the expectations around social support might differ between Black and White individuals. Because the discrimination Black individuals face on a daily basis threatens their economic success [6], their well-being [7], and their existence [7, 8], these hardships could affect the nature of their support interactions. For example, African Americans actively exchange support within family networks, such as sharing childcare responsibilities, providing financial help, and assisting with transportation [9], which may have initially developed as a strategy for survival in low socioeconomic communities [10]. Over time, certain kinds of support that were originally enacted as a way to survive may have become more culturally normative. Thus, Black individuals may have developed expectations for receiving different kinds of support than White individuals. Traditionally, social support behaviors have often been characterized in the literature based on type—for example, family members may offer tangible assistance and provision of resources (instrumental support), reassurance and emotional concern (emotional support), or advice and suggestions (informational support) [11]. Only a few studies have investig (...truncated)