Greater conceptual distinction between fatalism as a cultural value orientation (general fatalism) and disease-specific fatalism is necessary to evaluate fatalism as a predictor of health behaviors such as diabetes treatment adherence. We tested an integrated, theory-driven structural model of relationships among income, education, age, gender, general fatalism, diabetes fatalism, and type 2 diabetes treatment adherence, as measured by hemoglobin a1c levels (hba1c), in a sample of mainstream-Chileans (n=229) and indigenous people of Chile known as the Mapuche (n=134). Hypotheses were that higher income and education would predict more general fatalism and diabetes fatalism across ethnic groups and higher general fatalism would indirectly predict higher hba1c through diabetes fatalism. Multi-group structural equation modeling comparing ethnic groups revealed excellent fit of models (Mapuche: CFI = .995, χ2 (24, n = 229) = 27.26, p =.29, χ2/df = 1.14, RMSEA = .024, 90% CI (.000, .061), R2= 0.148; mainstream-Chilean: CFI = 1.000, χ2 (24, n = 134) = 22.15, p =.57, χ2/df = .92, RMSEA = .000, 90% CI (.000, .064), R2=0.043) and partial supported of study hypotheses. Fewer years of education significantly predicted general fatalism and lower income significantly predicted diabetes fatalism across ethnic groups. Higher general fatalism was a significant indirect predictor of hba1c through diabetes fatalism only for mainstream-Chileans. This study highlights the importance of measuring fatalism as a cultural value and disease-specific fatalism as antecedents of health behavior. Findings also underscore the necessity of studying how social structural factors influence health behavior through culture and disease-specific beliefs.

LLU Discipline

Clinical Psychology




School of Behavioral Health

First Advisor

Betancourt, Hector M.

Second Advisor

Flynn, Patricia M.

Third Advisor

Morrell, Holly E. R.

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Diabetes; Diabetes Mellitus; Health Behavior; Fate and fatalism - Psychological aspects; Cultural awareness - Chile; Educational Status;

Subject - Local

fatalism; Treatment adherence; Cultural Value Orientation; Disease-specific fatalism



Page Count


Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives