Date of Award

Summer 2019

Document Type

Open Access Dissertation


Health Promotion, Education and Behavior

First Advisor

Rachel E. Davis


This study used primary data from Kumasi, Ghana, to examine whether social networks, social support, diabetes-related stigma, religion, and traditional medicine affected blood glucose (HbA1c) control among adults with type 2 diabetes mellitus (T2DM). First, the study evaluated whether three social network characteristics (kin composition, household composition, and network density) were directly or indirectly (via social support) associated with HbA1c. Kin composition and household composition were significantly associated with social support. Neither network characteristics nor social support were associated with HbA1c, which suggests that social network characteristics may operate through mechanisms other than social support to affect HbA1c among study participants. Secondly, the study examined whether self-, perceived, or enacted stigma moderated associations between social network characteristics (network size, kin composition, household composition, and network density), social support, and HbA1c. Among study participants reporting low self-stigma, kin composition was positively associated with social support, but this association was not found among those reporting moderate self-stigma. Finally, the study assessed whether the frequency of participation in religious activities and the use of traditional medicine practitioners were associated with HbA1c control. Increased participation in religious activities was associated with decreased HbA1c, which suggests that religious activity may play a beneficial role in T2DM management among Ghanaians who identify as religious. Overall, this study provides important insights about the roles of social networks in T2DM management among Ghanaians, the detrimental effects of stigma on the social support that emanates from those social networks, and the influence of religion and traditional medicine on HbA1c control.