Obstacles to Wellness: A Study of Psychosocial Stress and Support Systems in Community Health Programming for Black Americans

Abstract

Type 2 Diabetes (T2D) poses a significant public health challenge, disproportionately affecting Black Americans. This dissertation investigates the efficacy of exercise interventions tailored for the management of T2D, emphasizing the interplay of psychosocial stress and community-based support systems within this demographic. Chapter I provides details about the pathophysiology of T2D and the compounded impact of psychosocial stressors and exercise, establishing the groundwork for targeted interventions. Chapter II conducts a systematic review to ascertain the effectiveness of various exercise modalities in improving T2D health outcomes. It highlights that combined aerobic and resistance training at moderate to high intensity significantly enhances insulin sensitivity and glucose metabolism. Chapter III examines a community-based exercise program, "Max Impact," focusing on how race-related stress affects the program’s efficacy. The study reveals that while exercise improves metabolic health indicators among participants, the effects are not statistically significant. This finding emphasizes that underlining factors, such as psychosocial stress, could have mediated this relationship, which highlights the necessity of better understanding psychosocial stress’s effect on health interventions and outcomes. Chapter IV explores qualitative insights from the participants of the Max Impact program, uncovering the complex barriers and supports for physical activity. It stresses the importance of accessible and relatable health education and community support in fostering sustained engagement in physical activity. The final chapter, V, synthesizes these findings, discussing the practical implications of integrating psychosocial elements into exercise prescriptions for T2D management. It calls for more comprehensive approaches that address both the physiological and psychological facets of health disparities faced by Black Americans. This research contributes to the literature on health disparities by highlighting the critical role of culturally sensitive, community-focused interventions in managing chronic diseases like T2D.